Ideomotor apraxia: symptoms, causes and treatment.

A type of neurological disorder associated with problems in performing movements.

Ideomotor apraxia is a neurological condition that results in the sufferer's inability to imitate gestures or movements, and to perform movements voluntarily and at the request of another person. Patients with this disorder end up having great difficulty in carrying out activities of daily living, such as brushing their teeth or correctly picking up the cutlery at the table.

In this article we explain what is ideomotor apraxia, what are the causes that explain it, the symptoms it causes and the appropriate treatment for this disorder. for this disorder.

What is ideomotor apraxia?

The ideomotor apraxia is a neurological disorder that involves. the inability to imitate gestures and to perform voluntary motor acts, on request or on verbal commandThis is due to an error in the configuration, temporal pattern and spatial organization of the body members in the context of the movement in question.

People suffering from this type of apraxia can manipulate tools and objects of daily life spontaneously, although sometimes this ability is also lost. The deficits caused by ideomotor apraxia appear to be the result of a disruption or failure in the system that links stored knowledge about the use of everyday objects and information about gestures with the state of the body to produce the desired or appropriate motor action.

Ideomotor apraxia causes patients to have difficulties in carrying out simple motor actions and movements. (greeting someone or turning off a faucet, for example), as opposed to other motor sequences or more complex movements (such as cleaning teeth or getting dressed). However, unlike other apraxias, such as ideational apraxia, these individuals can verbally express these actions.

It is believed that this system is related to the areas of the brain that are most often damaged when this apraxia occurs: the left parietal lobe and the premotor cortex of the brain.

Causes

Typically, the most common cause of apraxia is the left parietal lobe, the most common cause of ideomotor apraxia is ischemic damage (due to a stroke or stoppage of Blood flow) in one of the hemispheres of the brain. There are multiple brain regions where lesions have been correlated with this type of apraxia.

Initially, it was suggested that lesions in the subcortical white matter tracts of the subcorticalThe axons extending downward from the neuronal bodies in the cerebral cortex could be one of the main causes responsible for the onset of ideomotor apraxia.

It has also been suggested that lesions in the basal ganglia, a brain structure responsible for the initiation and integration of movements, could be another possible cause, although there is still debate as to whether damage to this brain region alone could be sufficient to induce ideomotor ataxia.

However, it has not been demonstrated that lesions in these subcortical brain structures are more prevalent in apraxic patients. The most recent research indicates that the damaged brain areas that have been most associated with patients with this type of apraxia would be: the parietal region, the left premotor cortex and the supplementary motor area.

Lesions in other types of brain structures, such as the corpus callosum (the fiber bundle that communicates one hemisphere with the other), could also induce apraxic symptoms, with variable effects in both hands. In addition, ideomotor apraxia also occurs comorbidly comorbidly occurs in Parkinson's disease, Alzheimer's dementia, Huntington's disease, corticobiliary degeneration of the corticocortical cortex and corticobiliary degeneration of the corticocortical cortex.corticobasal degeneration and progressive supranuclear palsy.

Signs and symptoms.

Ideomotor apraxia generates a whole series of symptoms that impact variably on each individual. Typically, this disorder affects a person's ability to carry out everyday movements and actions such as greeting someone, for example.

Affected individuals often show errors in the way they hold and move tools and objects when trying to use them in the correct way.. One of the most characteristic symptoms of ideomotor apraxia is the inability to perform motor acts under verbal command. For example, if the patient is given a comb and instructed to brush his hair, he will incorrectly execute the movement, circling around the head or holding the brush upside down.

Errors made by patients with ideomotor apraxia can be of a spatial nature, as in the example of the inappropriate use of the comb, and also of a temporal nature. Continuing with the previous example, the person would execute the act of combing his or her hair in an excessively slow or erratic manner, showing signs of committing a motor act with errors in the temporal sequence.

Another of the most characteristic symptoms of ideomotor apraxia is the inability to imitate hand gestures, whether or not they have a specific meaning.. Patients know what they have to do when someone asks them to do it, but they cannot execute the gesture correctly. This neurological disorder prevents affected individuals from performing any voluntary act and, on occasion, they may also lose the ability to carry out spontaneous actions and movements.

In recent years, several studies have shown that people with ideomotor apraxia seem to be unable to touch their fingers as fast as a control group of healthy subjects. In addition, apraxic patients are slower to point at a target light when they cannot see their hand. It appears that these individuals are much more dependent on visual information when performing movements than healthy subjects.

Treatment

The impact of ideomotor apraxia on the autonomy and functional capacity of the person suffering from it is variable and generally depends on the other associated disorders. The repercussions of this neurological disorder on activities of daily living are varied.

As far as personal hygiene is concerned: the person will have serious difficulties in orienting and correctly positioning toiletries, such as a comb, toothbrush or razor. With regard to eating, the patient will have difficulty in grasping the cutlery correctly when eating or in placing the cutlery on the table in the right way and in the right space. He or she will also experience problems with dressing, for example when putting on or taking off socks.

Although a small group of patients with ideomotor apraxia are known to recover spontaneously, this is not very common. What can happen is the phenomenon of hemispheric compensationwhereby the functions normally performed by one hemisphere could be performed by the other, if damaged.

Occupational therapy and neuropsychological rehabilitation are the most common treatments in cases of apraxia, in order for the patient to regain maximum functional capacity. Typically, work is done by dividing everyday tasks into separate components (e.g., the act of combing one's hair) and the patient is taught to perform each motor act individually and then complete the entire sequence.

The above procedure is repeated extensively, so that the person can regain skill in the execution of a given movement and eventually combine other sequences to create new and unique movement patterns.

Bibliographical references:

• Ardila, A. (2015). Kinesthetic, ideomotor, ideational and conceptual apraxia. Neuropsychology, Neuropsychiatry and Neurosciences Journal, Vol.15, Nº1, pp. 119 - 139.
• Sunderland, A.; Shinner, C. (Apr 2007). "Ideomotor apraxia and functional ability". Cortex. 43 (3): 359 - 367.
• Wheaton, L. A., & Hallett, M. (2007). Ideomotor apraxia: a review. Journal of the neurological sciences, 260(1-2), 1-10.