Apraxia
| Classification according to ICD-10 | |
|---|---|
| R48.2 | Apraxia |
| ICD-10 online (WHO version 2019) | |
As apraxia ( gr. Ἀπραξία "inaction", German and tool interference ) refers to a disorder of the execution of arbitrary targeted and orderly movements in intact motor function. There is neither paralysis nor ataxia . Involuntary movements can be carried out in a coordinated manner. Affected are facial expressions (apraxia of the face), language (apraxia of speech tools) and / or gestures or the use of tools (extremity apraxia).
The causes of this disorder are brain damage mostly to the language-dominant hemisphere of the cerebrum (in 95% of right-handers and 70% of left-handers this is the left hemisphere). The most common cause is a stroke ; other important causes can also be brain tumors , dementia , multiple sclerosis , encephalitis or alcoholism .
Classification of apraxia
The distinction between the various forms of apraxia is controversial and here follows the systematic classification of 1908 by Hugo Liepmann . The rough division can be made into motor and visual-constructive apraxia; the motor apraxias can be further divided into ideomotor and ideator apraxias. The motor apraxia usually occurs after damage to the language-dominant hemisphere of the brain, while the visual-constructive apraxia is more likely to be observed when the non-language-dominant side is damaged.
Ideomotor apraxia
Ideomotor apraxia, also called ideokinetic apraxia, usually occurs when the language-dominant hemisphere is damaged. The exact location of the damage is either in the motor association centers and / or in the connecting fibers of the same and / or the commissure fibers connecting the hemispheres of the brain.
Wrong expressions and gestures occur. Expressions are used incorrectly. Actions can no longer be imitated. This form of apraxia is particularly visible when prompted to mimic mimicking, e.g. B. also in physiotherapy . On the other hand, perseverations occur . The person concerned repeats the same course of action over and over again that he once recorded.
The damage more towards the vertex tends to lead to an apraxia of the extremities with preservation of the gestures. The lesion in the left frontal lobe has more of a buccofacial (face and facial expression) apraxia, whereas extremity movements tend to show fewer deficits.
Good compensation is often achieved through sensory feedback. The implementation of physiotherapy , occupational therapy and, if necessary, speech therapy is crucial for a favorable course of therapy.
Ideatory apraxia
The (less common) ideatory apraxia also usually occurs when the language-dominant hemisphere is damaged. The exact location of the damage is in the temporo-parietal association cortex.
A disturbed concept of action is assumed, which makes it impossible for the patient to combine individual movements into an action. Those affected do not seem to understand the meaning of individual actions, which is why they cannot initiate sequences of movements or break them off again immediately.
Despite completely intact muscles and movement coordination, those affected are unable to take a key out of their pocket and insert it into a keyhole. For example, the person concerned first tries to put something in the keyhole, then looks for the key, but cannot find the pocket, etc. Patients with this disorder are often not able to dress properly either, and for example pull their underpants over their street pants.
The disorder is very relevant to everyday life and leads to a considerable disability. In this case in particular, the implementation of physiotherapy , occupational therapy and, if necessary, speech therapy is crucial for a favorable course of therapy.
Constructive apraxia
This apraxia usually occurs when the non-language-dominant hemisphere is damaged. The exact location of the damage is in the parietal association cortex at the point of visuo-motor connection.
There is an inability to correctly grasp and trace geometric structures.
Other forms of apraxia
This list has not been checked for completeness.
- Buccofacial apraxia and speech apraxia
- The apraxia of the facial muscles (buccofacial apraxia) can lead not only to coordination deficits of the facial muscles but also to a disturbance of the voluntary closure of the eyes (lidapraxia). Disturbances in the programming of speech movements are called speech apraxia . Apraxia of Speech usually occurs in connection with aphasia (especially with so-called Broca's aphasia [in older literature also referred to as “motor aphasia”]). As with aphasia, the causes are diverse. In most cases, there are cerebro-vascular disorders (circulatory disorders) or traumatic effects (bleeding, accidents, surgical trauma). In speaking apraxia, disorders in the areas of articulation (segmental symptoms), prosody (suprasegmental symptoms) and speaking behavior are observed. The apraxia of speech must be distinguished from aphasic-phonological disorders and dysarthria (differential diagnosis) . Speech practice is treated, for example, by clinical speech scientists / linguists , speech therapists and other therapists. Research in linguistics (patholinguistics, psycholinguistics, phonetics ...) strives to design models of the exact structure and organization of the speech process. At the moment there are few or no scientifically founded treatment concepts for speech practice.
- Frontal gait apraxia
- Those affected trip over their own feet, walk with their legs apart and uncertain. If you then give them easy guidance, for example with an aid such as a walker , they often walk almost normally.
- Limb kinetic apraxia (innervatory apraxia)
- This apraxia describes the loss of finger and hand dexterity. This is due to a disruption of precise and coordinated movements and the inability to move fingers individually.
- Limb apraxia
- Tactile apraxia
- Visuo-motor apraxia
General symptoms of apraxia
Clumsy, trying movements are typical of apractical disorders. Sufferers have difficulty distinguishing between the objects and their own body parts. For example, they try to stick their finger into the keyhole instead of the key or to brush their teeth with their fingers instead of the toothbrush.
Reflex movements, long learned movements such as B. handshakes, expressive movements such as laughing and crying and movements such as. B. the swinging of the arms when walking are mostly retained.
Historical
The term apraxia was used by the English neurologist John Hughlings Jackson as early as the 19th century . Hugo Liepmann systematized the various forms of apraxia at the beginning of the 20th century. Since then, a distinction has been made between motor (ideomotor and ideatory) apraxia and constructive apraxia.
References and literature
- ↑ H. Liepmann: Agnosic disorders. (1908) In: Cortex. 2001; 37 (4), pp. 547-553.
- ^ On the life of Hugo Liepmann: G. Goldenberg: Apraxia and beyond: life and work of Hugo Liepmann. In: Cortex. (2003) Jun; 39 (3), pp. 509-524.
- ^ A b c d Mathias Bähr, Michael Frotscher: Duus' neurological-topical diagnostics. 8th edition. Georg Thieme Verlag, 2003, ISBN 3-13-535808-9 , p. 396f.
- ↑ Apraxia - Classification and Neuroanatomical Basics
