Can apraxia in adults be cured?

Table of Contents

What is apraxia?

Apraxia is a motor disorder caused by damage to the brain, specifically the areas involved in planning and executing movements. It affects the ability to perform learned skilled movements, even though the desire to move and the necessary muscles are intact. Apraxia is not caused by muscle weakness or paralysis. Rather, the brain has trouble communicating with the body to initiate and coordinate movements.

There are several types of apraxia:

Ideomotor apraxia affects the ability to pantomime tool use and gestures.
Ideational apraxia affects the ability to complete a sequence of actions or steps of a complex task.
Oral apraxia affects the muscles involved in speech production.

Limb apraxia affects the limbs and the ability to make precise movements with the arms and legs.
Constructional apraxia affects the ability to draw or construct things.

Apraxia often occurs after a stroke, particularly left hemisphere strokes, but can also result from other brain injuries or neurodegenerative diseases. The severity and type of apraxia depends on the location and extent of damage in the brain. Apraxia is more common in adults and seniors, but can occur at any age if there is injury to motor planning regions of the brain.

Main signs and symptoms

Common signs and symptoms of apraxia include:

Difficulty performing familiar tasks or learned motor skills despite normal mobility.
Trouble carrying out sequential actions in the correct order.

Mistakes in movements, gesturing, demonstrating tool use, or speech production.
Groping or trial-and-error movements to complete tasks.
Inability to imitate gestures or movements.

Inability to coordinate and position limbs or body properly.
Frustration and difficulty communicating.

The specific symptoms depend on the type and severity of apraxia. For example, ideomotor apraxia may cause someone to struggle brushing their teeth or using tools or utensils. Oral apraxia affects the coordination and positioning of lips, tongue and jaw required for speech. Limb apraxia makes fine motor skills of the arms and legs difficult.

Tests and diagnosis

A full medical history and neurologic exam is needed to diagnose apraxia. There are also several tests that can help confirm apraxia and pinpoint the type:

Imitation tasks: Asking the person to mimic a series of gestures or actions. Inability to accurately imitate indicates apraxia.
Transitive tasks: Asking the person to pantomime tool use or demonstrate how to use real tools. Errors demonstrate ideomotor apraxia.

Intransitive tasks: Asking the person to make meaningful hand or body gestures. This also tests for ideomotor apraxia.
Naturalistic activities: Observing the person perform real-world tasks like brushing teeth, cooking, dressing, or brushing hair. Errors and clumsy movements may indicate apraxia.
Oral mechanism exam: This evaluates the positioning and movements of the lips, tongue, soft palate for speech. Oral apraxia may be present if positioning is weak or uncoordinated.

Drawing tests: Asking the person to copy simple shapes or draw objects. Constructional apraxia affects this ability.

Performing poorly on these types of skilled motor tasks without any weakness, sensory loss, or paralysis is the hallmark of apraxia. Neuroimaging like MRI can also help pinpoint areas of brain damage.

Causes and risk factors

Common causes and risk factors for apraxia include:

Stroke – Especially left hemisphere strokes affecting frontal and parietal lobes
Traumatic brain injury
Tumors of the brain or brain inflammation

Neurodegenerative diseases like Alzheimer’s or Parkinson’s
Toxic or metabolic disorders
Advanced age

Frontotemporal dementia
Vascular dementia

Apraxia occurs when there is damage to areas of the brain involved in skilled motor planning and execution. The areas commonly affected include the:

Frontal lobe
Parietal lobe
Basal ganglia

Corpus callosum connecting the hemispheres

Left hemisphere strokes are a leading cause as the left side of the brain is dominant for motor function in most people. Neurodegenerative diseases like Alzheimer’s progressively damage the brain and can eventually affect motor planning cells.

Treatments

There are several treatments that can help improve apraxia and work around the deficits:

Occupational therapy: Focused on re-learning motor skills, using compensatory strategies, and improving functioning in daily activities.
Speech therapy: For those with oral apraxia to improve coordination of speech muscles and language production.
Physical therapy: Helps improve limb use, coordination, and walking for those with limb apraxia.

Communication strategies: Using communication devices, gestures, and other techniques to compensate for speech apraxia.
External cues: Verbal, visual or touch cues can help trigger the initiation and sequencing of movements.
Assistive devices: Built up handles on tools, utensils, and more to make them easier to grasp and use.

Environment setup: Modifying environment and tasks to simplify actions and remove excess movements needed.

There are currently no medications specifically for apraxia. However, medicines may help treat underlying causes like stroke or Alzheimer’s. With therapy, most patients see gradual improvement over time. However, severity and recovery depend on the extent and location of brain damage. Mild apraxia often improves more with therapy compared to severe cases.

Prognosis

The prognosis for apraxia depends on several factors:

Type and severity – Mild apraxia often has better outcomes than severe forms.
Cause – Apraxia from stroke may improve more than neurodegenerative apraxia.
Age and health – Younger patients have better ability to regain function.

Therapy intensity – More frequent therapy leads to better results.
Support – Good family support helps optimize function.
Coexisting issues – Other impairments like aphasia may limit progress.

In many patients, focused speech and occupational therapy can help regain some function. However, the underlying cause also impacts the prognosis. Apraxia from stroke or brain injuries has better outcomes compared to progressive brain disorders. Some important considerations:

Up to 80% of stroke patients experience some degree of apraxia immediately after. This decreases to 15% after 3 months with therapy.
About 50% of people with Alzheimer’s develop apraxia in moderate disease stages. It worsens with progression.

In dementia, issues like memory loss may limit the benefits of therapy.
With mild-moderate apraxia, the majority of patients become independent in many daily tasks.
Severe apraxia often has a poorer prognosis and needs assistance with activities long term.

With dedicated therapy, coping strategies and support, even those with chronic apraxia can gain back functional independence.

Can apraxia be cured?

There is no known cure for apraxia at this time. The underlying damage to motor control centers of the brain is permanent. However, focused therapy can help significantly improve function and daily living. Some key points on apraxia recovery:

Intensive therapy should start as early as possible for best outcomes.

Improvements may occur quickly in the first few months and slow down after.
Therapy helps find ways to work around and compensate for the apraxia.
Recovery is gradual, and apraxia may not fully resolve.

Development of coping strategies is a critical component of therapy.
Some patients may regain near normal motor function with time and practice.
The underlying apraxia does not go away entirely.

While apraxia itself may permanently remain, the symptoms and functional impacts can be greatly reduced with evidence-based therapies. With some adaptation and compensation strategies, even those with chronic apraxia can regain independence.

Home strategies and exercises

The following tips can help manage apraxia at home:

Provide extra time for tasks.

Break down activities into smaller, sequential steps.
Use picture schedules or checklists for task sequences.
Simplify multi-step tasks.

Try using larger utensils and thicker handles.
Place items needed in sequence for easier access.
Have backups available if items get dropped or misplaced.

Provide hand gestures or rhythmic tapping as cues.
Focus on the actions, not just end results.
Offer reassurance and limit distractions in the environment.

Daily exercises to practice motor skills include:

Folding towels or doing laundry
Stacking blocks or coins

Using spray bottles or squirt guns
Hammering pegs or playing croquet
Tracing patterns or cutting shapes from paper

Buttoning, zipping, tying, or snapping
Practicing speech sounds and tongue twisters

It’s important that home exercises simulate real-life activities as much as possible. With practice and cues, daily tasks can become easier over time. Support and encouragement also go a long way in managing apraxia.

Prevention

There are no proven ways to directly prevent the onset of apraxia, since the underlying brain damage is often unpredictable. However, steps that promote overall brain health may help lower risks:

Eat a balanced diet with brain-healthy foods like fish, fruits, vegetables, nuts and seeds.
Exercise regularly to improve blood flow and oxygen to the brain.

Stay mentally active by learning new skills and doing brain-stimulating activities.
Manage health conditions like high blood pressure, cholesterol or diabetes.
Don’t smoke and avoid secondhand smoke.

Drink alcohol only in moderation if at all.
Reduce stress through relaxation, social interaction and good sleep habits.
Wear protective gear during high-risk activities to avoid head injuries.

Consider cognitive assessment as part of routine health screening after age 50.

While these strategies support general brain health, they cannot always prevent apraxia onset. However, leading a brain-healthy lifestyle provides benefits at any age. Prompt treatment after any type of neurological injury also improves outcomes.

The takeaway

While apraxia has no cure, focused therapy helps manage symptoms and improve function. With practice of compensatory strategies and environmental adaptations, independence in daily activities is often possible. Mild apraxia from stroke or injuries has the best prognosis. Neurodegenerative causes are less reversible. However, all patients benefit from occupational and speech therapy targeting specific motor deficits. Support from caregivers also optimizes success in managing apraxia.