Ideational Apraxia: Definition, Causes And Symptoms
Ideational apraxia is a neurological condition that incapacitates the person to think and perform certain sequences of movements with everyday objects and tools, when asked to do so.
For example, when we tell a patient who suffers from this type of apraxia to communicate out loud the steps to take to brush his teeth, it will be impossible for him to do so.
Next, we will see in more detail what ideational apraxia consists of, what are the causes and its main symptoms, as well as the indicated treatment.
Ideational apraxia is a neurological disorder characterized by the loss of the ability to conceptualize, plan, and execute the complex sequences of motor actions involved in the use of tools and objects of everyday life.
This condition prevents the subject who suffers from it from planning movements in which there is some type of interaction with objects, because there is a loss of knowledge or perception of their purpose. The characteristics of this disorder include an alteration in the concept of sequential organization of voluntary actions. The patient appears to have requested knowledge of what a specific object represents.
It was the psychiatrist Arnold Pick who, a century ago, described the first patient who appeared to have lost the ability to use objects; This person made mistakes such as combing his hair with the wrong side of the comb or brushing his teeth with his finger, mistakes that often occur in ideational apraxia.
However, it was not until the 1900s when the German neurologist, Hugo Liepmann, redefined the term ideational apraxia, specifically describing a series of disorders that involved, above all, problems in motor planning, apart from alterations in the visual perception, language or symbolic capacity of patients.
The causes that cause ideational apraxia remain unknown to most researchers.
Nevertheless, Studies carried out with patients who have suffered brain damage indicate that this type of apraxia is related to lesions in the dominant hemisphere in areas close to those associated with disorders such as aphasia.
It was Liepmann at the beginning of the last century who proposed a hypothesis that implicated the motor processing system, responsible for executing actions, located in the left cerebral hemisphere and responsible for motor planning that guides body movements. However, he was never able to describe the same type of symptoms of ideational apraxia in two patients with the same brain damage.
Other researchers have pointed out that possibly damage to the lateral sulcus of the brain, also known as the Sylvian fissure, could help explain the subjects’ impaired recognition of objects. Another possible location that would lead to the typical symptoms of ideational apraxia could be the marginal gyrus, located in the parietal lobe of the brain.
In general, ideational apraxia has been identified with bilateral lesions in parieto-occipital and parietotemporal regions, although frontal and frontotemporal lesions in the left hemisphere have also been proposed as possible locations involved in the causes of this type of apraxia, since this would explain the problems in motor planning that are observed in this type of patients, as well as the difficulty in distinguishing this from certain aphasias.
In cases in which apraxia occurs together with some type of dementia (Alzheimer’s or Parkinson’s), extensive lesions in the left hemisphere and damage to the corpus callosum have been described.
Patients who present ideational apraxia, as we have mentioned previously, are unable to perform movements that involve an ordered sequence of acts. Although the person may be able to execute each act that makes up a movement separately, they cannot execute it in an orderly and logical manner.
To test this, Liepmann performed a series of tests, known as multiple-object tasks. Each task requires the patient to use more than one object; The researcher describes the task to the patient and asks him to perform that task as described. Liepmann gave the patients various items, such as a candle, a wick, and a box of matches. He then watched to see how they interacted with each object.
In the case of the matchbox, one of the patients brought the box close to the wick; another opened the box and took out a match, and brought it to the wick without lighting it; another patient hit the candle against the matchbox, and so on. The researcher was able to witness the discontinuity of the patients’ actions with respect to everyday objects, categorizing the errors they made, such as: poor placement of actions, misuse of objects, omissions or sequential errors.
In short, the deficit that patients with ideational apraxia present is not lacking the knowledge of how to use an object, since they perfectly understand the function of each one of them. The problem is that when they try to interact with multiple objects to execute one of their functions, the execution becomes defective
The person is, therefore, capable of performing more or less complex actions on a routine basis (lighting a match or opening a box), but is unable to do so under a verbal command or when asked to do so. Hence, for some researchers, this type of apraxia is nothing more than a severe ideomotor apraxia, which implies the inability to perform movements or gestures when they are required verbally or by imitation.
Currently, The most common treatment for ideational apraxia, which is still a disorder caused by brain damage, is occupational therapy and neuropsychological rehabilitation which aim to delay the progression of symptoms and help patients regain their independence and functional autonomy.
In younger patients, after a stroke that causes apraxia of this type, recovery is less complicated because their brains are more plastic than those of an adult or an elderly person, so as they develop new patterns and behaviors during rehabilitation, functional and intact neuronal areas can assume some of the functions performed by damaged regions.
Ideational apraxia has frequently been described in cases of Alzheimer’s type dementia, being an important cause of morbidity and also progressing with the underlying disease. In these contexts, people quickly lose autonomy and become very dependent, making it necessary to use technical aids and, in the most serious cases, transfer to a center where they can meet their needs.
