Apraxia is an inability to correctly perform learned skilled movements due to a cognitive deficit in motor programming. It is broadly divided into limb apraxia and buccofacial apraxia. Limb apraxia includes ideomotor apraxia, ideational apraxia, and limb kinetic apraxia caused by lesions in the parietal lobe, frontal lobe, and connections between the two. Buccofacial apraxia involves an inability to perform skilled mouth and tongue movements and is associated with left frontal lesions. Apraxia is assessed through tasks like pantomiming tool use, imitation of gestures, and performing commands.

1. Apraxia
DR BHAVIN J PATEL
SR NEUROLOGY
GMC, KOTA

2. Introduction
Apraxia is an inability to correctly perform learned skilled movements
A cognitive deficit in motor programming
“Apraxia is an acquired disorder of learned, skilled, sequential motor
movements that cannot be accounted for by elementary disturbances of
strength, coordination, sensation, or lack of comprehension or attention”
- Geschwind(1975)

3. Introduction
For the motor system to deal effectively with the environment ,at least two
major types of programmes are required: intentional and praxic
- Intentional-when to move
- Praxic -how to move
Disorders of this HOW or praxic system are called apraxias.
Broadly these can be divided into two main groups:
- Limb apraxia
- Buccofacial apraxia

4. Introduction
Clinicians use apraxia to describe nonlearned motor dysfunctions including
oculomotor movements, gait initiation (magnetic apraxia), and eyelid opening.
 They also use apraxia to describe skilled motor tasks that are dependent on
visuospatial processing, including optic, constructional, and dressing apraxia.
Apraxia correctly applies to conditions that are more clearly consistent with the
definition of disturbances in learned skilled movements

5. Praxis Model

6. Patophysiology
A:- ideomotor apraxia, parietal
variant
B:- ideomotor apraxia,
disconnection variant
C:- verbal dissociation apraxia
D:- visual dissociation apraxia
E:-conceptual apraxia
F:- limb kinetic apraxia
G:- Callosal apraxia
H:- Ideational apraxia

7. Causes of apraxia
Stroke
Corticobasal degeneration
Pick's disease
Alzheimer's disease
Progressive supranuclear palsy
Intra-cranial tumours
Taumatic brain injury

8. Examination of
Limb Apraxia

9. Examination of
Limb Apraxia

10. Types of Limb aprxia

11. Buccofacial apraxia
Inability to perform skilled actions involving the lips, mouth, and tongue in the
absence of paresis. In some pts apraxia is confined to speech movements where
it is called verbal apraxia
Commonly associated with damage in the left frontal operculum and insula .
How to test:
Patient should be asked :"show me how to-"
 Blow out a match.
 Protrude your tongue.
 Drink through a straw.

12. Constructional apraxia
Pt with this disorder do not have difficulty making most types of skilled movements with
their arms and hands.
They have no trouble using objects properly, imitating their use, or pretending to use
them.
The primary deficit in constructional apraxia appears to involve the ability to perceive and
imagine geometrical relations
Bedside tests of constructional apraxia include drawing overlapping pentagons,a cube, or
a clock face.
Caused by lesions of the right parietal lobe

14. Dressing apraxia
It signifies a feature of the impaired tactile and visuospatial
coordination plus hemineglect rather than the loss of the ability to
use tools.
Tested by asking the patient to wear a jacket with the sleeves
deliberately turned inside out.
Lesion is in right parietal lobe.

15. Gait Apraxia
Impaired ability to execute the highly practised, co-ordinated movements of the
lower legs required for walking.
Meyer and Baron called it apraxia of gait because despite severe gait disorder pt
can move their legs at will.
Pt appears to be stuck to the floor.There is difficulty in initiating walking
(magnetic gait).
There may be dissociation between gait and distal volitional movements.
Lesions in the pathway originating in the mesial frontal cortex.

16. Oculomotor apraxia
Impaired ability to generate saccades on command, although
reflexly induced saccades and random saccades are normal.
This abnormality is part of Balint syndrome.

18. Apraxia of eye lid opening
Inability to open the eyes volantarily in the absence of ptosis or blepharospasm.
Pt has to thrust his head backward to attempt eye lid opening or opens their lids
manualy.
Occurs with lesions of right hemisphere or bilateral hemispheric lesions.
Also seen in disorders of extrapyramidal system.

19. MCQ
Which of the following apraxia is associated with error in the content of action?
A. Ideomotor
B. Ideational
C. Dissociation
D. conceptual

20. MCQ
Which of the following syndrome is not associated with apraxia?
A. Cortico basal syndrome
B. Gerstman syndrome
C. Balint syndrome
D. Anton syndrome

21. MCQ
Most common type of apraxia in Alzheimer disease in early stage?
A. Ideomotor
B. Ideational
C. Dressing
D. construction

22. MCQ
Which of the following apraxia do not result secondary to parietal lobe lesion?
A. dressing apraxia
B. Gait apraxia
C. constructional Apraxia
D. optic apraxia

23. MCQ
48 yr old male patient sustained head injury in RTA and developed left sub dural
hematoma…after recovery of weakness on examination of apraxia patient is having impairment
in pantomime and imitating gestures but gesture knowledge is intact….pt is suffering from which
kind of apraxia and localization of apraxia?
A. Ideomotor apraxia----inferior parietal lobule
B. Ideomotor apraxia– supplementary motor area
C. Ideational apraxia---left frontal lobe and SMA
D. Callosal apraxia

24. Which type of apraxia?

25. Thank you

26. A:- ideomotor apraxia, parietal variant
B:- ideomotor apraxia, disconnection variant
C:- verbal dissociation apraxia
D:- visual dissociation apraxia
E:-conceptual apraxia
F:- limb kinetic apraxia
G:- Callosal apraxia
H:- Ideational apraxia