Each of the diseases, of course, is an individual case. But nevertheless, experts find common signs, symptoms, flow algorithms. Comprehensive diagnostic and therapy regimens are used. And here it is important to correctly determine the type of disease according to its clinical characteristics in order to choose the appropriate treatment for the patient. In this vein, we will consider the types of apraxia. Naturally, giving a description of each category.
Pathology definition
Any of the types of apraxia is a disease characterized by a violation of targeted actions. The patient has both a desire and a physical ability to perform one or another action. But at the same time he cannot make a body movement, a gesture. It is important to note that with types of apraxia there are no signs of paresis or impaired coordination of movements.
The disease affects both the cerebral hemispheres and the "routes" of the corpus callosum. It develops as a consequence of a large number of pathologies. Therefore, it is advisable to divide into types of apraxia, each of which is characterized by individual factors.
What could be a concrete example of a disease? This is a loss of drawing skills, playing a musical instrument (if they, of course, were present at the patient), spelling, simple tying shoelaces.
And now let's go directly to the classifications.
Graduation by the degree of disease progression
We start talking about the description and types of apraxia from this category system. Here are two varieties:
- One sided. It is characterized by violations of the human motor system on only one side - left or right.
- Bilateral. Here, before the specialist, a diffuse (general) lesion of the frontal lobe or cerebral cortex.
For the clinical characteristics of the disease, it is also important for the doctor to know how the affected area of the brain continues to function.
Graduation of localization of the lesion
A more common category system. Now the types and clinical characteristics of apraxia will be divided at the site of the lesion:
- Regulatory (or frontal). This is a violation of the regulation of body movements performed by the patient. In this case, the cortex of the prefrontal part of the cerebral hemispheres is damaged. The result is a violation of the act of complex movements, which are characterized by a consistent course. In other words, the patient’s actions cannot be completed. Speech regulation is disturbed, a person’s control over his movements and actions suffers, systemic perseveration is characteristic (the whole action begins to be repeated by the patient again). It is difficult for the patient to learn some new motor program, while he also loses old skills. However, some stereotypes, patterns still remain.
- Motor (or ideomotor). In this case, the patient with apraxia cannot perform the actions that he himself had planned.
- Dynamic (or premotor). Specialists distinguish here the pathological inertness of movements, their disautomatization. In addition, the patient will have impaired skills for translating movements into the category of more complex ones. Most often, dynamic apraxia occurs when the premotor area of the cerebral cortex or the area called the Bodman cytoarchitectonic field was previously damaged.
- Cortical. This form occurs as a result of damage to the cortex of the brain that is dominant in the patient’s hemisphere. A transformation of the motor sphere of the cerebral cortex is observed on the side where it was damaged.
- Bilateral. It affects motor abilities on both the right and left sides. It is characteristic of cases when foci of pathology are localized in the parietal lower lobe of the dominant hemisphere of the brain. Also, with bilateral form, disturbances in the interaction of two cerebral hemispheres can occur.
Grading by Cognitive Disorder
And further about apraxia, their types, mechanisms of speech impairment. If we classify the disease into categories of cognitive disorders, we will have the following gradation:
- Psychomotor (akinetic). With this disorder, there is no motivation to perform certain movements.
- Amnestic. What is characteristic here? Imitative movements remain, but deviations are observed in the system of arbitrary. It is noteworthy that the patient loses the memory of how the movement should be.
- Ideative. It is difficult for the patient to make a plan in the head, an algorithm of successive movements. And hence the difficulty in reproducing complex actions.
- Ideokinetic. The patient with this form of apraxia loses the ability to perform elementary targeted actions. Ability to random movements while remaining.
- Constructive. The variety is characterized by the loss of the skill of composing the whole of the parts.
- Apraxia dressing. For a variety of pathologies, the appearance of problems with clothing is characteristic. For example, a person confuses how an outfit should sit on it, on which foot the left boot should be. The form of the disease is characteristic of lesions of the right hemisphere of the brain.
- Oral. A person loses skills in performing complex movements with both his tongue and lips. As a result, speech impairment.
- Afferent. This variety is also characterized by problems with speaking, singing and so on.
- Kinetic. What is meant here? This is a kinetic afferentation disorder. It leads to violations of arbitrary movements when searching for the desired one. It is easier to illustrate this with examples. A person cannot correctly bend, straighten, or direct a limb for a specific situation. The patient has difficulty performing such actions as stroking, combing, etc.
Types of Kinetic Apraxia
Continuing the conversation about the types and characteristics of apraxia, we present an additional gradation of its kinetic type (for cognitive impairment):
- Spatial subcategory. A person has difficulties with orientation in space, it is difficult for him even if there is a desire to take one or another pose.
- Subcategory "Walk Apraxia". Violations are diagnosed only with the movement of the patient. Moreover, he retained vestibular and motor capabilities.
Graduation by A. R. Luria
Four types of apraxia according to Luria:
- Regulatory. The prefrontal zones of the brain are affected. The patient has a violation of speech regulation, control over the course of movements is knocked down. He cannot cope with motor tasks, repeats actions, it is difficult for him to learn a new program. Some skills are lost, some patterns remain. The result of the activity does not coincide with the plan.
- Spatial. The parietal-occipital sections are affected (characteristic of the left side). Spatial-visual contacts of movements are broken, switching from operation to operation is difficult. Spatial movements (washing, cooking, dressing) are not easy to carry out, which complicates everyday life. It is difficult for a patient to correlate his body with the surrounding world.
- Kinetic. The lower part of the premotor region is affected. Smooth switching from movement to movement is broken. The patient is literally "stuck" only when he begins to move. Writing skills are also impaired.
- Kinesthetic. The lower parietal zone is affected, most of all - the left hemisphere. Violation of afferentation, it is impossible to give the body the desired position. The patient does not feel fingers, hands, from here writing skills, substantive actions are violated.
Causes of the disease
And further on the types and causes of apraxia. The following causes the disease:
- Chronic disturbance of blood circulation in the brain.
- A consequence of inflammation of the brain.
- Traumatic brain injury.
- Oncological disease of the brain.
- Alzheimer's disease.
- Parkinson's disease.
Signs, symptoms of pathology
The specialist determines apraxia according to the following criteria:
- Stoop unusual to the patient.
- Loss of patient control over the facial muscles.
- Violations when walking.
- Difficulties in dressing, shoes.
- The patient is not able to coordinate the movements of the fingers and hands.
- Difficulty in using objects, in choosing a situation where these things are involved.
- Difficulty to overcome the obstacle.
Diagnosis and treatment
Diagnosis of apraxia is the following:
- Analysis of complaints, anamnesis.
- Inspection by a neuropsychologist, neurologist, neurosurgeon.
- Carrying out computer and magnetic resonance imaging.
Therapy depends on the cause of the disease, rarely is medication. The treatment includes the following:
- Classes with a speech therapist.
- Cognitive rehabilitation.
- Physiotherapy.
- Occupational therapy.
Apraxia can be expressed in various forms. They stand out according to several classifications with which you are already familiar.