Apraxia is a disorder of the ability to carry out sequential actions while maintaining the necessary volume of motor and sensory functions. Kinesthetic apraxia is observed with lesions of the subcortical nodes and various parts of the cerebral cortex.
The disease is diagnosed taking into account the data of neurological examinations, including neuropsychological specific tests. The cause of the diagnosed disorders is determined using neuroimaging methods. Therapy of kinesthetic apraxia depends on the localization of a particular lesion, is performed using neurosurgical, medical and rehabilitation methods. It is more common in boys than in girls.
Praxis
Praxis, translated from Greek, means “action”, in the understanding of medicine it is the highest nervous function that provides the ability to perform sequential purposeful actions. Learning to perform complex movements occurs in childhood with the participation of various subcortical ganglia and zones of the cerebral cortex. In the future, frequently performed daily actions reach automatism and are mainly provided by subcortical structures. The loss of motor skills acquired during the childhood period with the preservation of the motor sphere and adequate muscle tone was called apraxia in medicine.
What is the difference between kinesthetic apraxia and kinetic apraxia? The first occurs if the mid-lower parts of the cerebral hemispheres are affected. The second is associated with the defeat of the lower sections, which are responsible for the serial organization and automation of movements.
About motor apraxia
Motor kinesthetic apraxia is defined as the lack of the ability to perform intentional, focused actions, while elementary movements are preserved unchanged. Or they are slightly disturbed. This is not paresis or paralysis, because at the same time passive and active movements, muscular strength are preserved. Also, disorders such as rigidity, impaired tone, paging, bradykinesia, athetosis, chorea, ataxia are not apraxia. With apraxia, the patient becomes unable to carry out complex and solitary actions.
Disorders of movements during interaction with objects and disorders caused by the symbolic use of signs are described along with impaired perceptions as asymmetry and are called “lack of perception”.
Varieties
Kinesthetic apraxia is divided into three main varieties:
- kinetic apraxia of limbs or melokinetic apraxia;
- ideomotor;
- ideative.
Ideatic kinesthetic apraxia is understood as a violation of extrakinetic memory engrams, which contains a spatio-temporal ideator plan that determines the path that motor functions will follow, how the limbs and their parts will act, sequence, rhythm and speed of movements.
This disorder provokes violations of unusual and complex actions, while the usual, simplest actions remain. Formulas of actions that are stored in extrakinetic memory direct such complex movements, using kinetic, tactile and primary visual abilities to carry out these movements. Damage to extrakinetic engrams or an obstacle that occurs in the process of their formation, contributes to the gap and errors in the ideator's concept, and sometimes to the absolute inability to implement them.
It is believed that articulatory kinesthetic apraxia is a result of a break in the connection between the extrakinetic storage and storage of kinetic engrams, as well as a break in communication with new tactile, optical, and acoustic stimuli, which contributes to the development of apraxia of single simple motor actions.
Melokinetic Apraxia
Kinetic apraxia of the extremities or melokinetic apraxia is defined as damage or loss of kinetic engrams, which leads to disruption or weakening of simple, well-known motor actions. Such disorders in most cases are limited to a small group of muscles on one limb, opposite the damaged part of the brain. Why are there different types of kinesthetic apraxia?
The causes of the disease
Violations of praxis can develop with damage to different parts of the brain: subcortical formations, cortex, nerve pathways that provide their interaction. Most often, kinesthetic apraxia accompanies damage to the frontal and parietal cortical zones. Damaging factors in this case are usually:
- Brain tumors. These are neoplasms inside the brain (astrocytoma, glioma, ganglioneuroblastoma) that grow in the cortex and subcortical centers, which have a damaging effect on the areas involved in providing praxis.
- Strokes. For example, hemorrhagic stroke, which is characterized by cerebral hemorrhage. This pathology occurs after a rupture of the wall of the cerebral vessel. In addition, there is a stroke of the ischemic type, developing with spasm or thromboembolism of the cerebral arteries.
- Traumatic brain injuries. Kinesthetic apraxia can provoke direct damage to the cerebral areas responsible for praxis, as well as their secondary damage as a result of the formation of post-traumatic hematomas, ischemia, edema, and inflammatory reactions.
- Infectious brain lesions. These are meningoencephalitis, encephalitis of various etiologies, brain abscesses, with inflammatory foci localized in the cortex or subcortical ganglia.
- Degenerative processes. These are pathological processes that are accompanied by developing cortical atrophy: Peak's disease, dementia, Alzheimer's disease, corticobasal degeneration, alcoholic encephalopathy. Such diseases are caused by cerebral ischemia of a chronic nature, toxic damage, dysmetabolic disorders (diabetes mellitus), and hereditary factors.
Risk factors
There are also certain risk factors that increase the likelihood of developing praxis disorders. These include the age of more than 60 years, a genetic predisposition, a history of stroke, hypertension, chronic alcoholism and cardiovascular pathologies.
Most often, kinesthetic apraxia is observed with damage to the parietal zone of the brain.
Symptoms of the disease
Kinesthetic apraxia is often determined by such specific signs: excessive stoop, shuffling gait, sudden stop, inability to step over an obstacle. At the same time, patients often do not realize their own condition. Sometimes the symptoms of this deviation do not bother the patients at all, showing up only during special neurological studies.
Symptoms of this disease are manifested in the following:
- difficulties in reproducing team movements, when patients often do not remember the sequence of certain actions;
- difficulties in making movements that require spatial orientation, the ratio of space with actions changes in patients;
- walking in small steps, constrained by a gait;
- difficulty in dressing;
- motor perseveration, expressed in the steady reproduction of some elements of movement and jamming on them;
- difficulty opening eyes.
Treatment
Therapeutic measures for afferent kinesthetic apraxia are primarily aimed at eliminating the etiological factor. To date, special therapeutic techniques for the effective disposal of this pathology do not exist. Among the most effective therapeutic measures that contribute to the achievement of a lasting positive result, the following are distinguished:
- prescribing medications that help normalize the blood supply to brain structures, improve the delivery of vital substances to the brain;
- constant monitoring of blood pressure, taking measures to normalize it;
- the use of anticholinesterase drugs to increase the effectiveness of neuropsychological functions;
- restoration of the affected areas of the brain and other organs;
- surgical intervention (for example, removal of a tumor).
Medicines whose effect is aimed at slowing the progression of the symptoms of this pathology are practically ineffective in relation to the disease in question. Therapeutic measures also depend on the type of disorder. Modern doctors prefer individual methods for each individual patient. They may include: physiotherapeutic measures, occupational therapy, speech therapy, restoration of cognitive processes, elimination of etiological factors.
Prevention
Effective preventive procedures aimed at preventing the development of kinesthetic articulatory apraxia also do not exist at the moment. However, we can highlight some effective recommendations that will significantly reduce the likelihood of developing the described ailment:
- regular sports and walks in the air;
- refusal to drink alcohol and smoke;
- normalization of diet;
- nutritional balance;
- regularity of medical examinations;
- blood pressure control.
Conclusion
So, kinesthetic apraxia is a type of deviation, which is characterized by the inability of the patient to reproduce the sequence of the necessary motor operation. You need to understand that people with such a disorder are highly dependent on outside help, since they are not able to independently carry out some daily actions. Treatment, as a rule, is ineffective, so it is best to avoid the conditions that provoke this ailment.