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Apraxia and Related Syndromes

Apraxia has a neurologic cause that localizes fairly well to the left inferior parietal lobule, the frontal
lobes (especially the premotor cortex, supplementary motor area, and convexity), or the corpus
callosum. Any disease of these areas can cause apraxia, although stroke and dementia are the most
common causes.
Heilman defined apraxia in negative terms, characterizing it as “a disorder of skilled movement not
caused by weakness, akinesia, deafferentation, abnormal tone or posture, movement disorders such
as tremors or chorea, intellectual deterioration, poor comprehension, or uncooperativeness." [1] To
simplify matters, apraxia can be considered a form of a motor agnosia. Patients are not paretic but
have lost information about how to perform skilled movements.
Patients who have aphasia but who do not have coexisting apraxia can live independently, take the
bus or subway, and lead a relatively normal life, while a patient with significant limb apraxia is likely
to remain dependent.

In general, patients with apraxia become dependent for their activities of daily living and require at
least some degree of supervision; skilled nursing care may be required. Patients with degenerative
diseases or tumors usually progress to increased levels of dependence.

Types of Apraxia
There is no consensus on how to divide and organize the many different syndromes classified as
apraxia. Authors have divided apraxias based on the following:

Body part affected (eg, limb apraxia or buccofacial apraxia) [3]
Dysfunctional sensory area (left inferior parietal) or motor areas (left premotor and left
supplementary motor)
If use of tools is affected (transitive vs intransitive)
Deficits in pantomiming tool use and gesture (ideomotor apraxia)
If knowledge about the use of tools is preserved (conceptual apraxia)
Conceptual apraxia is defined as a loss of knowledge about tools and the movements associated
with their use. Patients with parietal lesions may have this condition.

Apraxialike Syndromes
The term apraxia is used to describe a variety of syndromes, including the following, that are not
considered true apraxias by some:

Inability to copy 2-dimensional (2D) drawings or 3D assemblies (may be associated with the right or left parietal and left frontal areas.       Dressing apraxia .Part of Balint syndrome. no relationship to ideomotor apraxia Gaze apraxia . no relationship to ideomotor apraxia Apraxia of eyelid opening .Part of the triad of symptoms of normal pressure hydrocephalus.Usually associated with right parietal lesions and part of a neglect syndrome Limb-kinetic apraxia Constructional apraxia .No relationship to ideomotor apraxia Magnetic apraxia . among other brain regions) Gait apraxia (also called Bruns ataxia) .