STUDY - Technical - New Dacian's Medicine
Apraxia
(Classical / Allopathic Medicine)
Apraxia is the
inability to perform purposeful movements in the absence of
significant weakness, sensory loss, poor coordination, or lack
of comprehension or motivation. This neurologic sign usually
indicates a lesion in the cerebral hemisphere. Its onset,
severity, and duration vary, depending on the location and
extent of the lesion.
Apraxia is
classified as ideational, ideomotor, or kinetic, depending on
the stage at which voluntary movement is impaired. It can also
be classified by type of motor or skill impairment. For
example, facial and gait apraxia involve specific motor groups
and are easily perceived. Constructional apraxia refers to
inability to copy simple drawings or patterns. Dressing
apraxia refers to inability to dress oneself correctly.
Callosal apraxia refers to normal motor function on one side
of the body accompanied by an inability to reproduce movements
on the other side. (See How apraxia interferes with purposeful
movement.)
HISTORY:
Review the patient's medical history for neurologic, cerebrovascular, and neoplastic disease; atherosclerosis; and infection.
Obtain a drug history, including prescription and over-the-counter drugs, herbal remedies, and recreational drugs. Also, ask the patient about alcohol intake.
Ask the patient about recent headaches or dizziness.
Review the patient's medical history for neurologic, cerebrovascular, and neoplastic disease; atherosclerosis; and infection.
Obtain a drug history, including prescription and over-the-counter drugs, herbal remedies, and recreational drugs. Also, ask the patient about alcohol intake.
Ask the patient about recent headaches or dizziness.
PHYSICAL
ASSESSMENT:
Take the patient's vital signs.
Assess level of consciousness, keeping alert for evidence of aphasia or dysarthria.
Test motor function, observing for weakness and tremors.
Test sensory function.
Check deep tendon reflexes for quality and symmetry.
Test for visual field deficits.
Take the patient's vital signs.
Assess level of consciousness, keeping alert for evidence of aphasia or dysarthria.
Test motor function, observing for weakness and tremors.
Test sensory function.
Check deep tendon reflexes for quality and symmetry.
Test for visual field deficits.
How apraxia
interferes with purposeful movement
Ideational apraxia:
Ideational apraxia:
The patient can
physically perform the steps required to complete a task but
fails to remember the sequence in which they're performed.
Ideomotor apraxia:
Ideomotor apraxia:
The patient
understands and can physically perform the steps required to
complete the task but can't formulate a plan to carry them
out.
Kinetic apraxia:
Kinetic apraxia:
The patient
understands the task and formulates a plan but fails to set
the proper muscles in motion.
ALERT:
If the patient displays signs and symptoms of increased intracranial pressure, such as headache and vomiting, during your assessment:
- elevate the head of the bed 30 degrees
- monitor him closely for altered pupil size and reactivity, bradycardia, widened pulse pressure, and irregular respirations
- have emergency resuscitation equipment nearby.
If the patient is having seizures:
- maintain airway patency and safety
- help him to a lying position, loosen tight clothing, and place a pillow or other soft object beneath his head
turn his head to provide an open airway.
ALERT:
If the patient displays signs and symptoms of increased intracranial pressure, such as headache and vomiting, during your assessment:
- elevate the head of the bed 30 degrees
- monitor him closely for altered pupil size and reactivity, bradycardia, widened pulse pressure, and irregular respirations
- have emergency resuscitation equipment nearby.
If the patient is having seizures:
- maintain airway patency and safety
- help him to a lying position, loosen tight clothing, and place a pillow or other soft object beneath his head
turn his head to provide an open airway.
SPECIAL
CONSIDERATIONS:
Because weakness, sensory deficits, confusion, and seizures may accompany apraxia, take measures to ensure safety.
Because weakness, sensory deficits, confusion, and seizures may accompany apraxia, take measures to ensure safety.
PEDIATRIC
POINTERS:
In many cases, detecting apraxia in children is difficult. However, any sudden inability to perform a previously accomplished movement warrants prompt neurologic evaluation because a brain tumor - the most common cause of apraxia in children - can be treated effectively if detected early.
In many cases, detecting apraxia in children is difficult. However, any sudden inability to perform a previously accomplished movement warrants prompt neurologic evaluation because a brain tumor - the most common cause of apraxia in children - can be treated effectively if detected early.
Brain damage in a
young child may cause developmental apraxia, which interferes
with the ability to learn activities that require sequential
movement, such as hopping, jumping, hitting or kicking a ball,
and dancing.
When caring for a child with apraxia, be aware of his limitations but provide an environment that's conducive to rehabilitation. Provide emotional support because playmates will often tease a child who can't perform normal physical activities.
When caring for a child with apraxia, be aware of his limitations but provide an environment that's conducive to rehabilitation. Provide emotional support because playmates will often tease a child who can't perform normal physical activities.
PATIENT
COUNSELING:
Explain the patient's apraxia to him, and encourage his participation in normal activities. Avoid giving complex directions, and teach the family to participate in rehabilitation. Refer the patient to a physical or occupational therapist.
Explain the patient's apraxia to him, and encourage his participation in normal activities. Avoid giving complex directions, and teach the family to participate in rehabilitation. Refer the patient to a physical or occupational therapist.
Bibliography:
1. Rapid Assessment, A
Flowchart Guide to Evaluating Signs & Symptoms, Lippincott
Williams & Wilkins, 2004.
2. Professional Guide to
Signs and symptoms, Edition V, Lippincott
Williams & Wilkins, 2007.
3. Guide to common
symptoms, Edition V, McGraw - Hill, 2002.
Dorin,
Merticaru (2010)