Apraxia is a neurological disorder that affects the ability to perform voluntary, coordinated movements, despite the fact that motor function and comprehension are intact. This disorder, usually manifests after brain damage such as stroke or traumatic brain injury, significantly impacts the patient’s quality of life, limiting independence and functionality. Cognitive intervention in apraxia is presented as an essential approach to address this disorder, focusing not only on motor rehabilitation, but also on the underlying cognitive areas involved in praxias.
Types of Apraxia
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- Ideomotor apraxia: Difficulty in performing simple gestures, such as waving or pointing, although the patient can describe how to make the gesture.
- Ideational apraxia: Problems with sequencing and execution of complex tasks, such as making coffee or getting dressed, although individual movements can be performed correctly.
- Constructional Apraxia: Difficulty in constructing or assembling objects into a coherent whole.
- Apraxia of Speech (Verbal Apraxia): Difficulty in planning and coordinating the movements necessary for speech.
- Gait Apraxia: Difficulty initiating and coordinating the movements necessary for walking, without paralysis or balance problems.
- Ocular Apraxia (Gaze Apraxia): Difficulty in moving the eyes voluntarily toward a specific target, even though vision is intact.
Areas of cognitive intervention in Apraxia
Praxias, which are voluntary and organized movements with a specific purpose, depend on a series of cognitive functions that allow planning, coordinating and executing these movements. Understanding the cognitive areas involved is crucial to design an effective cognitive intervention in apraxia.
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- Attention: Attention allows the patient to focus on the motor task to be performed, ensuring the correct execution of coordinated movements.
- Memory: Procedural and working memory are essential for storing and retrieving sequences of learned movements and for handling information during task execution.
- Spatial Perception: Spatial perception is key to orienting the body and objects in space, crucial for the execution of precise movements.
- Language: Verbal comprehension and association between words and actions are critical, especially in ideomotor apraxia, where following verbal instructions is required.
- Executive Function: Executive functions allow planning, sequencing, and coordinate the actions necessary to perform a complex motor task.
- Motivation and Emotion: Motivation influences the patient’s willingness to engage in motor activities, while emotions can modulate attention and memory, affecting task performance.
Types of cognitive intervention in Apraxia
Cognitive intervention in apraxia should be comprehensive, addressing both motor impairments and affected cognitive functions. Different tools can be used for rehabilitation:
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- Virtual reality: To apply techniques such as motor imagery .
- Virtual cognitive exercises: To reinforce cognitive domains such as attention, memory, perception, language or executive functions.
- Visual supports in daily life. With images or pictures of the different steps of a motor sequence, the learning of the sequenceis reinforced.
- Family and caregiver training: In order to apply and reinforce tasks treated during the rehabilitation session in the home environment.
