Apraxia post Stroke Paul Morris Occupational Therapist GSTT

Overview  Explore what apraxia is  The parts of the brain contribute to apraxia  How apraxia can present  Intervention techniques

Task Performance  All tasks require cognitive and perceptual components to complete them  Our ability to process the information in our environment has a direct impact on what we can do  Praxis is an extremely important link between brain and behaviour. This allows us to interact with the world

Apraxia is….. A reduced ability to interact with the environment and physical world. A reduced ability to interact with the environment and physical world. The inability to perform skilled and purposeful motor tasks in the absence of motor deficits, paresis and paralysis.

Apraxia  Developmental Dyspraxia  Acquired Apraxia: Resulting from CVA, Traumatic Head Injury, Acquired Brain Injury (hypoxia, encephalopathy and other conditions)  Apraxia can be thought of being able to be broken into two distinct yet interactive components. Yet there are many subcategories that we come across in our practice

 Ideomotor Apraxia: inability to produce the correct movements and components of a task even though the individual retains the concept of the task  Ideational Apraxia: an inability to formulate plans in order to execute tasks. So how might these presently differently?

Ideomotor Apraxia Difficulty imitating common movements or gestures Difficulty imitating common movements or gestures Difficulty with common tool use Difficulty with common tool use Concept remains intact, it’s the execution Concept remains intact, it’s the execution Poor control Poor control Plane of movement and accuracy Plane of movement and accuracy

Ideational Apraxia Inappropriate tool use Inappropriate tool use Sequence of task Sequence of task Omissions Omissions Perseveration Perseveration Use of own hand as a tool Use of own hand as a tool

Ideomotor Apraxia  Pre motor cortex of bilateral hemispheres  Left inferior parietal lobe  Corpus callosum  Basal ganglia  Thalamus

Ideational Apraxia  Pre frontal and premotor cortex of bilateral hemispheres  Left inferior parietal lobule  Corpus callosum

Intervention Techniques  Tactile, kinesthetic and proprioceptive input  Simple commands  Contextual environments  Spontaneity  Reduced distractions  Goal directed

Questions?

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