Ideomotor apraxia: how it affects movement after a stroke

Ideomotor apraxia is a neurological disorder that affects the ability to plan and execute voluntary movements, even though the muscles are intact and the commands are understood. This condition is commonly associated with brain injuries, such as those caused by a stroke, which disrupt the connections between the areas of the brain responsible for movement.

What is ideomotor apraxia?

Ideomotor apraxia is a type of apraxia, a term used to describe the inability to perform intentional or complex movements. In this case, the problem does not lie in muscle strength, coordination, or comprehension, but in the disconnection between the intention to perform a movement and its execution.

For example, a patient with ideomotor apraxia may have difficulty imitating simple gestures, such as waving, or using tools, like a hairbrush, even though they fully understand their function.

Causes of ideomotor apraxia

Ideomotor apraxia is associated with damage to the brain areas responsible for planning and coordinating movement, especially in the parietal cortex and frontoparietal connections. The main causes include:

1. Stroke:
   Strokes that affect the left hemisphere of the brain are one of the most common causes of ideomotor apraxia, as this region is involved in controlling complex movements.
2. Traumatic brain injury:
   Traumatic brain injuries can disrupt the neural pathways responsible for motor planning.
3. Neurodegenerative diseases:
   Conditions such as Alzheimer’s disease or frontotemporal dementia can also lead to ideomotor apraxia.
4. Brain tumors:
   The pressure exerted by tumors in motor areas can trigger this disorder.
5. Brain infections or inflammation:
   Diseases such as encephalitis can damage the brain regions involved in motor function.

Main symptoms

Patients with ideomotor apraxia exhibit specific difficulties related to the execution of voluntary movements:

• Difficulty imitating gestures: such as pointing or waving.
• Problems using objects: like attempting to drink from an imaginary cup but performing incorrect movements.
• Errors in the sequence of movements: they may carry out actions out of order or incompletely.
• Lack of fluency in movements: their actions are often clumsy or uncoordinated.

These symptoms can vary in severity depending on the extent and location of the brain damage.

Relationship between ideomotor apraxia and stroke

Ideomotor apraxia is a common complication in patients who have suffered a stroke, especially when the damage affects the left hemisphere of the brain. This happens because the left hemisphere contains critical areas such as:

• The inferior parietal cortex, which is responsible for integrating sensory information and planning movement.
• The frontoparietal connections, which are responsible for translating intentions into concrete actions.

After a stroke, the disconnection between these areas can lead to ideomotor apraxia, making everyday activities difficult and reducing the patient’s independence.

Diagnosis of ideomotor apraxia

The diagnosis of ideomotor apraxia requires a detailed neurological evaluation to rule out other possible causes of motor difficulty, such as muscle weakness or coordination problems.

The most commonly used tests include:

• Clinical evaluation:
  • The patient is asked to perform simple gestures, such as waving, imitating movements, or using imaginary objects.
• Brain imaging:
  • Magnetic resonance imaging (MRI) or computed tomography (CT) help identify brain lesions, such as those caused by a stroke.
• Neuropsychological tests:
  • They assess the patient’s cognitive and motor abilities to determine the extent of the damage.

Treatment of ideomotor apraxia

The treatment of ideomotor apraxia focuses on improving the patient’s functionality through rehabilitation strategies. The most common options include:

1. Occupational therapy:
   • Helps the patient regain motor skills needed for daily activities such as dressing or eating.
2. Physical therapy:
   • Focuses on strengthening brain connections through repetitive and targeted exercises.
3. Speech and language therapy:
   • Used in cases where apraxia affects gestures related to communication, such as pointing.
4. Neuropsychological rehabilitation:
   • Designed to train the brain in the planning and execution of movements.
5. Assistive technology:
   • Devices that support the performance of daily tasks in patients with limited mobility.

Prevention and management after a stroke

Although it is not always possible to prevent ideomotor apraxia, it is essential to reduce the risk of having a stroke. Some strategies include:

1. Controlling risk factors such as high blood pressure, elevated cholesterol, and diabetes.
2. Adopting a healthy lifestyle: balanced diet, regular exercise, and avoiding smoking.
3. Having regular medical checkups to identify cardiovascular problems early.

In patients who have already suffered a stroke, early diagnosis and intensive rehabilitation are key to improving their quality of life.

Conclusion

Ideomotor apraxia is a complex motor disorder often associated with strokes. Despite the challenges it presents, appropriate treatment and consistent rehabilitation can help patients regain some of their functionality and independence.

Recognizing the symptoms and seeking early medical attention can make a significant difference in the quality of life for those facing this neurological challenge.

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