[intro piano music]
Hi everyone, good morning.
Welcome back to the OTmiri channel.
If you're new here and we haven't met, my name is Miri.
I'm a licensed occupational therapist
and in today's video, I'll be talking to you guys about apraxia,
specifically the difference between
ideational and ideomotor apraxia.
But before I get started, I just want to say congratulations
to all of you who've found out
that you passed the NBCOT exam this morning.
I woke up so happy to all of your messages
and thoughtful, sweet notes,
whether on Instagram or on Facebook or here on this channel.
I want you guys to know that it makes such a big difference uh,
when you guys share the news with me
and to know that um, I was able to share this journey with you
leading to your success.
It uh, gives me such a great sense of satisfaction and pride for you
and it motivates me to keep going.
So much so that this is the first thing that I'm doing in the morning.
I haven't even showered. I'm still in my pajamas,
which I guess making a video in my pajamas
is not my first time so you guys are probably used to it,
but thank you, guys.
Um, I, I will be celebrating in spirit with you today.
Um, but let's get started. Apraxia.
Now if you're preparing uh, for the exam
and you're studying this content area,
you might find yourself feeling confused
or frustrated at times. I know I was.
Because, depending on the literature,
the authors, or even the country
where these articles are written, or textbooks,
you'll come across a wide range of terminologies,
ranging from oculomotor apraxia,
dressing, constructional,
limb apraxia, there's also limb kinetic apraxia,
and the list goes on and on.
And the way these are classified
are not always universally accepted,
which makes it that much more challenging.
So in this video today, and for the purposes
of making it less overwhelming for you guys,
I am going to talk about two general categories
that you'll see most often in the rehabilitation literature
as well as in your clinical setting,
which are the ideational apraxia and ideomotor apraxia.
So let's first get started by defining what apraxia is.
It's basically a dysfunction or difficulty
in execution of a skilled or purposeful activity
that cannot be attributed to or explained
by sensorimotor or cognitive comprehension deficits.
So in other words, put another way,
apraxia can occur even in the absence of weakness,
spasticity, motor or sensory loss,
memory or comprehension or cognitive deficits.
Interesting, right?
And it's typically lateralized to the left hemisphere,
meaning it's due to a damage to the left hemisphere of the brain.
And patients are oftentimes unaware of these deficits,
which makes treatment that much more challenging.
Now to really understand apraxia,
it's helpful to know what the praxis system is.
And I'm going to just talk about it very briefly.
And a lot of the information that I'm talking about today
is cited from Dr. Glen Dillon's work,
and he's a fantastic resource
so I'll list his books in the video description.
But basically he talks about the praxis system
as a two step process
that results in the execution of a purposeful activity.
The first step being ideation, or conceptualization,
so it's having the idea or the right idea
about the task and what needs to be done.
And then the second step is production,
so this is the actual execution of that task.
And together, that results in execution of a purposeful activity.
And when there is a breakdown
in either one of those steps in the praxis system,
you have apraxia,
inability to perform these purposeful movements and tasks, okay.
So now that you know what apraxia is,
let's get into a little more detail
and talk about ideational apraxia,
which is referring to the breakdown in the ideation component.
And so the patient with ideational apraxia
will have no idea
or have, don't have the right idea
about what needs to be done with the task.
And this includes not understanding the purpose of a tool or an object.
So a classic example, and you may have seen this many times
if you're in my Facebook study group
or on my Instagram page, I also have this,
um, is a photo of Ariel. [Chuckles]
Not a surprise, right?
My favorite character.
I know I talk about her all the time.
But you have to remember that scene in The Little Mermaid
where she's sitting across the dining table hall with Prince Eric
and she sees a fork and enthusiastically
and unabashedly, she takes it up to her hair
and she starts brushing her hair with the fork.
This is a really good example of ideational apraxia,
inability to use the tool appropriately,
because she has lost the sense,
has no idea what the purpose of the object is,
and so she brushes her hair with a fork.
In the clinical setting, you might see this
being played out with a patient trying to write with a spoon
or trying to brush their teeth with a comb, okay.
Another component of ideational apraxia
can be seen when the patient tries to engage in tasks
that require multi steps.
So sequencing is really difficult
because patients don't have an idea
of the demands of the task, okay.
So again, idea comes into play here.
And so um, think about a patient
trying to uh, put on a shirt,
but instead of putting their arms through the sleeve,
they'll try to put their legs in instead, okay.
Or um, they might try to wear socks over their shoes,
so they've forgotten the steps and the sequence
in which these activities occur.
So uh, ideational apraxia is pretty straightforward.
You just have to remember the word "idea" in ideational
and understand that the patient with ideational apraxia
has no idea what the task uh, requires,
so they don't know how to use the object,
they don't know how to,
how the objects work in relation to each other,
and they don't understand, they don't have an idea
of the demands of the task, okay.
Now contrast that with um,
ideomotor apraxia.
This is also known as, and used synonymously,
with motor apraxia.
And unlike ideational apraxia
where patients have no idea what the demand of the task is
and how to use an object,
in ideomotor apraxia,
patients actually do have an idea.
They have an understanding of what the task requires.
Um, and given, and if their language is intact,
they might even be able to verbalize to you
what the task is that they have to perform.
But in ideomotor apraxia,
they have lost access
to kinesthetic or kinetic memory
related to that task,
so they're no longer able to perform that task, okay.
And so uh, this is really fascinating.
Let me give you an example in a scenario.
Uh, you see a patient,
when you pass by a patient's hall,
and you notice that he is brushing his hair with a comb, okay.
20 minutes later, into the session,
you ask him to brush his hair.
You give him the verbal command and you say,
"Can you show me how you brush your hair in the morning?"
And although he was able to do it earlier in the morning,
automatically, in context,
he will no longer be able to do that upon verbal command,
where if you try to ask him
or have him mimic or imitate your movement
and say, "Can you try to do this, brush your hair?",
he won't, the patient won't be able to copy it.
So, inability to perform a movement upon verbal command
or mimic or imitate gestures.
This is a classic indeomotor apraxia.
Isn't the brain really fascinating? [Laughs]
Um, so uh, that's how it's differentiated
from ideational apraxia,
and in ideomotor, they have an understanding
of what the task is and what needs to be done,
but because they have lost access to that kinetic memory,
they're no longer able to do that
um, or execute those movements.
Now clinically and in daily life,
ideomotor apraxia will present as uh,
just general uh, motor planning difficulty or in movement,
and so what you might observe
is movements that are um,
awkward or imprecise or um,
is not coordinated
or the timing of the movement may not be right,
so it might be too fast or too slow.
Or you might see uh,
a patient that has difficulty with the manipulation of objects.
A lot of tasks that require fine motor movements,
so think about what you might need to do
when you want to get food out of the vending machine.
You have to be able to manipulate coins out of your hand,
into your palm, like those translation.
Um, you won't be able to do that very well.
Opening the jar, or adjusting the grip on your hand,
fingers to use the key to open the door.
All of these things that require precise movements
will be challenging for patients with ideomotor apraxia.
Am I talking really fast? [Laughs]
My god, I'm like sweating right now. [Laughs]
It's because I'm trying to finish this video
before my baby wakes up
and still have a little bit of free time to myself.
So that's it for today.
Congratulations again to everyone who found out
that they passed.
And if you are still um, preparing for your exam
and you're still striving,
I just want to leave you with a quote
that was always a comfort to me,
um, by Winston Churchill,
which, and he once said,
"Success is not final and failure is not fatal."
And so to those of you who passed, um,
know that this is just the beginning.
This is not your final destination.
You're going to go on to achieve so much more
than just merely passing this exam.
And to those of you who did not pass today, uh,
be slow to be discouraged
but quick to be encouraged
knowing that this is not a fatal moment,
no matter how much you might think it is.
Your efforts and everything that you're learning
and all the uh, ways that you're disciplining yourself to keep going,
this, this is not going to be in vane.
It will all come back to serve you well
and serve your patients in the future.
So, keep your spirit up and um,
keep going. Alright?
Okay, guys. Until next time.
Take good care. I love you guys so much.
[Blows kiss] Bye.
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