WEBVTT

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[intro piano music]

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Hi everyone, good morning.

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Welcome back to the OTmiri channel.

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If you're new here 
and we haven't met, my name is Miri.

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I'm a licensed occupational therapist

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and in today's video, I'll be talking 
to you guys about apraxia,

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specifically the difference between

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ideational and ideomotor apraxia.

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But before I get started, 
I just want to say congratulations

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to all of you who've found out

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that you passed 
the NBCOT exam this morning.

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I woke up so happy to all of your messages

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and thoughtful, sweet notes,

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whether on Instagram or on Facebook 
or here on this channel.

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I want you guys to know that 
it makes such a big difference uh,

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when you guys share the news with me

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and to know that, um, I was able 
to share this journey with you

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leading to your success.

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It uh, gives me such a great sense 
of satisfaction and pride for you

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and it motivates me to keep going.

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So much so that this is the first thing
that I'm doing in the morning.

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I haven't even showered. 
I'm still in my pajamas,

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which I guess making 
a video in my pajamas

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is not my first time so you guys
are probably used to it,

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but thank you, guys.

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Um, I, I will be celebrating 
in spirit with you today.

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Um, but let's get started. Apraxia.

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Now if you're preparing uh, for the exam

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and you're studying this content area,

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you might find yourself feeling confused

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or frustrated at times. I know I was.

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Because, depending on the literature,

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the authors, or even the country

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where these articles 
are written, or textbooks,

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you'll come across 
a wide range of terminologies,

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ranging from oculomotor apraxia,

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dressing, constructional,

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limb apraxia, 
there's also limb kinetic apraxia,

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and the list goes on and on.

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And the way these are classified

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are not always universally accepted,

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which makes it 
that much more challenging.

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So in this video today, 
and for the purposes

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of making it less overwhelming
for you guys,

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I am going to talk about 
two general categories

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that you'll see most often 
in the rehabilitation literature

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as well as in your clinical setting,

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which are the ideational apraxia 
and ideomotor apraxia.

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So let's first get started 
by defining what apraxia is.

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It's basically a dysfunction or difficulty

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in execution of a skilled
or purposeful activity

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that cannot be attributed to or explained

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by sensorimotor 
or cognitive comprehension deficits.

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So in other words, put another way,

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apraxia can occur
even in the absence of weakness,

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spasticity, motor or sensory loss,

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memory or comprehension 
or cognitive deficits.

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Interesting, right?

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And it's typically lateralized 
to the left hemisphere,

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meaning it's due to a damage 
to the left hemisphere of the brain.

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And patients are oftentimes 
unaware of these deficits,

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which makes treatment 
that much more challenging.

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Now to really understand apraxia,

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it's helpful to know 
what the praxis system is.

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And I'm going to just 
talk about it very briefly.

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And a lot of the information 
that I'm talking about today

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is cited from Dr. Glen Dillon's work,

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and he's a fantastic resource

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so I'll list his books 
in the video description.

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But basically 
he talks about the praxis system

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as a two step process

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that results in the execution 
of a purposeful activity.

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The first step being ideation, 
or conceptualization,

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so it's having the idea or the right idea

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about the task and what needs to be done.

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And then the second step is production,

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so this is the actual execution
of that task.

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And together, that results 
in execution of a purposeful activity.

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And when there is a breakdown

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in either one of those steps
in the praxis system,

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you have apraxia,

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inability to perform these purposeful 
movements and tasks, okay.

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So now that you know what apraxia is,

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let's get into a little more detail

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and talk about ideational apraxia,

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which is referring to the breakdown 
in the ideation component.

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And so the patient with ideational apraxia

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will have no idea

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or have, don't have the right idea

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about what needs
to be done with the task.

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And this includes not understanding 
the purpose of a tool or an object.

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So a classic example,
and you may have seen this many times

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if you're in my Facebook study group

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or on my Instagram page, I also have this,

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um, is a photo of Ariel. 
[Chuckles]

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Not a surprise, right?

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My favorite character.

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I know I talk about her all the time.

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But you have to remember 
that scene in <i>The Little Mermaid</i>

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where she's sitting across 
the dining table hall with Prince Eric

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and she sees a fork and enthusiastically

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and unabashedly, 
she takes it up to her hair

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and she starts brushing her hair 
with the fork.

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This is a really good example 
of ideational apraxia,

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inability to use the tool appropriately,

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because she has lost the sense,

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has no idea what the purpose 
of the object is,

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and so she brushes her hair with a fork.

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In the clinical setting, 
you might see this

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being played out with a patient 
trying to write with a spoon

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or trying to brush their teeth 
with a comb, okay.

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Another component of ideational apraxia

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can be seen when the patient 
tries to engage in tasks

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that require multi steps.

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So sequencing is really difficult

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because patients don't have an idea

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of the demands of the task, okay.

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So again, idea comes into play here.

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And so um, think about a patient

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trying to uh, put on a shirt,

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but instead of putting their arms 
through the sleeve,

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they'll try to put 
their legs in instead, okay.

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Or um, they might try 
to wear socks over their shoes,

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so they've forgotten the steps
and the sequence

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in which these activities occur.

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So uh, ideational apraxia 
is pretty straightforward.

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You just have to remember 
the word "idea" in ideational

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and understand that the patient 
with ideational apraxia

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has no idea what the task uh, requires,

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so they don't know
how to use the object,

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they don't know how to,

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how the objects work 
in relation to each other,

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and they don't understand, 
they don't have an idea

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of the demands of the task, okay.

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Now contrast that with um,

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ideomotor apraxia.

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This is also known as, 
and used synonymously with,

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motor apraxia.

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And unlike ideational apraxia

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where patients have no idea 
what the demand of the task is

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and how to use an object,

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in ideomotor apraxia,

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patients actually do have an idea.

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They have an understanding 
of what the task requires.

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Um, and given, 
and if their language is intact,

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they might even be able 
to verbalize to you

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what the task is that 
they have to perform.

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But in ideomotor apraxia,

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they have lost access

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to kinesthetic or kinetic memory

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related to that task,

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so they're no longer able
to perform that task, okay.

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And so uh, this is really fascinating.

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Let me give you an example in a scenario.

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Uh, you see a patient,

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when you pass by a patient's hall,

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and you notice that he is brushing
his hair with a comb, okay.

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20 minutes later, into the session,

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you ask him to brush his hair.

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You give him the verbal command 
and you say,

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"Can you show me how you 
brush your hair in the morning?"

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And although he was able
to do it earlier in the morning,

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automatically, in context,

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he will no longer be able 
to do that upon verbal command,

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where if you try to ask him

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or have him mimic 
or imitate your movement

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and say, "Can you try to do this, 
brush your hair?",

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he won't, the patient 
won't be able to copy it.

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So, inability to perform 
a movement upon verbal command

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or mimic or imitate gestures.

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This is a classic indeomotor apraxia.

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Isn't the brain really fascinating? 
[Laughs]

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Um, so uh, that's how it's differentiated

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from ideational apraxia.

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And in ideomotor, 
they have an understanding

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of what the task is 
and what needs to be done,

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but because they have lost access 
to that kinetic memory,

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they're no longer able to do that

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um, or execute those movements.

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Now clinically and in daily life,

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ideomotor apraxia will present as uh,

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just general uh, 
motor planning difficulty or in movement,

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and so what you might observe

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is movements that are um,

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awkward or imprecise or um,

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is not coordinated

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or the timing of the movement 
may not be right,

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so it might be too fast or too slow.

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Or you might see uh,

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a patient that has difficulty 
with the manipulation of objects.

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A lot of tasks that require
fine motor movements,

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so think about what you might need to do

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when you want to get food
out of the vending machine.

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You have to be able to manipulate 
coins out of your hand,

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into your palm, like those translation.

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Um, you won't be able
to do that very well.

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Opening the jar, 
or adjusting the grip on your hand,

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fingers to use the key to open the door.

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All of these things 
that require precise movements

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will be challenging for patients 
with ideomotor apraxia.

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Am I talking really fast? 
[Laughs]

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My god, I'm like sweating right now. 
[Laughs]

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It's because I'm trying to finish 
this video before my baby wakes up

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and still have a little bit
of free time to myself.

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So that's it for today.

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Congratulations again 
to everyone who found out

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that they passed.

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And if you are still um, 
preparing for your exam

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and you're still striving,

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I just want to leave you with a quote

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that was always a comfort to me,

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um, by Winston Churchill,

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um, which, and he once said,

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"Success is not final 
and failure is not fatal."

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And so to those of you who passed, um,

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know that this is just the beginning.

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This is not your final destination.

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You're going to go on 
to achieve so much more

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than just merely passing this exam.

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And to those of you 
who did not pass today, uh,

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be slow to be discouraged

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but quick to be encouraged

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knowing that this is not a fatal moment,

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no matter how much you might think it is.

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Your efforts and everything 
that you're learning

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and all the uh, ways that you're 
disciplining yourself to keep going,

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this, this is not going to be in vain.

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It will all come back to serve you well

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and serve your patients in the future.

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So, keep your spirit up and um,

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keep going. Alright?

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Okay, guys. Until next time.

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Take good care. 
I love you guys so much.

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[Blows kiss] 
Bye.

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[Outro piano music]