Apraxia | Ideational vs. Ideomotor | OT Miri

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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 of 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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