Apraxia | Ideational vs. Ideomotor | OT Miri

[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,

um, 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 vain.

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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