Neurology · MU Sofia

19. Praxis and apraxia

Explains praxis as the learned, purposeful skilled movement that depends on intact motor, sensory and comprehension systems, with the dominant parietal lobe and its frontal connections involved, then defines apraxia and its usual lesion site. It sets out five types (ideomotor, ideational, constructional, dressing and buccofacial) with features, examples and lesion locations, followed by how to examine praxis at the bedside and the conditions in which apraxia is commonly seen.

Inside: 3 sections · 15 flashcards · 2 min

Topic 19 of 88 in the MU Sofia syllabus for Neurology (Medicine, Year 4). The free AceMed note covers it in 3 sections, about 322 words (2 min of reading), with 15 flashcards.

In this note

  1. Praxis and apraxia
  2. Apraxia
  3. Examination of Praxis

Praxis and apraxia

Praxis

Praxis is the ability to plan, organize, and perform learned, purposeful, skilled movements on command, despite intact motor function, sensation, coordination, and comprehension.

Praxis depends on:

  • Intact motor and sensory systems
  • Normal coordination
  • Preserved comprehension
  • Dominant hemisphere (usually the left parietal lobe)
  • Connections between parietal and frontal lobes

Examples of Praxis: Combing hair. Brushing teeth. Using a key. Saluting. Writing

Apraxia

Apraxia is the inability to perform learned purposeful movements despite preserved strength, sensation, coordination, and understanding of the task.

It is usually caused by lesions of the dominant (left) parietal lobe or its connections.

Types of Apraxia

1. Ideomotor Apraxia: The patient understands the command and knows the action but cannot perform it correctly on command.

  • Features: Unable to imitate gestures. Unable to perform learned actions when asked. May perform the action spontaneously
  • Example: Asked to salute or wave goodbye but performs the movement incorrectly.
  • Lesion: Dominant parietal lobe. Frontoparietal connections

2. Ideational Apraxia: Loss of the concept of a complex action.

  • Features: Cannot perform a sequence of actions correctly. Misuses objects
  • Example: Attempts to brush teeth with a comb.
  • Lesion: Dominant parietal lobe

3. Constructional Apraxia:Inability to construct, copy, or draw figures.

  • Features: Cannot copy geometric shapes. Difficulty assembling objects
  • Lesion: Parietal lobe (often nondominant/right)

4. Dressing Apraxia: Difficulty dressing despite normal motor function.

  • Lesion: Usually right parietal lobe

5. Buccofacial (Orofacial) Apraxia: Inability to perform purposeful facial movements on command.

  • Example: Cannot whistle, blow, or lick lips when asked.
  • Lesion: Dominant frontal or parietal regions

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