Apraxia is the inability to perform purposeful movements in the absence of significant weakness, sensory loss, poor coordination, or lack of comprehension or motivation. Apraxia usually indicates a lesion in the cerebral hemisphere. Its onset, severity, and duration vary.
Apraxia is classified as ideational, ideomotor, or kinetic, depending on the stage at which voluntary movement is impaired. It can also be classified by type of motor or skill impairment. For example, facial and gait apraxia involve specific motor groups and are easily perceived. Constructional apraxia refers to the inability to copy simple drawings or patterns. Dressing apraxia refers to the inability to correctly dress oneself. Callosal apraxia refers to normal motor function on one side of the body accompanied by the inability to reproduce movements on the other side. (See How apraxia interferes with purposeful movement.)
Obtain the patient’s history. Ask whether he has a previous history of neurologic disease. Does he have a history of headaches or dizziness?
Ask about previous cerebrovascular disease, atherosclerosis, neoplastic disease, infection, or hepatic disease.
First, obtain the patient’s vital signs and assess his level of consciousness. Perform a neurologic assessment, staying alert for evidence of aphasia or dysarthria. Assess motor function, observing for weakness and tremors. Assist with testing sensory function, deep tendon reflexes, and visual field deficits.
Stay alert for signs and symptoms of increased intracranial pressure (ICP), such as headache and vomiting. If present, elevate the head of the bed 30 degrees and monitor the patient closely for altered pupil size and reactivity, bradycardia, widened pulse pressure, and irregular respirations. Have emergency resuscitation equipment nearby, and be prepared to give mannitol I.V. to decrease cerebral edema after inserting a urinary catheter to avoid bladder rupture.
If the patient is experiencing seizures, stay with him and have another nurse notify the physician immediately. Avoid restraining the patient. Assist him into a supine position, loosen tight clothing, and place a pillow or other soft object beneath his head. Don’t place anything into his mouth. Turn the patient’s head to the side to provide an open airway.
Detecting apraxia in children can be difficult. However, a sudden inability to perform a previously accomplished movement warrants prompt neurologic evaluation because a brain tumor — the most common cause of apraxia in children — can be treated effectively if detected early.
Brain damage in a young child may cause developmental apraxia, which interferes with the ability to learn activities that require sequential movement, such as hopping, jumping, hitting or kicking a ball, or dancing. When caring for a child with apraxia, be aware of his limitations and provide an environment conducive to rehabilitation. Provide emotional support because playmates will usually tease a child who can’t perform normal physical activities.
Pre-existing diseases, such as dementia (Alzheimer’s type, vascular, or others), previous stroke, or dehydration, may interfere with assessing the patient for apraxia.
See Apraxia: Causes and associated findings.
Prepare the patient for diagnostic studies, which may include computed tomography and radionuclide brain scans. Because weakness, sensory deficits, confusion, and seizures may accompany apraxia, take measures to ensure the patient’s safety. For example, assist him with gait apraxia in walking.
Explain the disorder to the patient. Encourage him to participate in his normal activities as tolerated. Help him overcome frustration arising from the inability to perform routine tasks by breaking each task down into separate steps, demonstrating these steps, and having the patient repeat the actions you demonstrated as taught by the physical and occupational therapists. Allow him sufficient time to perform each step. Avoid giving complex directions. Encourage family members to assist in the patient’s rehabilitation.
Read excerpts from these other book chapters related to Apraxia:
Copyright Details: Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series, Copyright © 2008 Williams & Wilkins.
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More About This Book:
Title: Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series Authors: Springhouse Publisher: Lippincott Williams & Wilkins Copyright: 2007 ISBN: 1-58255-624-5 
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