How a Brain Injury Affects Spatial Abilities

Ideomotor Apraxia After a Brain Injury

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Getty Images/ Roger Charity

An impairment of spatial abilities is the decreased ability to appreciate three dimensional space and to coordinate use of one's own body or physical objects. Often described as ideomotor apraxia, this is one of the handicaps that can occur as a result of a stroke that affects the parietal lobe of the brain.

Ideomotor apraxia is one of the most challenging neurological disorders to overcome. It affects the ability to carry out simple motor tasks, yet is not related to weakness or loss of sensation. In fact, ideomotor apraxia is a more complex problem stemming from a diminished ability to integrate spatial awareness and coordination of movement.

Symptoms

Ideomotor apraxia, also known as voluntary-automatic dissociation, is characterized by the inability to perform a variety of task oriented physical movements, despite normal strength.

People who have ideomotor apraxia may exhibit frustration, depression, or may simply give up on trying to do simple tasks. You might not recognize it right away, as most families initially assume that it is caused by a deficit in motor strength or coordination.

The most common symptoms include:

  • Inability to make physical movements when asked
  • Inability to imitate a physical gesture, such as waving
  • Inability to hold an object as it is intended
  • Mistaking one object for another and using the objects incorrectly

These problems are usually first noticed in the context of routine self care, such as brushing teeth, buttoning buttons, or shaving. Actions such as using a hammer or waving goodbye can become clumsy and confusing for someone suffering with ideomotor apraxia.

Even when a stroke survivor is trying to re-learn how to use an object or perform a skilled task, it is not easy to mimic simple movements, such as brushing hair or eating with a knife and a fork. This makes rehabilitation and therapy a challenge. More sophisticated physical skills, such as mending or cooking, may be almost impossible to carry out.

Associated symptoms include hemiagnosia, which is ignoring one side of the body, and visual changes, such as not seeing one side of the room.

Complications

People who are dealing with apraxia are often unable to live independently because of trouble with functioning on a day-to-day basis.

Possible complications of ideomotor apraxia include:

  • Physical injuries
  • Social isolation
  • Lowered self-esteem
  • Depression, apathy, decreased food intake
  • Frustration

Causes

A stroke of the parietal lobe most is the most common cause of ideomotor apraxia, but it can be caused by anything that damages the parietal lobe, such as a tumor, an abscess, or a traumatic injury.

The Parietal Lobe

The right and left sides of the brain often function as mirror images of each other, controlling the same functions, but on opposite sides of the body. The parietal lobe is a unique area of the brain because the left and right sides control different functions, which has an impact on stroke outcome.

For most people who are right handed, the right side of the brain controls spatial abilities, while the left side controls language. The opposite is true for about 50 percent of left handed people. A right sided stroke is far more likely to cause impairment in spatial abilities than a left sided stroke.

Diagnosis

The diagnosis of ideomotor apraxia involves a thorough neurological examination, which includes evaluation of language, cognition (thinking skills) and motor strength, as well as testing of specific skills such as reading words, writing, reading a clock, or describing what is seen in a picture. 

Your doctor may order some diagnostic tests to help with the diagnosis. These tests may include any of the following:

  • CT scan of the brain
  • MRI scan of the brain
  • Electroencephalogram (EEG)
  • Lumbar puncture (a test which evaluates the health of spinal fluid)

These medical tests can help identify a specific problem in the brain that could be responsible for the symptoms- such as a stroke, a brain tumor, or an infection.

Medical Management

The treatment of ideomotor apraxia involves physical therapy, speech therapy and occupational therapy. The outcome of treatment largely depends on the underlying cause of the ideomotor apraxia and the severity of the brain injury to the parietal lobe and surrounding regions.

Many conditions, such as stroke and head trauma, may improve over time. Other conditions, such as a brain tumor or an infection, may improve after medical or surgical treatment. Other causes of ideomotor apraxia, such as Alzheimer's disease and other types of dementia, tend to worsen over time.

A Word From Verywell

Problems with spatial function and spatial awareness pose a special challenge when it comes to independent living. Often, people who have ideomotor apraxia are unaware that they have a handicap. If you are a caregiver of a person who has ideomotor apraxia, be sure to seek support and resources as you navigate recovery and daily life.

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