# 23 - Types of apraxia

# Types of apraxia

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8. Apraxia 
 Damasio and Geschwind (1985) defined apraxia as a condition with varying combinations of the 
following disturbances in order of progressive dysfunction: 
o A failure to produce the correct movement in response to a verbal command, 
o A failure to correctly imitate a movement performed by the examiner, 
o A failure to perform a movement correctly in response to a seen object and 
o A failure to handle an object correctly 
 Although a number of categories, such as limb kinetic, ideomotor, and ideational, exist, these labels 
are seldom useful in clinical practice. It is more helpful to describe the apraxia by region (orobuccal 
or limb), and to provide a description of impaired performance, recording both spatial and 
sequencing errors on several different types of task. 
 Apraxia is of limited localizing ability, but the left parietal and frontal lobes appear to be of greatest 
importance. 
 Progressive, isolated limb apraxia is virtually diagnostic of corticobasal degeneration. 
Types of apraxia 
Functional classification: 
Apraxia type 
Definition 
Localization 
Constructional 
apraxia 
 
Inability to construct elements into a meaningful 
whole. e.g., inability to draw or copy simple diagrams 
or figures. 
Right cerebral hemisphere, often 
parietal lobe. 
Ideational/concept
ual 
Impairment in carrying out sequences of actions 
(multiple-step task) requiring the use of various 
objects in the correct order to achieve an intended 
purpose. The patient does not know ‘what’ to do. 
Left parieto-occipital and 
parietotemporal regions 
Ideomotor 
(most common 
type among all 
apraxias) 
The disorder of goal-directed movement. The patient 
knows what to do but not how to do it. Impairment of 
pantomiming ability to use tool. Abnormalities include 
the use of body-part-as-object substitution, e.g. the 
patient uses his own finger to represent a toothbrush 
when asked to brush his teeth and abnormal 
orientation of body part performing the action. 
Improves on imitation and with the use of the actual 
tool. Tool use is more affected than gestures. 
Mainly in the left hemisphere; frontal 
and parietal association areas. 
Unilateral lesions of the left 
hemisphere in right-handed patients 
produce bilateral deficits, usually less 
severe in the left than in the right 
limb 
 
 
Regional classification: 
Buccofacial 
apraxia (aka 
facial-oral 
apraxia) 
Inability to coordinate and carry out facial and 
lip movements such as whistling, winking, 
coughing, etc. on command. 
The most frequent type of all focal brain lesion 
related apraxia syndromes. Associated with 
left inferior frontal lobe and the insula, and 
commonly accompanies the aphasia caused by 
lesions of Broca’s area. 
Limb-kinetic 
Loss of hand and finger dexterity resulting 
Dominant frontoparietal or primary motor

© SPMM Course 
from the inability to connect or isolate 
individual movements. Affects use of tools, 
gestures, especially distal fingers movements. 
Can be either ideomotor or ideational type. 
cortex 
Other variants 
Apraxia of speech, apraxia of eyelid opening 
and apraxia of gait.