Research: Apraxia Occurs in MS

EpubKamm et al. Limb Apraxia in Multiple Sclerosis: Prevalence and Impact on Manual Dexterity and Activities of Daily Living.Arch Phys Med Rehabil. 2012 Mar.

OBJECTIVE: To evaluate the prevalence and impact of limb apraxia on manual dexterity and activities of daily living (ADLs) in patients with multiple sclerosis (MS).

Apraxia is big word to describe a software problem in the motor system of the brain. Despite the nerves and muscles working the brain cannot activate pre-programmed motor routines. This can occur at a concious or unconscious level. For example, you may forget how to use a brush to comb your hair when asked to do it voluntarily, but you can do it automatically on getting up in the morning. The problem is that you cannot activate the hair brushing programme within your brain.

METHODS: MSers (N=76) with clinically isolated syndrome, RRMS, SPMS or PPMS with and EDSS score from 0 to 6.5, and aged from 18 to 70 years were included. Apraxia was assessed by the apraxia screen of TULIA (Test of Upper Limb Apraxia. AST). The relationship of apraxia with  activities of daily living (ADLs) and manual dexterity was evaluated using a dexterity questionnaire and the coin rotation task, respectively.

RESULTS: Overall, limb apraxia was found in 26.3% of patients (mean AST score ± SD, 7.3±1.3; cutoff <9). Apraxia was significantly correlated with higher EDSS scores, longer disease duration, and higher age with the EDSS being predictive. Furthermore, patients with SPMS and PPMS were more apraxic than patients with RRMS. Finally, limb apraxia was significantly associated with impaired ADLs and manual dexterity.

CONCLUSIONS: Limb apraxia is a frequent and clinically significant symptom contributing to disability in MS. It should therefore be evaluated and possibly treated, particularly in patients with MS reporting manual difficulties in everyday life.

“Apraxia is characterized by loss of the ability to execute or carry out learned purposeful movements,despite having the desire and the physical ability to perform the movements. You can see how this is done at TULIA. The more disability the more likely that apraxia can occur and this interfers with daily life activities.”

“This study’s results are a surprise to me; I don’t routinely look for apraxia when I do a neurological examination on someone with MS. The researchers conclude that we should treat these apraxias. This is easier said than done, particularly in MS which is a progressive disease. In addition, they don’t acknowledge that the physical therapies that we use to treat apraxia are at best moderately effective. In reality we simply teach apraxic people to adapt to their disabilities.”

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