Occupational Performance Issues
A client's occupational performance in the categories of self-care, productivity, and leisure can be severely impacted by apraxia. "How [apraxia] impacts a particular client depends on his or her goals and lifestyle" (Quintana, 2008, p. 248). Below is a list of potential occupational performance issues that a client with apraxia may have trouble with, specifying whether the OPI is related to Ideational Apraxia (IA) or Ideomotor Apraxia (MA) (Gillen, 2009, Table 5-2).
Self Care
Dressing:
- A client may put underwear on top of pants, exhibiting difficulty with sequencing (IA).
- The client may not be able to plan movement sequence for donning shirt upon command (MA).
- A client may use a tube of toothpaste to brush their teeth instead of a toothbrush (IA), or they may comb their hair with a fork (IA), showing difficulty with tool use (Quintana, 2008).
- A client may also have trouble adjusting the grasp of a hairbrush or razor when moving from one side of the head to the other (MA- movements crossing midline).
- The client may not know how to turn a faucet on (IA).
Watch the following video of a person with apraxia attempting to brush his teeth. What type of apraxia are you observing? (Answer below) |
Video clip retrieved from Molyneux (n.d.).
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Toileting:
- A client may forget how to use the toilet paper that is in front of them appropriately (IA).
- People with apraxia may use less utensils (IA), misuse a utensil (use a spoon as a straw- IA), be less organized and efficient while eating (IA or MA), or place too much or too little food on their utensil (IA or MA) (Gillen, 2009).
- The client may also have difficulty with spatial movements, so he/she would have trouble successfully moving a utensil to their mouth without spilling (MA). The client may use an awkward grasp of their fork which will interfere with their ability to pick up food (MA).
Video clip retrieved from Molyneux (n.d.).
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Watch the following video of a person with apraxia eating a meal. What type of apraxia are you observing? (Answer below) |
Meal preparation:
- Apraxia, especially ideational, results in difficulties with the sequencing required to successfully prepare a meal.
- A client may forget how to appropriately use a mobility device. For example, try to put the breaks on their wheelchair by pulling on the arm rests (IA).
- Client cannot plan movements to roll and sit up on the edge of the bed (MA)
- "People with ideomotor apraxia have increased dependency in grooming, bathing, and toileting relative to age-matched control subjects" (Gillen, 2009, p.120).
- The number of errors made during both basic and complex ADLs is correlated with the severity of the apraxia (Gillen, 2009).
Productivity
- "The absence of apraxia is a significant predictor of the ability to return to work" (Gillen, 2009, p. 120).
- Apraxia can negatively affect a client's ability to engage in employment, volunteering, driving, and home management (depending on the demands of the task and the severity/type of apraxia).
Watch the following video of a person with apraxia attempting to use a stapler. What type of apraxia are you observing? (Answer below) |
Video clip retrieved from Molyneux (n.d.).
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Leisure
- Clients with apraxia may find certain leisure activities (including physical activity, crafts, shopping) to be less enjoyable.
Answers |
Video 1 Toothbrush
Answer: Ideational Apraxia- The client has trouble sequencing, lacks knowledge of how to use the toothpaste, and is not able to complete the task. Video 2 Eating Answer: Ideational Apraxia- The client lacks knowledge of how to use familiar tool (knife and fork) appropriately. The client is, however, able to bring the knife and food to his mouth (not exhibiting spatial movement errors associated with Ideomotor apraxia) Video 3 Stapler Answer: Ideomotor Apraxia- The client demonstrates difficulty orienting the upper extremity to objects and inflexible hand posture. |