Ideational apraxia is notoriously confusing. Especially when trying to distinguish it from its other apraxia brothers. To get started, let’s define “apraxia” so that we can use this as a foundation once we add “ideational” to it.
This inability is caused by the brain, regardless of any physical limitations that may also be present. For example, my arms may be fully capable physically, but I might still struggle to thread my arms through my shirt.
There are several types of apraxia that relate to speech, movement, verbal commands, sequencing and more. Each of these types of apraxia have differing causes and differing treatments. While all neurologically based, ideational apraxia specifically results from lesions in the parietal lobe.
So, What is Ideational Apraxia Exactly?
Ideational apraxia is a neurological condition that makes it difficult to know the steps necessary to complete a process. While our bodies can physically complete the task, our brains don’t know what steps to do and in what order to do them in.
Here are some examples that might help this make sense:
–I pick up my toothbrush, but don’t know to put paste on it
–I pull my keys out of my pocket, but don’t know where to put the key to unlock the door
–I put my arm through a shirt sleeve, but I don’t know I need to put my other arm through before pulling it over my head
As you can see, ideational apraxia is about having an “idea” of every step of a process and how to put those steps in order to complete a task successfully.
Strategies for Managing Ideational Apraxia
While it’s true that life with ideational apraxia can be frustrating, there are ways to manage it that can make life easier.
In general, people with ideational apraxia will benefit from tasks being simplified. Given that the brain struggles to sequence events, the fewer events there are to sequence, the better. Think about a song that has 2 lyrics as opposed to 20. It’s much easier to remember the order of the lyrics in the 2 lyrics song than the one with 20.
Eliminate as many steps from tasks as you can. This will make it easier to remember any necessary steps, as there will be fewer steps to remember overall.
Backward chaining is a common strategy used to help teach kids new skills. This strategy works as the name implies. Start by breaking down a task into its steps. Then, complete all of the steps except for the last one. Let the child complete the final step, giving them the feeling of success.
Repeat the task a number of times. Each time you repeat it, do one fewer step of the task until the child is doing the task on their own.
Let’s look at an example: brushing teeth. To the right, you’ll see how this applies to hand washing.
–First time: an adult grabs the brush from the holder, wets the tooth brush, and puts paste on in it. The child then brushes their teeth.
–Second time: an adult grabs the brush from the holder and wets the tooth brush. The child puts the paste on and brushes their teeth.
–Third time: an adult grabs the brush from the holder. The child wets the tooth brush, puts the paste on it, and brushes their teeth.
–Fourth time: the child completes the process on their own.
Now, the above example is a bit idealistic. It will likely take more than 4 tries for a child to become independent in a task. You may need to spend a good deal of time repeating steps of the task before progressing along to greater independence.
Regardless, backward chaining gives you a framework to practice with. Not only does it help children learn how to appropriately sequence tasks, they always get to complete the task and feel a sense of accomplishment. This is a big motivating factor that can help them feel ready to keep practicing.
While it can be challenging for those with ideational apraxia to do tasks independently, this doesn’t mean that a few verbal cues can’t go a long way in easing the situation.
Think of this like a GPS. If I’m going to a place I’ve never been before, I need my GPS to direct me through every turn and stop along the way. Helping someone with ideational apraxia navigate complicated tasks works the same way.
Similar to when you’re using a GPS, there may be times when you’re familiar with a location and you barely need any help or direction. Other times, you may be driving to a new place and need all of the help you can get from your GPS.
If your child has ideational apraxia, take their lead. There may be days when they are more tired and may need more cues. Or, there may be days when they’re feeling comfortable with everyday tasks and need little direction. Keep an open mind and know that your child’s needs may fluctuate on a day-to-day basis (if not on a minute-to-minute basis!).
Chat with your Occupational Therapist
Here’s my regular, “occupational therapist” reminder! It’s likely your child’s OT has already identified ideational apraxia as a focus area for your child if it’s something they need to work on. That said, it may be something you’re slowly beginning to notice and want to learn more about. Either way, talk with your child’s OT about what they’re noticing and what they suggest would help.
While the 3 strategies above are fantastic, every child is unique and will require personalized attention to make sure that their needs are being met.