The ability to locate oneself in space and control movement are basic functions that people depend heavily on to perform everyday tasks. Something almost automatic in human behaviour. Such as using a key. But what if all of a sudden someone is unable to properly use a key? Like not being able to insert the key into a door lock, not knowing how to use the key once inserted, or just trying to use it as a pencil.
A patient called B.O., 52 years old, had an evaluation after a stroke. In the evaluation, he was asked to show how to use a spoon to eat soup. Instead of following the order, the patient showed how to brush his teeth. Also, he was given the task of closing an envelope, but he closed it before putting a letter inside. And that is a brief look inside ideomotor apraxia.
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What Is Ideomotor Apraxia?
Before the definition of ideomotor apraxia, it needs to be understood what apraxia is. Apraxia can be defined as the inability to perform motor acts (or actions) that were previously learned. Even if the motor and sensory systems, coordination, comprehension and cooperation are preserved (Gross & Grossman, 2008).
Ideomotor apraxia is only one of the forms apraxia can present. Other types of apraxia are: ideational (difficulties performing multistep tasks), orofacial apraxia (difficulties with movements involving the face), limb-kinetic apraxia (clumsy movements) (Gross & Grossman, 2008), conceptual (loss of tool knowledge and inappropriate use), verbal-motor dissociation (inability to properly respond to verbal commands to make movements), tactile (disruption of use of the hand as a sense organ) (Wheaton & Hallett, 2007).
In particular, ideomotor apraxia can be defined as the inability to imitate and use tools properly. Other symptoms that are present in this inability are movements spatially incorrect, also there is difficulty performing communicative gestures; orientation errors (holding things on the wrong side); spatial and temporal errors; movement errors; and patients can also perform “body part as object” errors (using a part of the body as a tool) (Wheaton & Hallett, 2007).
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From Intention to Movement: How Does the Brain Normally Do It?
Producing a purposeful movement requires more than muscle activation. The brain must transform an intended goal into an appropriate action by accessing representations of objects, tools, and the body, predicting possible movements, and selecting the action that best fits the goal and context. These processes depend on a distributed network in the left hemisphere that includes temporal, parietal, and frontal regions (Buxbaum & Randerath, 2018). Within this network, the left inferior parietal lobe plays a particularly important role in representing tools and body-related information, predicting actions, and selecting movements appropriate to a specific situation (Buxbaum & Randerath, 2018).
Evidence from studies of pantomime further supports the importance of this network. Niessen et al. (2014) reviewed structural lesion and functional imaging studies examining the ability to demonstrate how an object or tool is used without physically holding it. Their findings indicated that object-use pantomime relies primarily on a left-hemisphere fronto-parietal network, with contributions from temporal regions. The left parietal cortex appears to be especially important for activating the appropriate motor schemas when an action must be produced in the absence of the actual object, whereas frontal regions contribute to implementing the selected movement (Niessen et al., 2014).
Together, these findings suggest that translating intention into action involves several interconnected stages rather than a single motor command. When damage occurs to components of this network, individuals may retain knowledge of an intended action but experience difficulty selecting, organising, or producing the purposeful movement required to carry it out (Buxbaum & Randerath, 2018; Niessen et al., 2014).
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What Does Ideomotor Apraxia Look Like?
When someone with ideomotor apraxia goes into an evaluation, there are signs to be aware of. These patients show difficulties when asked to perform a certain movement following verbal commands. Also, sometimes there can be an inability to perform gestures or make a movement using an object, for example, using a hammer or a knife (Gross & Grossman, 2008).
Another observation in the movements of the person with ideomotor apraxia is meaningless gestures or the use of invented hand postures and using a part of the body instead of an object if needed to act (like cutting bread and using a hand instead of a knife) (Gross & Grossman, 2008).
Ideomotor apraxia patients can have different levels of difficulty shown during the tests. For example, in some cases, patients could imitate an action after observing someone else perform it rather than simply being presented with an object and given an instruction. The person being evaluated may perform better depending on the type of gesture used: transitive gestures, such as kicking a ball, and intransitive gestures, such as waving goodbye. That is why researchers recommend using a variety of tasks when evaluating ideomotor apraxia (Gross & Grossman, 2008).
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Causes and Assessment in Ideomotor Apraxia
In apraxia, the usual causes related to it are strokes, traumatic brain injuries or degenerative dementias such as Alzheimer’s and corticobasal ganglionic degeneration. One common affected part observed in research is the dominant hemisphere stroke (Sathian et al., 2011). Also, according to Hanna-Pladdy (2001), it points out subcortical lesions as another cause of apraxia due to possible damage in premotor and motor areas that could lead to difficulty in gesture execution.
The procedure to test for a possible ideomotor apraxia diagnosis in a person is through test batteries. This test includes the imitation of pantomimes, meaningful and meaningless actions and the use of tools present and with only the hands. The evaluation focuses on identifying possible errors, such as omissions, perseveration, and incorrect grip postures. Although researchers have developed faster evaluation methods, these methods may produce inaccurate results because, as mentioned earlier, individuals may not immediately respond to an object or follow an instruction (Buxbaum & Randerath, 2018).
There is no exclusive treatment for apraxia. But rehabilitation for patients with apraxia focuses its efforts on a behavioural training program. The program consists of 30 sessions that work on gesture-production exercises that use the treatment of meaningless and meaningful gestures and the use of objects (Park, 2017). Recovery from apraxia, especially ideomotor apraxia, shows that the effects of strokes are persistent, with mild improvement over time, but patients with less severe apraxia on the initial test recover (Sathian et al., 2011).
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Why Does Ideomotor Apraxia Matter?
Park (2017) found that patients who received treatment for apraxia improved in praxis and were able to do daily life activities compared to patients who received treatment for aphasia. That shows the importance of an early and proper diagnosis. Timely intervention can help improve the quality of life of the affected person. Another component of the importance of being able to recognise ideomotor apraxia is the associated neuropsychiatric disorders.
Besides the causes already identified in apraxia research, such as stroke and Alzheimer’s disease, researchers have also suggested that other psychiatric disorders may contribute to the development of ideomotor apraxia. Researchers introduced this idea because other patients with conditions such as Richardson syndrome, Parkinson’s disease, multiple sclerosis, depressive disorder, and bipolar disorder also showed difficulties performing gestures or movements (Stoll et al., 2025). With an early and precise diagnosis and treatment, the quality of life of the patient with ideomotor apraxia can improve.
Conclusions
Apraxia is the inability to perform motor actions such as gestures (using a tool or communicative gestures). There are types of apraxia. Among them, there is ideomotor apraxia. This one consists of the inability to perform some actions, such as gestures and difficulty following multi-step tasks or actions from oral instructions. For example, not being able to use a key properly.
The causes can be a stroke, Alzheimer’s or traumatic brain injuries. Although recent research has linked ideomotor apraxia to other neuropsychiatric disorders, further research is needed to establish these relationships. The evaluation of ideomotor apraxia involves a test battery of performing acts to observe if there are signs of apraxia. Treatment, called a behavioural training program, is one of the treatments that has shown results. If applied, it has shown positive results.
References +
- Buxbaum, L. J., & Randerath, J. (2018). Limb apraxia and the left parietal lobe. Handbook of clinical neurology, 151, 349-363.
- Gross, R. G., & Grossman, M. (2008). Update on apraxia. Current neurology and neuroscience reports, 8(6), 490-496.
- Hanna-Pladdy, B. (2001). Cortical and subcortical contributions to ideomotor apraxia: Analysis of task demands and error types. Brain, 124(12), 2513–2527. https://doi.org/10.1093/brain/124.12.2513
- Niessen, E., Fink, G. R., & Weiss, P. H. (2014). Apraxia, pantomime and the parietal cortex. Neuroimage: clinical, 5, 42-52.
- Sathian, K., Buxbaum, L. J., Cohen, L. G., Krakauer, J. W., Lang, C. E., Corbetta, M., & Fitzpatrick, S. M. (2011). Neurological principles and rehabilitation of action disorders: common clinical deficits. Neurorehabilitation and neural repair, 25(5_suppl), 21S-32S.
- Stoll, S., Lorentz, L., Binkofski, F., & Randerath, J. (2025). Apraxia: from neuroanatomical pathways to clinical manifestations. Current Neurology and Neuroscience Reports, 25(1), 1.
- Park, J. E. (2017). Apraxia: review and update. Journal of Clinical Neurology, 13(4), 317-324.
- Wheaton, L. A., & Hallett, M. (2007). Ideomotor apraxia: A review. Journal of the Neurological Sciences, 260(1–2), 1–10. https://doi.org/10.1016/j.jns.2007.04.014
