What is Limb Apraxia?

by Moira Kowalczyk, Pediatric Occupational Therapist (OT)

Many children with verbal apraxia do NOT have limb apraxia, but it’s always important to have a knowledgeable professional diagnose your child.

“Overall apraxia” is often referred to as “limb apraxia,” referring to the arms and legs. Like verbal apraxia, it has a number of names. It is also referred to as “motor planning” deficits, global apraxia/dyspraxia, postural praxis, etc.

In the 70’s and 80’s, Occupational Therapists were very interested in dyspraxia and its relationship to learning disabilities. An Occupational Therapist by the name of Jean Ayres was the primary researcher in this area and developed a very sophisticated battery of standardized tests called the Sensory Integration and Praxis Tests (SIPT). This battery of tests can only be administered by a SIPT certified therapist. A child should ideally be of a mental age of about 5 years in order to sit through and comprehend the complexity of these tests. There are a number of subtests that evaluate all aspects of “motor planning” (praxis), some of which include:

constructional praxis: the ability to motor plan how to copy a 3-D block structure

praxis on verbal command: telling a child what to do (“stick out your tongue”; “cross your arms”)

postural praxis: imitating different body/limb positions, etc.

In order to determine whether or not your child actually has “dyspraxia,” it is not necessary that they have this test performed. An experienced OT can make clinical interpretations based on your information, developmental history, observations and administration of a variety of motor tasks.

Not being able to stick out tongue is considered oral-motor praxis, which can exist without global apraxia; shaking head yes/no may be related to a deficit in “gestural praxis or symbolic communication.” Technically, children with apraxia should have intact muscle strength and skill but simply aren’t able to demonstrate these skills “on command” or “voluntarily”. That is why one might see a child with apraxia shake her head yes/no when happy/sad but cannot do this upon request or in imitation. She might smile spontaneously but not in imitation/command, might be able to lick peanut bitter off her upper lip, but cannot stick out tongue on command / voluntarily (suggesting it is not a problem with coordination / strength / ability, but rather an issue with “voluntary control” out of a task context). The child should be able to pick up a cheerio with a pincer grasp, but cannot imitate this finger position when asked to touch her thumb to each finger tip, nor would she be able to be successful with an UNFAMILIAR or NOVEL motor task that has not been “practiced” or achieved after multiple attempts, (i.e. using scissors, placing a peg in a hole when one has not had this experience before)

For more information on global praxis/motor planning deficits, see the following web sites:

Sensory Integration International, will provide you with specific information regarding therapists that have been certified to administer the SIPT. This organization was founded by Jean Ayres.