Apraxia is defined as the difficulty or inability to perform learned skilled actions. Identifying apraxia in patients has prognostic implications. The praxis network is predominantly in the left hemisphere, and comprises parietal lobe regions that connect to several circuits involving the frontal, temporal and occipital cortices and the basal ganglia. This review discusses the types of apraxia and the disorders associated with apraxia, highlighting studies based on corticobasal syndrome and stroke as disease models. The evolution of historical concepts of praxis leading up to the current ‘pathway’ models is discussed in the context of neuroanatomical and imaging studies. Bedside testing and interpretation of apraxia are elucidated with examples.

Key Concepts

  • Apraxia is the difficulty in performing acquired actions and can be seen independent of other symbol‐mediated disorders such as aphasia.
  • Apraxia is associated with several neurodegenerative disorders such as corticobasal syndrome, as well as with strokes and head trauma.
  • There are several different forms of apraxia such as ideomotor, ideational and orofacial apraxia, and each is characterised by the specific manner in which action performance or interpretation is compromised.
  • The praxis network involves circuits from frontal, temporal and parietal cortices and the basal ganglia.
  • Left parietal lobe is pivotal for the praxis network.
  • Newer models of praxis propose bilaterally represented ventral and dorsal processing streams, with the dorsal stream further subdivided into dorso‐dorsal and ventrodorsal substreams. The dorso‐dorsal or the ‘grasp’ system processes characteristics of a tool such as size, shape and orientation, while the ventrodorsal or the ‘use’ system stores object‐specific actions.
  • In patients with left hemisphere damage, apraxia often coexists with aphasia; in patients with right hemisphere lesions, apraxia is often associated with a visuospatial disorder.
  • Testing of apraxia at bedside is important for diagnostic and prognostic reasons.

Keywords: praxis; apraxia; ideomotor apraxia; corticobasal syndrome; parietal lobe; frontal lobe

Figure 1. Schematic representation of the anatomic location of the dorso‐dorsal, ventro‐dorsal and ventral streams (arrows). The main parts of the parietal lobe are highlighted: postcentral gyrus (blue), the supramarginal gyrus (red), the superior parietal lobule (green) and the angular gyrus (purple). The arrows representing the streams emerge from the primary visual cortex. The ventral (‘what’) stream projects from the occipital cortex to the inferior temporal cortex, retrieving information on identifying an object. The dorso‐dorsal (‘grasp’) stream processes characteristics of a tool such as size, shape and orientation. The ventro‐dorsal stream (‘use’) stores object‐specific actions.


Achilles EIS, Fink GR, Fischer MH, et al. (2016) Effect of meaning on apraxic finger imitation deficits. Neuropsychologia 82: 74–83. DOI: 10.1016/j.neuropsychologia.2015.12.022.

Ahmed S, Baker I, Thompson S, Husain M and Butler CR (2016) Utility of testing for apraxia and associated features in dementia. Journal of Neurology, Neurosurgery, and Psychiatry 87 (11): 1158–1162. DOI: 10.1136/jnnp-2015-312945.

Armstrong MJ, Litvan I, Lang AE, et al. (2013) Criteria for the diagnosis of corticobasal degeneration. Neurology 80 (5): 496–503.

Barrett AM, Dore LS, Hansell KA and Heilman KM (2002) Speaking while gesturing: the relationship between speech and limb praxis. Neurology 58 (3): 499–500.

Bianchi M, Cosseddu M, Cotelli M, et al. (2015) Left parietal cortex transcranial direct current stimulation enhances gesture processing in corticobasal syndrome. European Journal of Neurology 22 (9): 1317–1322.

Binkofski F and Buxbaum LJ (2013) Two action systems in the human brain. Brain and Language 127 (2): 222–229. DOI: 10.1016/j.bandl.2012.07.007.

Bolognini N, Convento S, Banco E, et al. (2015) Improving ideomotor limb apraxia by electrical stimulation of the left posterior parietal cortex. Brain 138 (2): 428–439. DOI: 10.1093/brain/awu343.

Coslett HB (2018) Apraxia, neglect, and agnosia. Continuum: Lifelong Learning in Neurology 24 (3, BEHAVIORAL NEUROLOGY AND PSYCHIATRY): 768–782.

Damasio AR, Tranel D and Rizzo M (2000) Disorders of complex visual processing. In: Mesulam M‐M (ed.) Principles of Behavioral and Cognitive Neurology, pp. 332–370. Oxford University Press.

Daumüller M and Goldenberg G (2010) Therapy to improve gestural expression in aphasia: a controlled clinical trial. Clinical Rehabilitation 24 (1): 55–65.

De Renzi E, Faglioni P and Sorgato P (1982) Modality‐specific and supramodal mechanisms of apraxia. Brain 105 (2): 301–312.

Fukutake T (2002) Apraxia of tool use: an autopsy case of biparietal infarction. European Neurology 49 (1): 45–52. DOI: 10.1159/000067027.

Geschwind N (1965) Disconnexion syndromes in animals and man. part II. Brain 88 (3): 585–644. DOI: 10.1093/brain/88.3.585.

Geschwind N (1975) The apraxias: neural mechanisms of disorders of learned movement: The anatomical organization of the language areas and motor systems of the human brain clarifies apraxic disorders and throws new light on cerebral dominance. American Scientist 63 (2): 188–195.

Giovannetti T, Libon DJ, Buxbaum LJ and Schwartz MF (2002) Naturalistic action impairments in dementia. Neuropsychologia 40 (8): 1220–1232.

Goldenberg G (2009) Apraxia and the parietal lobes. Neuropsychologia 47 (6): 1449–1459.

Goldenberg G (2014) Apraxia – the cognitive side of motor control. Cortex 57: 270–274. DOI: 10.1016/j.cortex.2013.07.016.

Goldenberg G and Randerath J (2015) Shared neural substrates of apraxia and aphasia. Neuropsychologia 75: 40–49. DOI: 10.1016/j.neuropsychologia.2015.05.017.

Goodale MA and Milner AD (1992) Separate visual pathways for perception and action. Trends in Neurosciences 15 (1): 20–25. DOI: 10.1016/0166-2236(92)90344-8.

Graham NL, Zeman A, Young AW, Patterson K and Hodges JR (1999) Dyspraxia in a patient with corticobasal degeneration: the role of visual and tactile inputs to action. Journal of Neurology, Neurosurgery & Psychiatry 67 (3): 334–344.

Gross RG and Grossman M (2008) Update on apraxia. Current Neurology and Neuroscience Reports 8 (6): 490.

Grossman M, Libon DJ, Ding XS, et al. (2001) Progressive peripheral agraphia. Neurocase 7 (4): 339–349.

Heilman KM, Rothi LJ and Valenstein E (1982) Two forms of ideomotor apraxia. Neurology 32 (4): 342.

Heilman KM, Maher LM, Greenwald ML and Rothi LJ (1997) Conceptual apraxia from lateralized lesions. Neurology 49 (2): 457–464.

Heilman KM, Meador KJ and Loring DW (2000) Hemispheric asymmetries of limb‐kinetic apraxia A loss of deftness. Neurology 55 (4): 523–526.

Heilman KM and Watson RT (2008) The disconnection apraxias. Cortex 44 (8): 975–982.

Helm‐Estabrooks N (1992) TOLA: Test of Oral and Limb Apraxia. Chicago: Riverside Publishing Company.

Hoeren M, Kümmerer D, Bormann T, et al. (2014) Neural bases of imitation and pantomime in acute stroke patients: distinct streams for praxis. Brain 137 (10): 2796–2810. DOI: 10.1093/brain/awu203.

Johnen A, Tokaj A, Kirschner A, et al. (2015) Apraxia profile differentiates behavioural variant frontotemporal from alzheimer's dementia in mild disease stages. Journal of Neurology, Neurosurgery, and Psychiatry 86 (7): 809–815. DOI: 10.1136/jnnp-2014-308773.

Josephs KA, Duffy JR, Strand EA, et al. (2012) Characterizing a neurodegenerative syndrome: primary progressive apraxia of speech. Brain 135 (5): 1522–1536.

Josephs KA, Duffy JR, Strand EA, et al. (2014) The evolution of primary progressive apraxia of speech. Brain 137 (10): 2783–2795. DOI: 10.1093/brain/awu223.

Kalénine S, Buxbaum LJ and Coslett HB (2010) Critical brain regions for action recognition: lesion symptom mapping in left hemisphere stroke. Brain 133 (11): 3269–3280. DOI: 10.1093/brain/awq210.

Kouri N, Whitwell JL, Josephs KA, Rademakers R and Dickson DW (2011) Corticobasal degeneration: a pathologically distinct 4R tauopathy. Nature Reviews Neurology 7 (5): 263–272.

Leiguarda RC, Pramstaller PP, Merello M, et al. (1997) Apraxia in parkinson's disease, progressive supranuclear palsy, multiple system atrophy and neuroleptic‐induced parkinsonism. Brain: A Journal of Neurology 120 (1): 75–90.

Leiguarda RC and Marsden CD (2000) Limb apraxias: higher‐order disorders of sensorimotor integration. Brain 123 (5): 860–879.

Leiguarda RC, Merello M, Nouzeilles MI, et al. (2003) Limb‐kinetic apraxia in corticobasal degeneration: clinical and kinematic features. Movement Disorders: Official Journal of the Movement Disorder Society 18 (1): 49–59.

Leiguarda R, Clarens F, Amengual A, Drucaroff L and Hallett M (2014) Short apraxia screening test. Journal of Clinical and Experimental Neuropsychology 36 (8): 867–874. DOI: 10.1080/13803395.2014.951315.

Liepelt I, Maetzler W, Blaicher H, Gasser T and Berg D (2007) Treatment of dementia in parkinsonian syndromes with cholinesterase inhibitors. Dementia and Geriatric Cognitive Disorders 23 (6): 351–367.

Liepmann H (1920) Apraxie: Brugschs ergebnisse der gesamten medizin. Berlin (Germany): Urban & Schwarzenberg.

Litvan I, Agid Y, Goetz C, et al. (1997) Accuracy of the clinical diagnosis of corticobasal degeneration a clinicopathologic study. Neurology 48 (1): 119–125.

Merians AS, Clark M, Poizner H, et al. (1999) Apraxia differs in corticobasal degeneration and left‐parietal stroke: a case study. Brain and Cognition 40 (2): 314–335.

Niessen E, Fink GR and Weiss PH (2014) Apraxia, pantomime and the parietal cortex. NeuroImage: Clinical 5: 42–52. DOI: 10.1016/j.nicl.2014.05.017.

Ochipa C, Rothi LJ and Heilman KM (1992) Conceptual apraxia in alzheimer's disease. Brain : A Journal of Neurology 115 (Pt 4): 1061–1071.

Ozsancak C, Auzou P, Dujardin K, Quinn N and Destée A (2004) Orofacial apraxia in corticobasal degeneration, progressive supranuclear palsy, multiple system atrophy and parkinson's disease. Journal of Neurology 251 (11): 1317–1323.

Platz T (2006) Apraxia. In: Selzer M, Clarke S, Cohen L, Duncan P and Gage F (eds) Textbook of Neural Repair and Rehabilitation: Medical Neurorehabilitation, pp. 424–443. Cambridge: Cambridge University Press. DOI: 10.1017/CBO9780511545078.029. Retrieved from https://www.cambridge.org/core/books/textbook‐of‐neural‐repair‐and‐rehabilitation/apraxia/8EF92EF2F9DD62FD365A1B06846D033E.

Polanowska KE and Pietrzyk‐Krawczyk I (2016) Post‐stroke pure apraxia of speech – A rare experience. Neurologia i Neurochirurgia Polska 50 (6): 497–503. DOI: 10.1016/j.pjnns.2016.08.005.

Quencer K, Okun MS, Crucian G, et al. (2007) Limb‐kinetic apraxia in parkinson disease. Neurology 68 (2): 150–151.

Randerath J, Goldenberg G, Spijkers W, Li Y and Hermsdörfer J (2011) From pantomime to actual use: how affordances can facilitate actual tool‐use. Neuropsychologia 49 (9): 2410–2416. DOI: 10.1016/j.neuropsychologia.2011.04.017.

Rohrer JD, Rossor MN and Warren JD (2010) Apraxia in progressive nonfluent aphasia. Journal of Neurology 257 (4): 569–574.

Rose ML, Raymer AM, Lanyon LE and Attard MC (2013) A systematic review of gesture treatments for post‐stroke aphasia. Aphasiology 27 (9): 1090–1127.

Rothi LJG and Heilman KM (1996) Liepmann (1900 and 1905): A Definition of Apraxia and a Model of Praxis. London: Psychology Press. DOI: 10.4324/9780203304112-17. Retrieved from https://www.taylorfrancis.com/.

Rothi LJG and Heilman KM (2003) Apraxia. In: Heilman KM and Valenstein E (eds) Clinical Neuropsychology, pp. 215–235. New York: Oxford University Press.

Smania N, Aglioti SM, Girardi F, et al. (2006) Rehabilitation of limb apraxia improves daily life activities in patients with stroke. Neurology 67 (11): 2050–2052.

Stamenova V, Roy EA and Black SE (2009) A model‐based approach to understanding apraxia in corticobasal syndrome. Neuropsychology Review 19 (1): 47–63.

Strand EA, Duffy JR, Clark HM and Josephs K (2014) The apraxia of speech rating scale: a tool for diagnosis and description of apraxia of speech. Journal of Communication Disorders 51: 43–50. DOI: 10.1016/j.jcomdis.2014.06.008.

Sunderland A (2007) Impaired imitation of meaningless gestures in ideomotor apraxia: a conceptual problem not a disorder of action control?: A single case investigation. Neuropsychologia 45 (8): 1621–1631. DOI: 10.1016/j.neuropsychologia.2007.01.011.

Sunderland A, Wilkins L and Dineen R (2011) Tool use and action planning in apraxia. Neuropsychologia 49 (5): 1275–1286.

Tessari A, Toraldo A, Lunardelli A, Zadini A and Rumiati R (2015) STIMA: a short screening test for ideo‐motor apraxia, selective for action meaning and bodily district. Neurological Sciences 36 (6): 977–984. DOI: 10.1007/s10072-015-2203-4.

Togasaki DM and Tanner CM (2000) Epidemiologic aspects. Advances in Neurology 82: 53–59.

Wadia PM and Lang AE (2007) The many faces of corticobasal degeneration. Parkinsonism and Related Disorders 13 (suppl. 3): S336–S340.

Weintraub S (2000) Neuropsychological assessment of mental state. In: Mesulam MM (ed.) Principles of Behavioral and Cognitive Neurology, pp. 135–136. New York: Oxford University Press.

Weiss P, Ubben S, Kaesberg S, et al. (2016) Where language meets meaningful action: a combined behavior and lesion analysis of aphasia and apraxia. Brain Structure and Function 221 (1): 563–576. DOI: 10.1007/s00429-014-0925-3.

Wicklund MR, Duffy JR, Strand EA, et al. (2014) Quantitative application of the primary progressive aphasia consensus criteria. Neurology 82 (13): 1119–1126.

Zadikoff C and Lang AE (2005) Apraxia in movement disorders. Brain 128 (7): 1480–1497.

Zwinkels A, Geusgens C, van de Sande P and Van Heugten C (2004) Assessment of apraxia: Inter‐rater reliability of a new apraxia test, association between apraxia and other cognitive deficits and prevalence of apraxia in a rehabilitation setting. Clinical Rehabilitation 18 (7): 819–827. DOI: 10.1191/0269215504cr816oa.

Further Reading

Goldenberg G (2013) Apraxia: The Cognitive Side of Motor Control. Oxford: Oxford University Press. DOI: 10.1093/acprof:oso/9780199591510.001.0001.

Rothi LG and Heilman K (eds) (1997) Apraxia. London: Psychology Press.

Contact Editor close
Submit a note to the editor about this article by filling in the form below.

* Required Field

How to Cite close
Rajan, Suraj, and Pantelyat, Alexander(Nov 2018) Apraxias. In: eLS. John Wiley & Sons Ltd, Chichester. http://www.els.net [doi: 10.1002/9780470015902.a0024019.pub2]