Both ataxia and apraxia are disorders of the muscles, but they are not the same. The muscles in your body won’t work together correctly, leading to ataxia, which impairs movement. It’s similar to a miscommunication between signals in your brain, making it challenging to control your muscles. However, apraxia is the inability to perform already proficient tasks. It feels more like a neurological glitch that prevents you from performing familiar movements, even though you want to. It’s not a muscle issue. Ataxia is the sensation that your muscles are not coordinating correctly, typically caused by a problem in the cerebellum, a brain region. 

On the other hand, apraxia occurs when there is difficulty comprehending and executing instructions in your brain because of problems in the brain, namely the cerebrum. When you experience ataxia, it might feel like your muscles are giving way or not doing what you want them to do. However, in apraxia, it’s more about having the ability and desire to move, yet something’s stopping the brain signal from turning into actual movement. Ataxia involves sensory and motor function problems, making your movements uncoordinated. In contrast, apraxia is strictly about struggling with the motor parts that make your muscles move like they should.

What is Ataxia?

Ataxia is a neurological disorder that represents symptoms including a lack of coordination, unsteady movements, and experiencing balance difficulties. It happens when there is dysfunction in the parts of the nervous system that control voluntary muscle movements, including the cerebellum, which is a part of the brain responsible for coordinating and regulating muscle activities. These movements could be more stable and may appear clumsy. People with this disorder may experience problems walking and speaking. 

These symptoms can vary in severity and even progress with time. Moreover, it can be caused by various factors like injury, toxins, genetic mutations and, without any doubt, certain medical conditions. Its treatment depends on the severity or causes, such as adaptive devices like walkers or canes, which might help maintain balance. However, there are different types of ataxia and their symptoms and causes; also, it depends on the person to person it has.

Symptoms and signs of Ataxia

Ataxia can develop over time in a person, or it happens suddenly. It is a sign of a significant neurological disorder. Patients end up with poor coordination, change in speech or poor balance. The symptoms and signs linked to issues in the cerebellum depend on where the problems are located, whether the trouble is on one side or lateralised. It causes issues on that same side, which is ipsilateral, while widespread problems lead to more overall and symmetric symptoms. 

When there are issues in the cerebellar hemisphere, it disturbs limb (appendicular) movements, making coordination challenging. If the trouble is in the vermis, it causes problems with balance and walking, which are truncal and gait ataxia, but the limbs might be okay. Vestibulocerebellar issues create a mix of problems like feeling off-balance, dizzy (vertigo) and having trouble walking (gait ataxia). Interestingly, even if the cerebellum shows significant changes in structure on scans, the person might get better over time, and the problems can even disappear. 

It can also be due to abnormal tissue growth (neoplasms) or long-lasting infections. This shows that all sorts of things can affect the cerebellum and cause problems with how we move. Understanding these connections helps doctors determine what might happen and how to help people with these challenges.

Terms Describing Ataxia

Stance

When standing, a fit person can naturally place their feet closer together—less than 12 centimetres apart—and maintain their balance for more than 30 seconds. A person struggling to maintain a steady posture without showing apparent weakness or uncontrollable movements may indicate problems such as sensory or cerebellar ataxia.

 Gait Ataxia

It occurs when there is a loss of awareness of one’s body position (also referred to as a cerebellar problem that results in a lack of coordination in the lower extremities. Individuals with gait ataxia may experience instability, frequently require furniture or walls for support, and favour spreading their feet apart when walking. If the instability increases without visual cues (like walking in the dark), it hints at a sensory or vestibular component. In cerebellum cases, the gait ataxia remains consistent regardless of visual cues.

Sensory Ataxia

As mentioned before, walking is primarily affected by sensory ataxia. Individuals with sensory ataxia may exhibit a positive Romberg sign walk with a high-stepping or feet-slapping gait (perhaps due to simultaneous weakness). When their eyes are closed, they may show unpredictable finger movements (pseudoathetosis), particularly in the upper limbs.

Types of Ataxia

Ataxia can start as a kid or show up much later when you’re grown up. The way it acts can be different based on the type. For some, the symptoms stick around the same. For others, they get worse over time, and in a few cases, they get a bit better, but it happens very slowly. So, it depends on the kind of ataxia someone has. There are three main categories:

1-Hereditary Ataxia

The symptoms of this kind of ataxia appear gradually over many years instead of striking like a lightning storm. It’s a slow journey where obstacles to movement become challenging in the family history. It is a movement-coordination puzzle that has been passed down through the generations. For those who have hereditary ataxia, the journey is lengthy; however, not every family experiences this. 

Because of the genetic link, kids may share the same issues with coordination as their parents or grandparents. Hereditary ataxia knowledge enables families and medical professionals to collaborate in navigating the difficulties and providing the appropriate support, even though it may appear to be a problematic family story.

2-ILOA

In this type, idiopathic late-onset cerebellar ataxia is the part of the brain that assists in coordination, namely the cerebellum. In contrast, for some ataxias with precise reasons, this disorder is unexplained. Because ILOA is a slow unravelling of the brain coordination centre over time, it’s like a puzzle where we know something is happening with the cerebellum, which is a part of the brain, but it would be hard to find the exact reason. Subsequently, it remains mysterious. This disorder is intriguing because it usually shows up later with time, and the causes still need to be better understood. It’s like discovering a puzzle piece missing but not exactly knowing where it went with time

3- Acquired Ataxia

The immediate symptoms set apart acquired ataxia from the slow development observed in hereditary ataxia. These signs can be brought on by several conditions, including stroke, brain injury, and other illnesses that affect the brain’s ability to coordinate movement. The body experiences an abrupt difficulty in coordinating movements. 

These three primary categories also highlight the variety of ataxia. Each type poses different challenges, whether it is a slow, inherited illness, challenging neurological damage, or a sudden onset brought on by brain-related issues. Understanding these differences is crucial for diagnosis, treatment, and offering support to those navigating the complexities of ataxia.

Treatment of Ataxia

Helping with Symptoms

In this way, there are types of hereditary ataxias. We can only partially fix things but ease people’s difficulties. This is called symptomatic treatment. It’s like giving comfort for the symptoms, even though it doesn’t make the whole situation go away. For instance, if someone has episodic ataxia type 2, which brings episodes of unsteady movements, we might use acetazolamide to make them feel better during those times. Another example is with ataxia. Due to insufficient vitamin E, we can give vitamin E supplements to help.

Exercises and Support

Physiotherapy is like exercise to keep the muscles strong and flexible. It’s helpful to prevent the muscles from getting weak or stiff. Sometimes, special braces stretch the muscles and keep them working well.

Improving Communication

As this ataxia progresses, talking might become more arduous. Speech and language therapy is like having a guide to help with slurred speech or trouble communicating. This therapist can make a big difference in preventing these problems and making things easier for those with ataxia.

What is Apraxia?

It’s a neurological disorder which characterises the person’s ability to plan and execute purposeful movements despite having the physical capacity and willingness to perform specific actions. It disrupts the brain’s ability to coordinate movements, not due to muscle weakness and paralysis. There are different types of this disorder, and there are various aspects to these terms relating to apraxia. It can result from multiple causes, traumatic brain injury, including stroke, brain tumours and other neurological conditions. Moreover, the severity can vary from person to person and rehabilitation therapy is often used to help individuals improve their motor and coordination skills. 

Causes And Symptoms of Apraxia

Apraxia occurs when certain parts of the brain don’t work correctly. This can happen if there’s a problem in the neural pathways that remember how to do movements we’ve learned. It’s like the brain forgets how to access this information. Things like a stroke, head injury, dementia, tumours, or corticobasal ganglionic degeneration can cause apraxia. It’s more common in older adults, primarily because of issues like stroke and dementia that affect the brain. 

The main sign of apraxia is struggling to do simple movements, even though the person can move and understand commands. It’s like their brain has trouble controlling and coordinating movements independently. Some people with apraxia might also have difficulty with language, a problem called aphasia, making it harder to understand or use words correctly.

Types of Apraxia

There are different types of apraxia which affect the body in slightly different ways:

Ideomotor Apraxia

This happens when a portion of the brain doesn’t work enough, making it hard to do planned movements. You can feel this when you want to wave or grab something, but your brain struggles to coordinate these actions. Most of the time, it occurs due to issues like a stroke, head injury, dementia, or other brain problems. People with ideomotor apraxia have trouble carrying out movements they understand, even though they can move and know what to do. The brain forgets how to make the body do things, causing challenges in everyday actions.

Limb-kinetic Apraxia

Limb-kinetic apraxia makes using their fingers, arms, or legs challenging for precise and coordinated movements. They might know how to use tools like a screwdriver and have done it before, but now they need help to do the same actions. Their brains have trouble telling their limbs precisely what to do, even if they understand the task. So, while they grasp the idea of using tools, their hands or arms struggle to follow through with the movements they once did quickly.

Conceptual Apraxia

It is like ideomotor apraxia, which means people have trouble doing a process or tasks requiring more than one step. They might experience the hassle of completing a task with different steps, like cooking a meal and finding it hard to follow through. People with this disorder might understand what needs to be done, but the brain struggles to coordinate the steps. It’s like the brain has difficulty organising and executing actions involving multiple steps, making sure tasks are challenging for those with this condition.

Treatment

If someone has apraxia because of another health issue, they’ll get treatment for that problem. Physical and occupational therapy would be the best and can be helpful. In these therapies, people practice making sounds repeatedly, matching them with specific movements, and working on speech rhythms using finger snapping. 

Most people used to express themselves using pen and paper or a computer. Having one-on-one sessions with a speech therapist is another way to improve apraxia symptoms. In these sessions, people learn how to move mouth muscles for specific sounds. They also use sign language if speech is harsh; moreover, it involves all senses, like listening to sounds and using a mirror to see how the mouth moves.

Final Thoughts

In conclusion, understanding the disparity between ataxia and apraxia is crucial for accurate diagnosis and appropriate treatment. While both conditions manifest as movement disorders, ataxia involves coordination and balance issues, often rooted in cerebellar dysfunction. On the other hand, apraxia pertains to the inability to execute purposeful movements despite intact motor functions. Clear comprehension of these distinctions empowers individuals, caregivers, and healthcare professionals to navigate these challenges more effectively.