Dressing apraxia (Apraxie de l’habillage)

ClothesDressing apraxia is a syndrome of the right (incorrectly defined as minor) hemisphere, indicating the incapacity of effectuating the acts of dressing correctly (for example passing the head in the sleeve or dressing trousers at the inverse etc…). However this difficulty should not be explained by a primary motor or sensory deficit or by a general attention failure (as it can be observed in patients with dementia, delirium or with a severe frontal syndrome). Interestingly, several cases reports of patients with pure dressing apraxia have been published, without the evidence of the co-presence of other forms of apraxia or other significant deficits in other cognitive spheres.
The clinical assessment consists of demanding to the patient to dress himself or to dress a doll or a mannequin, or to indicate the correct succession of drafts showing the different steps of someone dressing himself. It would be better to film all the patients with dressing apraxia in uniform conditions. When dressing apraxia is related to a posterior parietal right hemisphere lesion (tumor or stroke) the condition is generally associated with signs of left unilateral spatial heminattention and there is almost always some attentional or spatial motor difficulties with the left limbs. However executive dysfunction, motor imagery deficits or constructional apraxia can also contribute. With parietal lesions of the left hemisphere dressing apraxia appears to be more related to general deficits of planning of gestures with both limbs.
Patients with dementia (Alzheimer’s disease, frontal lobe dementia and others) and dressing apraxia appear to exhibit some other peculiar behaviors that can affect negatively the acts o dressing such as passivity, perplexities, motor perseveration, and dispersion and so on.
Finally it seems that the brain might be able to plan motor acts of dressing independently from other conventional motor acts or gestures or tool use. However, the key deficit of dressing apraxia appears in the majority of cases to be spatial and related to the right hemisphere (parietal areas) lesions. This deficit interferes with the one’s ability to spatially orient a body part to an article of clothing. What do you think about dressing apraxia?

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