Dressing apraxia: when we forget how to dress

Dressing apraxia is a disorder that causes us to forget how we should dress. This case is mainly associated with people who may have neurodegenerative damage. Therefore, it is not common for it to occur independently of these diseases.

It is important to understand this syndrome, since It can significantly affect the development of a person’s basic activity and generates many frustrations.. These can trigger anxiety problems or develop behavioral problems in those who suffer from it.

How can we define dressing apraxia?

The term dressing apraxia was proposed by Brain in 1941. In this case, the person shows a deficit in the organization of motor acts that specifically affects dressing skills. Noticeably altering people’s autonomy, and generating the needs of third parties’ care.

Within the practice of dressing, characteristics such as

Knowledge of body scheme.Bimanual motor coordination. Three-dimensional conceptualization of a garment.

Therefore, as it is a complex activity – which depends on several factors – the moment one fails, some difficulty can already arise. As a consequence, the person may develop dressing apraxia.

Likewise, people with this disorder show problems locating and properly handling garments of clothing on the body.

Likewise, they handle clothing items with amazement and confusion when putting them on. They tend to be clumsy and perseverant in their movements, without being successful in the development of the action.

Progress in dressing apraxia

It is important to note that this disorder, like neurodegenerative damage, usually progresses. In the case of dressing apraxia, usually starts with problems in much more complex activities.

For example, tying your tie or tying your shoes. As time goes by, tasks that may be much simpler, such as putting on a jacket or shirt, begin to be affected.

Likewise, it is important to keep in mind that there is an alteration in the proper sequence of placing clothing on the body. An example of this is that in some cases they put on the jacket before the shirt. This aspect occurs when the disease has already progressed for some time.

When the disorder progresses to more severe stages, difficulties in undressing begin.. Therefore, you become completely dependent on third parties in all aspects related to dressing.

How can it be detected?

It is important to keep in mind that dressing apraxia affects multiple aspects. In most cases, they are caregivers are the ones who detect problems.

At first, there are difficulties in correcting the action sequences when putting on or taking off a piece of clothing. That is to say, they forget the proper order.

The way to exemplify this aspect is observed with the use of a shirt. In this case, they may not unbutton it before putting it on or, when they go to button it, they may look for the buttonholes on the same side of the shirt as the buttons.

A second aspect that can be observed is the difficulty orienting clothing towards one’s body. Likewise, it costs them coordinate the movements necessary to put on clothes properly.

An example of this is wrapping the sock between your toes or rotating the sock with the heel facing up. They may also rotate the hand in such a way that the fingers cannot fit properly into the gloves.

Brain and associated functions in dressing apraxia

It is important to note that dressing apraxia can be related to affects in different parts of the brain.

It has been found that people with this type of apraxia may have impairments in the right hemisphere, especially in the cortex:

Parietal. Temporoparietal territory. Anterior cingular. Occipital-temporal.

Regarding cognitive functioning, there is presence of anosodiaphoria, which indicates that there is no awareness of the difficulties in dressing. This condition increases notably when the severity of the deficit is greater.

Likewise, there are problems in recognizing self-image in the mirror. As a result, other daily activities related to this aspect may be affected. Even so, it is important to clarify that these difficulties are not as severe as dressing apraxia.

Also exist difficulties in executive functions. These occur especially in planning, cognitive flexibility and the ability to compensate, reflected in the difficulties in seeking execution strategies.

What aspects are preserved?

Within the preserved aspects, the person can verbally describe the process to take off or put on any of the articles of clothing. In the same way, you can correctly gesture the mime of the descriptions. However, the moment the item of clothing is given, problems begin to appear.

People with dressing apraxia retain the ability to make and imitate gestures, like whistling or sticking out your tongue. This ability is known as ideomotor praxias.

Finally, it is important to indicate that depending on the comorbid deficit that the person is presenting, some of the cognitive functions may be affected and preserved.

Therefore, It is important to indicate that this type of apraxia is mainly found in:

Alzheimer disease.Pick type dementia.Cortico-basal degeneration.Progressive supranuclear palsy.Unspecified cortical degeneration.

What can be done with a person who suffers from dressing apraxia?

As explained previously, since it is a disorder that is included in other types of degenerative diseases, it is necessary develop comprehensive and multidisciplinary work. Which should include neuropsychology, medicine, physiotherapy and occupational therapy. Likewise, the participation of the family in the process is of great relevance.

In the case of dressing apraxia, it has been useful the use of implicit learning techniques. Therefore, a practice of movements and cognitive activities that are more relevant to the adequate development of therapeutic and daily tasks is carried out.

With this objective, it is expected that the effects of rehabilitation will be better transferred to out-of-office activities. As a result, it will be easier for the results to be maintained in the long term.

Durand and collaborators (2017) used mechanisms of understanding, restitution and retraining of practical skills. They proposed exercises focused on strengthening memory processes, perception, attention and executive functions.

Likewise, they worked on spatial and proprioceptive abilities that the person had altered. Work on upper limb mobility and bilateral coordination was also part of the rehabilitation.

Conclusion

Finally, it is important to indicate that dressing apraxia It is a disorder that significantly affects the quality of life. Likewise, it can be a greater burden for their caregivers, since they also need to take care of this basic activity.

Although it does not occur alone, it can be a disorder that amplifies the difficulties and the therapeutic process. Its rehabilitation involves not only the improvement of bilateral manual coordination or the body scheme, but it is also necessary to work on all cognitive functions.. These will be the support for the patient to learn to dress again.

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