Occupational Therapy (OT) is a health profession focused on enabling individuals across the lifespan to engage in meaningful activities of daily life. These activities, or occupations, encompass self-care, work, leisure, and social participation. Successfully engaging in these purposeful tasks relies on a foundational neurological skill known as praxis. Praxis is the complex, internal process required to plan and execute a novel motor act, making it a core concept in OT practice.
Defining Praxis: The Foundation of Skilled Movement
Praxis is the neurological process that allows a person to conceptualize, organize, and carry out a new, skilled movement. This ability is often referred to as motor planning, and it is distinct from simple reflexes or movements that have become automatic through repetition. For example, learning to ride a bike requires praxis, while walking does not.
Praxis enables an individual to approach unfamiliar challenges, such as assembling furniture using only an instruction diagram. It is the ability to use one’s body effectively and purposefully in response to an environmental demand. This foundational skill relies heavily on the accurate processing of sensory input, including information about body position and movement in space. A well-developed praxis system allows for smooth, coordinated, and successful interaction with the physical world.
The Three Stages of Motor Planning
The cognitive process of praxis is broken down into three sequential stages, beginning before any physical movement occurs.
Ideation
The initial stage is Ideation, which involves generating the idea or goal for the desired action. This is the “what to do” phase, where the individual recognizes a problem and formulate a plan to solve it, such as deciding to make a peanut butter sandwich.
Motor Planning or Sequencing
This second stage organizes the steps and movements needed to achieve the goal. The brain creates a mental map, determining the order of movements and the precise timing and force required. This is the “how to do it” stage, which requires integrating sensory information to form an organized action sequence.
Execution
The final stage is Execution, where the motor plan is carried out by activating the muscles and joints in the coordinated sequence. A breakdown at any point in this three-stage process affects the final outcome, resulting in movements that appear awkward or inaccurate. After execution, the brain receives feedback about the movement’s success, which is used to refine the motor plan for future attempts.
Understanding Dyspraxia and Apraxia
When the process of praxis is impaired, it results in specific movement difficulties, often categorized as dyspraxia or apraxia.
Dyspraxia
Dyspraxia, also known as Developmental Coordination Disorder (DCD), is a chronic condition that begins in childhood, characterized by difficulties in motor planning and coordination. Children with dyspraxia may appear clumsy, struggle to learn new skills like riding a scooter, or have difficulty with fine motor tasks such as handwriting and fastening buttons. This is considered an immaturity in the neurological ability to plan and execute novel or complex movements.
Apraxia
Apraxia, by contrast, is the acquired loss of a previously learned or skilled movement, often due to neurological injury like a stroke or traumatic brain injury. An individual with apraxia may understand the command to perform an action but is unable to execute the motor plan despite having the physical strength and coordination to do so. This can manifest as an inability to use tools correctly, such as trying to brush teeth with a spoon, or an inability to perform a previously mastered task like tying a shoe. The primary distinction is that dyspraxia is a developmental difficulty, while apraxia is the loss of motor skills that were once successfully performed.
Occupational Therapy’s Role in Addressing Praxis Deficits
Occupational therapists begin intervention by conducting detailed assessments to pinpoint where the breakdown in the praxis system is occurring (ideation, planning, or execution). Treatment is then tailored to help the individual develop more efficient internal feedback loops for motor planning. Therapists focus on structured, multi-sensory activities that encourage active problem-solving and self-correction.
A common intervention involves using obstacle courses, which require the individual to constantly adapt their body to new challenges, thus generating new motor plans. Therapists also employ techniques from therapeutic models like Sensory Integration, which help the brain better process sensory information needed for accurate planning. By breaking down complex tasks into smaller, manageable steps, the OT provides a framework for the individual to practice and internalize the sequence. This approach helps the client develop a library of successful motor plans, increasing their confidence and independence in daily activities.