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caregiving strategies for apraxia

Key points

  • Apraxia is a brain glitch, not stubbornness. Up to 52% of people with dementia experience it.
  • Instead of giving a direct command, 'talk around' the task by describing the situation.
  • Break every task into one step at a time and only put out the items needed for that step.
  • Use hand-over-hand guidance gently and with permission.
  • Stay calm; your anxiety makes their confusion worse.
  • Celebrate small successes and use positive encouragement.

General caregiving information, not medical advice. Check medications and major care changes with your clinician.

Step-by-step

  1. Step 1: Pause and take a deep breath. Your own anxiety can make their confusion worse. Before you speak, remind yourself: 'This is apraxia, not defiance.' Use a soft, gentle voice and a calm facial expression.

  2. Step 2: Reduce the verbal demand. Instead of giving a multi-step instruction like 'go get dressed,' try a single, simple cue. For example, if they are struggling to put on a jacket, do not say 'put on your jacket.' Instead, hold the jacket open and say 'it is cold outside, let us get warm' or 'here, your arm goes in here.'

  3. Step 3: Break the task into one step at a time. Place only the items needed for the current step in front of them. For example, if they are trying to brush their teeth, put only the toothbrush with toothpaste on it in their hand. Do not have the cup, floss, or other items visible yet. After they brush, then hand them the cup for rinsing.

  4. Step 4: Use hand-over-hand guidance if they are comfortable with it. Gently place your hand over theirs and guide them through the motion. For example, when helping them put on a shirt, you can say 'let me help you get your arm through' and physically guide their arm into the sleeve. Always ask permission first, like 'may I help you with this part?'

  5. Step 5: Talk around the task. Instead of directly commanding the action, describe the situation. For example, if they are struggling to come to the table for dinner, do not say 'come to the table.' Instead, say 'dinner is ready, I smell the chicken' and walk toward the table yourself. They may follow naturally.

  6. Step 6: Use a 'distraction break' if frustration builds. If they become upset or stuck, stop the task entirely. Sing a silly song, do a little dance, or point to something outside the window. This resets their brain and reduces anxiety. Then try again with a simpler approach.

  7. Step 7: Check for physical discomfort before starting. Stiff joints or pain can make apraxia worse. Gently move their arms and legs through a small range of motion before helping them dress. This warms up the muscles and can make the task feel less overwhelming.

  8. Step 8: Offer a choice between two options, not an open-ended question. Instead of 'what do you want to wear?' hold up two shirts and say 'do you want the blue one or the red one?' This limits the cognitive load and makes it easier for their brain to process.

  9. Step 9: Use a timer or a simple countdown for tasks that need to be done. For example, 'let us see if we can get your shoes on before I count to ten.' This can turn the task into a game and reduce the pressure.

  10. Step 10: Celebrate small wins. After they complete a step, say 'you did that so well, thank you for your help.' Positive reinforcement builds their confidence and reduces your own frustration.

What not to do

  • Do not give multi-step commands. Saying 'go brush your teeth, wash your face, and get dressed' will overwhelm their brain. Instead, give one simple instruction at a time and wait for them to complete it before moving on.

  • Do not argue or correct them if they do a step in the wrong order. For example, if they put on their shoes before their socks, do not say 'no, that is wrong.' Instead, gently say 'let us try the socks first' and hand them the socks. Arguing only increases frustration for both of you.

  • Do not take over and do the task for them completely. This can make them feel helpless and increase their agitation. Instead, do the task with them, guiding their hands or offering verbal cues. Let them do as much as they can, even if it is slow and messy.

  • Do not use logic or reasoning. The part of the brain that handles reasoning is damaged. Trying to explain why they need to do something a certain way will not work. Use distraction, redirection, and simple cues instead.

  • Do not rush. Apraxia makes everything take longer. If you are in a hurry, you will both become stressed. Build in extra time for tasks like dressing, bathing, and eating. If you are always rushed, consider asking for help from a friend or hiring a home care aide for part of the day.

Practical tools

  • The 'Talk Around It' Script

    When your loved one freezes on a task, use this script: Instead of 'put on your jacket,' say 'it is cold outside, let us get warm' while holding the jacket open. Instead of 'come to the table,' say 'dinner smells good, I am going to sit down' and walk to the table yourself. This bypasses the verbal command and triggers a more automatic response.

  • One-Step-at-a-Time Setup

    Before starting any task, remove all extra items from the area. For dressing, lay out only the next item to put on. For eating, put only the fork on the table, not the knife and spoon. For bathing, put only the washcloth in their hand, not the soap and shampoo. This reduces sensory overload and helps them focus on one action.

  • Adaptive Clothing and Tools

    Use clothing with elastic waistbands, Velcro closures, and magnetic buttons. A long-handled shoehorn can help them put on shoes independently. Pre-cut vegetables allow them to help cook without using a knife. These tools maintain their independence and reduce frustration.

  • The 'Fidget Basket'

    Keep a small basket of safe, interesting objects they can manipulate with their hands. Examples: a soft stuffed animal, a piece of fabric with different textures, a set of large wooden beads to string, or a box of old photos to sort through. This gives their hands something to do and can reduce anxiety and repetitive behaviors.

  • The 'I Need Your Help' Invitation

    Instead of telling them to do a task, ask for their help. Say 'I could use your help folding these towels' or 'I need you to hold this for me.' This frames the activity as a partnership and reduces the feeling of being bossed around. It also taps into their desire to be useful.

  • A Simple Visual Checklist

    For tasks with multiple steps, create a simple picture checklist. For example, for brushing teeth: picture 1: toothbrush, picture 2: toothpaste, picture 3: brush, picture 4: rinse. Laminate it and put it in the bathroom. Point to each picture as you go. This provides a visual cue that can bypass the verbal confusion.

Discuss with your clinician

Ask the doctor or neurologist: 'Could an occupational therapy evaluation help us with strategies for apraxia at home?'

Discuss any medications that might be contributing to confusion or movement problems, especially anti-anxiety or antipsychotic drugs.

Ask about the possibility of a speech-language pathologist evaluation, as they can provide specific techniques for apraxia.

If your loved one is on hospice, ask the hospice team for guidance on comfort-focused care when apraxia makes eating or drinking difficult.

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