Brain injuries can cause different disorders depending on the area that is affected and how severe it is.

One of the disorders whose cause is this is apraxia, and there are many types depending on the symptoms and the brain area affected. Apraxias imply difficulties when performing sequential movements.

One of the best known apraxias is the constructive apraxia , in which there are difficulties in drawing in a detailed and organized way or assembling objects, which is the subject of this article. Let’s see what it is, what are its causes, symptoms and treatment.

What is constructive apraxia?

Constructive apraxia is a disorder in which there is difficulty or complete loss of the ability to perform the sequential movements necessary to assemble an object or draw .

Patients diagnosed with this type of apraxia have difficulty performing everyday actions, such as assembling a piece of furniture or drawing a simple picture on paper.

These difficulties are not the result of motor problems such as tremors or muscle stiffness, nor are they the result of visual problems such as blindness. There is no loss of muscle sensation, strength or coordination .

Nor is there a deficit in the understanding of what should be done, i.e. the patient understands what actions should be taken to, for example, set up a wardrobe. The problem is in what does not perform the sequence correctly and the action is disorganized.

Constructive apraxia can be identified by observing that the patient carries out inefficiently and poorly apparently simple tasks such as copying drawings, building figures with blocks or putting together a puzzle.


Generally, constructive apraxia is the result of a brain injury , usually in the right hemisphere and, specifically, in the parietal and occipital lobes. This injury may be the result of a stroke, head trauma, stroke or cerebral ischemia.

It has been known for a long time that visuoconstructive abilities, that is, those that involve using the path of vision to organize movements to build objects, have a bilateral representation in the brain, but there is asymmetry in terms of their cortical organization . It is the right hemisphere where there is greater specialization in visuoconstructive abilities.

This does not mean that there are no patients with constructive apraxia who have lesions in the left hemisphere; however, the characteristics are different from those with the lesion in the right.

When the injury occurs in the right hemisphere, patients, when evaluated by drawing copy tests, tend to draw in detail, but have difficulty in showing the spatial relationships between the parts of the drawing. In contrast, when the lesion is in the left hemisphere, the drawings tend to be less detailed, and are copied more slowly and with difficulty in the line.

Although injuries are usually found in the parietal and occipital lobes, sometimes injuries can be found in the frontal lobe , and patients with injuries in that area usually present problems of perseveration and planning in the drawings.


Depending on the area affected, whether it has occurred in the right or left hemisphere, and whether the injury is severe or mild, the symptoms of constructive apraxia are highly variable. However, generally, patients diagnosed with this disorder have the following symptoms :

  • Difficulty or omission of details in the drawing to be copied.
  • Drawing a horizontal line does it in small pieces
  • Turn, reverse or rotate the figures.
  • Change the angles of the drawings.


The diagnosis is usually made by a psychologist or a neurologist . The psychologist can administer different tests to know more accurately the characteristics of the patient’s constructive apraxia and the degree of affectation on a functional level. Using neuroimaging techniques, it is possible to find the lesion and its extension, relating it to the severity of what was seen in the patient.

Two types of tests are usually used to detect constructive apraxia. On the one hand, there are the assembly tasks, which consist of building blocks and assembling two and three-dimensional models, such as puzzles, tangram figures or models. On the other hand, and being more used, there are the drawing tasks, in which the professional orders the copy of a certain figure or verbally tells the patient to draw something , such as a square, circle, cube, among other geometrical figures.

Drawing tasks are the most used in practice because of their economic value, since only paper and pens are needed.

The tasks of copying drawings not only allow us to know what the patient’s artistic skills are. They help us to see various cognitive aspects, such as visual perception, the ability to differentiate between background and figure, spatial organization, hand-eye coordination. In addition, it allows us to observe how planning, memory, sequencing and attention occur.

Among the most commonly used drawing tests are the complex figure of Rey and the watch copy test . The first one consists of a figure without semantic meaning, that is, a very complex abstract drawing, while the second one is the simple copy, either with a model or verbally, of a clock, something that is understood to be known by the patient before.


The treatment of this type of apraxia is usually done by means of motor therapies and by insisting that you look more closely at the parts of the picture. However, the best option is to intervene directly on the focus of the disorder , that is, on the lesion, either surgically or with drugs. Normally, complete recovery does not occur in apraxias, although this depends on the location and severity of the injury.

It is very important for the family to be involved in the recovery and to give emotional support to the patient with this type of disorder so that he/she can go to therapy and get better.

The special case of dressing apraxia

Although it has traditionally been related to constructive apraxia, the apraxia of dressing presents a series of particularities that differentiate it.

This type of apraxia has been associated with an alteration of body schema and a deficit in the movements needed to dress. However, must be differentiated from constructive apraxia since the problems are related only to the acts of dressing , and not in other areas such as the assembly of figures or the copying of drawings typical of apraxia explained in depth in this article.

Patients with dressing apraxia have their autonomy significantly affected: they place their clothes in the wrong order (e.g., jacket before shirt), often manage to put their clothes on after several trial and error attempts, and more complex actions, such as tying their shirt or lacing their shoes, are real odysseys.

This type of apraxia may be accompanied by constructive apraxia, and has been associated with lesions in the temporoparietal cortex of the right hemisphere and anterior cingulate cortex.

Bibliographic references

  • Garcia, R. and Perea, M.V. (2015). Constructive and dressing apraxia. Journal Neuropsychology, Neuropsychiatry and Neurosciences, 15, 1, 159-174.
  • Greene, J.D.W. (2005). Apraxia, agnosias and higher visual function abnormalities. Journal of Neurology, Neurosurgery & Psychiatry; 76:v25-v34.