Ataxia vs. Apraxia: 6 Key Differences

Ataxia and apraxia are both neurological (nervous-system related) conditions that affect movement. Because their names sound similar, they’re sometimes confused with each other. However, they’re separate disorders involving the brain, each with its own causes, symptoms, and treatments.

Ataxia affects the brain’s ability to control coordination and balance. Apraxia, on the other hand, affects the brain’s ability to plan and carry out purposeful movements, even when the muscles themselves work normally. Some people may have symptoms of both conditions at the same time, but this overlap is uncommon.

In this article, we’ll explain six major differences between these commonly confused conditions and one instance where they overlap.

1. Ataxia Affects Coordination While Apraxia Affects Movement Planning

The biggest difference between ataxia and apraxia is how they affect muscle movements.

Ataxia causes problems with muscle coordination that can make movements look shaky, clumsy, or unsteady. People with ataxia may have trouble:

• Walking steadily
• Keeping their balance
• Speaking clearly
• Controlling hand movements

Ataxia happens because of problems in the cerebellum, a part of the brain that helps coordinate movement.

In apraxia, the muscles are able to perform a movement, but the brain has trouble planning or sending the correct instructions to the muscles. A person with apraxia may know what they want to do but cannot carry out the movement correctly.

Apraxia happens because of damage to nerve pathways of the brain responsible for learned patterns of movement.

For example, someone with apraxia may struggle to wave goodbye, brush their teeth, or use a spoon, even though they understand the task and don’t have muscle weakness (called ideomotor apraxia).

Children with speech apraxia may know what they want to say but have trouble doing the mouth movements needed for speech.

People with ataxia often describe feeling off-balance or uncoordinated. People with apraxia are more likely to have difficulty performing learned movements in the right order (called ideational apraxia).

2. Ataxia Often Involves Balance Problems While Apraxia Usually Doesn’t

Balance issues are one of the hallmark symptoms of ataxia.

Many people with ataxia have an abnormal gait in order to stay stable. Gait is how a person moves on their feet. With ataxia, a person may stumble, sway, or fall more easily.

Fine motor tasks, such as writing, buttoning clothing, or picking up small objects, can also become difficult.

Speech may sound slurred or slow, a symptom called dysarthria. Eye movement problems can also happen in certain forms of ataxia.

In apraxia, balance is usually not the main problem. Instead, the issue is carrying out specific learned actions. A person with apraxia may perform a movement incorrectly, out of order, or not at all.

For example, a person with limb apraxia may have trouble pretending to use a hammer or comb their hair when asked. Someone with speech apraxia may pause, repeat sounds, or struggle to pronounce words consistently.

Because ataxia and apraxia affect movement differently, healthcare providers often use physical exams and neurological testing to help tell them apart.

3. Ataxia Can Be Hereditary While Apraxia Is Very Rarely Hereditary

There are many possible causes of ataxia.

Some types are hereditary, meaning they are caused by inherited genetic changes. Friedreich ataxia is one of the most common inherited ataxias. It usually begins in childhood or adolescence and can affect walking, speech, coordination, vision, hearing, and heart health.

Other inherited ataxias include spinocerebellar ataxias and ataxia-telangiectasia.

Ataxia can also be acquired later in life because of:

• Stroke
• Multiple sclerosis
• Alcohol misuse
• Brain injury
• Vitamin deficiencies
• Certain infections
• Tumors
• Medication side effects

Apraxia is more commonly linked to damage in pathways of the brain involved in motor planning. In adults, apraxia may develop due to:

• Stroke
• Dementia
• Traumatic brain injury
• Brain tumors
• Neurodegenerative diseases

In children, childhood apraxia of speech is often developmental, meaning it appears during early childhood development rather than after an injury. But there are also some rare hereditary forms of childhood apraxia of speech.

Because the causes differ, doctors may order different tests depending on which condition they suspect. Genetic testing is commonly used for hereditary ataxias.

4. Inherited Ataxias Often Progress, While Apraxia May Improve With Therapy

Many forms of ataxia are progressive, meaning symptoms gradually worsen over time.

For example, people with Friedreich ataxia may notice increasing difficulty with walking, coordination, speech, and daily tasks over the years. Certain inherited ataxias also affect other body systems, including the heart, spine, or eyes.

However, progression depends on the specific type and cause. Some acquired ataxias may stabilize or improve if the underlying problem is treated. For instance, ataxia caused by vitamin deficiency or medication side effects may improve once the underlying cause is addressed.

Apraxia follows a different pattern.

When apraxia is caused by stroke or brain injury, some symptoms improve with rehabilitation and therapy. Children with speech apraxia may also improve significantly with long-term speech therapy, although progress can take time.

But if apraxia is caused by a progressive neurological disease such as Alzheimer’s disease, symptoms may worsen over time along with the underlying condition.

5. Treatments for Ataxia and Apraxia Focus on Different Goals

There is currently no cure for many inherited forms of ataxia. Treatment usually focuses on managing symptoms, improving safety, and maintaining independence.

Common ataxia treatments include:

• Physical therapy to improve balance and strength
• Occupational therapy for daily activities
• Speech therapy for communication or swallowing problems
• Mobility aids such as canes, walkers, or wheelchairs
• Specific treatment for related symptoms such as muscle stiffness or fatigue
• Several investigational medications

People with ataxia may also work with specialists like neurologists, cardiologists, rehabilitation specialists, and genetic counselors depending on the type of ataxia they have.

Treatment for apraxia focuses more on retraining the brain to plan and perform movements correctly.

Examples include:

• Speech therapy for speech apraxia
• Occupational therapy for daily movement skills
• Repetitive practice of specific tasks
• Communication tools for severe speech difficulties

Unlike ataxia, apraxia treatment often centers on practicing purposeful movements repeatedly to strengthen motor planning pathways in the brain.

6. Ataxia May Affect the Eyes and Vision More Often Than Apraxia

Eye movement problems are relatively common in some types of ataxia.

People may experience:

• Difficulty tracking moving objects
• Jerky eye movements
• Double vision
• Trouble focusing
• Delayed eye movements

These symptoms happen because the cerebellum helps coordinate eye movement as well as body movement.

Certain inherited ataxias can also affect the nerves and muscles involved in vision. In Friedreich ataxia, vision changes may include difficulty with eye coordination or visual processing.

Although apraxia can sometimes affect eye movements, it’s much less common. When it does happen, it’s usually called oculomotor apraxia.

Oculomotor apraxia is a rare condition that affects voluntary eye movements. People with this condition have difficulty moving their eyes quickly from one target to another. Instead of moving only their eyes, they may turn their head first and then move their eyes afterward.

Ataxia With Oculomotor Apraxia: Where the Two Conditions Overlap

Oculomotor apraxia can occur on its own, but it’s also seen in some inherited neurological disorders called ataxias with oculomotor apraxia (AOA). These rare genetic conditions combine coordination problems with abnormal eye movements.

Symptoms may include:

• Trouble shifting gaze
• Quick head turns to help the eyes focus
• Poor balance and coordination
• Peripheral nerve problems
• Difficulty walking

AOA usually begins in childhood or adolescence. It’s much rarer than Friedreich ataxia but belongs to the broader group of hereditary ataxias.

Because both coordination and eye movement problems are involved, AOA can include features that resemble both ataxia and apraxia.

Join the Conversation

On MyAtaxiaTeam, people share their experiences with ataxia, get advice, and find support from others who understand.

Do you or a loved one experience vision problems from ataxia? Let others know in a comment below.