A stroke patient can climb stairs in the community but cannot do so when practicing in the therapy gym. Which diagnosis BEST describes this difficulty?

• A. Ideomotor apraxia
• B. Impaired body schema
• C. Impaired problem solving
• D. Ideational apraxia

Answer: (A)

Ideomotor apraxia is when a person understands the goal of a movement and has the ability to perform it, but has trouble translating that intent into action when asked to demonstrate, though automatic or habitual actions can be preserved.

In this scenario, the patient can climb stairs in the community—an automatic, well-practiced activity—yet struggles to do so when asked to practice in the therapy gym. The cueing or command to demonstrate disrupts the translation of intended movement into execution, which is characteristic of ideomotor apraxia.

If the issue were impaired body schema, you’d expect problems with perceiving your body's position in space across tasks, not the context-dependent split between automatic versus cued performance. If it were ideational apraxia, the problem would be with the conceptual plan of the task, leading to difficulties with the sequence or the use of tools even in automatic settings. If it were impaired problem solving, broader cognitive deficits would be involved, not specifically the motor planning to perform movements on command.

So the best fit is ideomotor apraxia.