Which cueing strategy would best support initiation of dressing for an individual with ideational apraxia?

• A. Verbal step-by-step instructions
• B. Sequenced photos of the steps in dressing
• C. Mirror feedback during performance
• D. Physical prompts to initiate steps

Answer: (D)

Initiation of dressing in ideational apraxia is best supported by physical prompts to start the first step. When ideational apraxia affects the ability to conceptualize or plan a multi-step action, the person may struggle to begin even though they can perform the steps once started. Providing a hands-on cue—hand-over-hand or a gentle touch to initiate the first movement—gives the necessary proprioceptive input to trigger the motor plan and start dressing. Verbal step-by-step instructions rely on internal sequencing and can fail at initiation; sequenced photos help with remembering the order but don’t provide an immediate start cue. Mirror feedback shows how the action is performed but doesn’t prompt the initial action. Using physical prompts can be gradually faded as independence increases, promoting initiation without long-term reliance on prompts.