Apraxia of tool use: Assessment strategies

Abstract

A substantial proportions of patients with brain damage and neurodegenerative diseases misuse common tools. However, this neuropsychological syndrome affecting everyday life is relatively unexplored in the field of experimental and clinical neuropsychology. Little is known about long-term evolution and specific evaluation and/or rehabilitation. This is partially due to the fact that apraxia of tool use faces the lack of an integrative theoretical framework taking into account all cognitive processes underlying gesture orientation, object selection or action sequencing. Indeed, apraxia of tool use goes far beyond the traditional, obsolete, distinction between ideational apraxia and ideomotor apraxia. This is a complex symptomatology requiring a conceptual and clinical differential analysis. After a brief overview of the theoretical principles underpinning our evaluation method, the purpose of this presentation is to describe the various types of tests, which are required to exhaustively assess tool use disorders. In that sense, we want to reemphasize the importance of preliminary neurological examination as well as the exploration of language, body schema (probably involved in imitation disorders) and motor sequences (unilateral, limb-kinetic apraxia). We will then focus on tool use assessment: types of object, basic knowledge related to them, presentation modalities, action planning. Finally, we illustrate our approach with studies in patients with left brain damage.