Abstract
Buccofacial Apraxia and the Expression of Emotion JOSHUA DAVID WOOLLEY Memory and Aging Center and the Department of Neuroscience, University of California–San Francisco, San Francisco, California 94143-1207, USA K EYWORDS : buccofacial voluntary dissociation apraxia; emotion; expression; automato- Apraxia is a disorder in executing “learned” 1 or “skilled” movement (exclud- ing explicitly symbolic movements 2 ) not accounted for by weakness, inco- ordination, sensory loss, incomprehension or inattention to commands. 3, 4 In a classic case, the patient carried out commands such as, “show me how you would use a hammer” with his right arm without hesitation. 1 However, when asked to perform the same actions with his left arm, the patient would either do nothing or make an obviously incorrect response. When given real ob- jects, the patient showed no deficits with either arm. The fact that the right arm performed the actions normally rules out the possibility of incomprehen- sion, inattention, or uncooperativeness; while the successful performance of the left arm with real objects rules out the possibility of weakness or incoor- dination. This particular pattern of deficits is now called ideomotor apraxia. When patients have damage centered in the premotor area of the left frontal lobe, they may exhibit limb apraxia (LA) but may also show apraxia of the face, so-called buccofacial apraxia (BFA). These patients cannot pretend or imitate facial movements such as blowing out a match or sucking through a straw, but they usually perform normally when presented with a real match or straw. BFA, while fairly common, has been less studied than limb apraxia and has seldom been related to facial emotion expression. Care must be taken to separate BFA from automato-voluntary dissociation (AVD) affecting the face. In AVD, corticospinal innervation of the face is im- Address for correspondence: Joshua David Woolley, Memory and Aging Center, UCSF, 350 Parnassus St., Suite 706, San Francisco, CA 94143-1207. Voice: 415-476-6880; fax: 415-476- jwoolle@itsa.ucsf.edu Ann. N.Y. Acad. Sci. 1000: 395–401 (2003). © 2003 New York Academy of Sciences. doi: 10.1196/annals.1280.039
Highlights
Memory and Aging Center and the Department of Neuroscience, University of California–San Francisco, San Francisco, California 94143-1207, USA
The fact that the right arm performed the actions normally rules out the possibility of incomprehension, inattention, or uncooperativeness; while the successful performance of the left arm with real objects rules out the possibility of weakness or incoordination
When patients have damage centered in the premotor area of the left frontal lobe, they may exhibit limb apraxia (LA) but may show apraxia of the face, so-called buccofacial apraxia (BFA)
Summary
The authors accept that their study design did not separate the effects of cueing from task order They claim that the improved response of patients with BFA to emotional cueing is different from apraxic patients’ known lack of improvement with repeated trials.[19] They suggest that since the right hemisphere may have a “special role in emotion processing, it may [be] mediating the facilitation effect.”[20] Given more recent evidence showing no particular connection between right or left hemisphere damage with deficits in spontaneous or voluntary expression of emotions,[21,22] this hypothesis seems unlikely. This would allow the specific nature of the deficit in BFA to be investigated (TABLE 1)
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