Abstract
Humans differ from other animals in the way they can skilfully and precisely operate or invent tools to facilitate their everyday life. Tools have dominated our home, travel and work environment, becoming an integral step for our motor skills development. What happens when the part of the brain responsible for tool use is damaged in our adult life due to a cerebrovascular accident? How does daily life change when we lose the previously mastered ability to make use of the objects around us? How do patients suffering from compromised tool use cope with food preparation, personal hygiene, grooming, housework, or use of home appliances? In this literature review we present a state of the art for single and multiple tool use research, with a focus on the impact that apraxia (impaired ability to perform tool-based actions) and action disorganization syndrome (ADS; impaired ability to carry out multi-step actions) have on activities of daily living (ADL). Firstly, we summarize the behavioral studies investigating the impact of apraxia and other comorbidity syndromes, such as neglect or visual extinction, on ADL. We discuss the hallmarks of the compromised tool use in terms of the sequencing of action steps, conceptual errors committed, spatial motor control, and temporal organization of the movement. In addition, we present an up-to-date overview of the neuroimaging and lesion analyses studies that provide an insight into neural correlates of tool use in the human brain and functional changes in the neural organization following a stroke, in the context of ADL. Finally we discuss the current practice in neurorehabilitation of ADL in apraxia and ADS aiming at increasing patients’ independence.
Highlights
Left brain damage caused by ischemic or hemorrhagic stroke is the most frequent neurological correlate of apraxia (Goldenberg, 2013)
The review summarized the most significant research conducted on the impact of AADS on the ADL in stroke survivors
The difficulties with execution of ADL were categorized arbitrarily into three components: problems with sequencing of the multi-step actions, conceptual knowledge about tool use and spatiotemporal aspects of the movement. This classification is novel in comparison to the original descriptions of AADS
Summary
Left brain damage caused by ischemic or hemorrhagic stroke is the most frequent neurological correlate of apraxia (Goldenberg, 2013). Apraxic behavior in tool use is primarily attributed to the impaired or lost access to the tool related knowledge, concepts of use and problem solving (Goldenberg, 2013). Patients frequently show compromised ability to carry on everyday activities and often show action disturbances leading to safety hazards after dismissal from hospital units (Hanna-Pladdy et al, 2003). Such slips might involve attempts to use a knife in a wrong orientation to cut a slice of bread, bite a toothbrush instead of applying a brushing movement inside the mouth, toy with boiled water or tear the teabag to make a cup of tea. Patients are not able to perform the task even with the contralesional limb which might have preserved motor functionality
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