Apraxia Test Research Articles

Distortion errors characterise visuo-constructive performance in Huntington’s disease

Objective: Visuospatial deficits have been extensively studied in Huntington’s disease (HD), particularly in relation to visuomotor integration, with less emphasis on visuo-constructive abilities. Quantitative analyses have demonstrated that individuals with HD perform worse than healthy controls (HC) but similarly to people with Alzheimer’s disease (AD). The aim of the present study was to conduct a qualitative investigation of visuo-constructive abilities in both HD and AD. By employing both simple and complex tasks, we hypothesized that a qualitative analysis of performance would reveal a distinct pattern of errors specific to HD. Methods: Participants for this study were identified retrospectively. The sample included 41 individuals with HD, 25 with AD, and 35 HC. All participants underwent a neuropsychological battery, which included the Constructional Apraxia Test (CAT) and the Rey-Osterrieth Complex Figure (ROCF) test. Results: Our results showed no significant quantitative difference in visuo-constructive performance between the two patient groups. However, distinct qualitative patterns of drawing errors emerged. Simplifications were more frequent in the AD group, while distortions were distinctive errors in the HD group. These qualitative error patterns were consistent across both the CAT and ROCF. Conclusion: Our study emphasises the value of qualitative analysis in interpreting visuo-constructive performance, shifting the focus from “how much” a participant achieves to “how” they perform a neuropsychological task. This qualitative approach is useful to capture the complexity and variability of individual performance, providing deeper insight into the cognitive processes affected by different neurological conditions.

Localizing apraxia in corticobasal syndrome: a morphometric MRI study.

Apraxia localization has relied on voxel-based, lesion-symptom mapping studies in left hemisphere stroke patients. Studies on the neural substrates of different manifestations of apraxia in neurodegenerative disorders are scarce. The primary aim of this study was to look into the neural substrates of different manifestations of apraxia in a cohort of corticobasal syndrome patients (CBS) by use of cortical thickness. Twenty-six CBS patients were included in this cross-sectional study. The Goldenberg apraxia test (GAT) was applied. 3D-T1-weighted images were analyzed via the automated recon-all Freesurfer version 6.0 pipeline. Vertex-based multivariate General Linear Model analysis was applied to correlate GAT scores with cortical thickness. Deficits in imitation of meaningless gestures correlated with bilateral superior parietal atrophy, extending to the angular and supramarginal gyri, particularly on the left. Finger imitation relied predominantly on superior parietal lobes, whereas the left angular and supramarginal gyri, in addition to superior parietal lobes, were critical for hand imitation. The widespread bilateral clusters of atrophy in CBS related to apraxia indicate different pathophysiological mechanisms mediating praxis in neurodegenerative disorders compared to vascular lesions, with implications both for our understanding of praxis and for the rehabilitation approaches of patients with apraxia.

실행증의 작업치료

Purpose: Apraxia is a target of occupational therapy because it negatively affects a person ability and independence in performing basic and instrumental activities of daily living and the person’s social participation. We aimed to provide comprehensive information related to apraxia to effectively provide occupational therapy for patients with apraxia. Subjects: Diagnosis of apraxia involves evaluation through clinical observation, such as the ability to pantomime, imitate, and complete multi-step tasks, and standardized evaluation tools, such as the Test of Upper Limb Apraxia (TULIA) and the Apraxia Screen of TULIA (AST). Evidence-based interventions for apraxia include gesture and strategy training. Although evidence is still lacking, interventions using virtual reality or mirrors are also being introduced to treat apraxia. Interventions based on functional cognition concepts can also be applied to the treatment of apraxia. Functional cognitive interventions include tasks/habits and strategies and indirect interventions. Conclusion: Apraxia can cause difficulties when attempting to perform intentional movements, thereby reducing a participant's ability to perform functional activities. Accordingly, implementing patient-centered occupational therapy tailored to the special needs of patients with apraxia is necessary. Findings of this study will be meaningful for the implementation of evidence-based occupational therapy for apraxia.

Apraxia Patterns for the Differentiation between Alzheimer's Disease and Frontotemporal Dementia Variants.

Background and Objectives: Despite the increasing use of biomarkers, differentiation between Alzheimer's disease (AD), behavioral variant Frontotemporal Dementia (bvFTD), and Primary Progressive Aphasia (PPA) remains a challenge. Apraxia is a supportive feature for diagnosing AD but is underrepresented in other dementia types. Herein, we investigated the presence and characteristic profiles of limb, verbal, and non-verbal apraxia in three major dementia types. Materials and Methods: Test for Upper Limb Apraxia (TULIA) and Apraxia Battery for Adults-2 (ABA-2) were administered in patients with AD (n = 22), bvFTD (n = 41), and PPA (n = 22), with 20 individuals serving as healthy controls (HC). Composite and subdomain scores were compared between each patient group and the HC. Praxis profiles indicative of each dementia type and a possible predictive value were sought. Results: Apraxia provided high diagnostic accuracy for detecting dementia compared with HC (sensitivity: 63.6-100%, specificity: 79.2-100%). Patients with AD performed worse when imitating intransitive gestures as well as pantomiming transitive gestures (mean differences: 2.10 and 3.12, respectively), compared with bvFTD. PPA patients, compared with bvFTD, had comparable results in limb, verbal, and non-verbal praxis assessments, despite the greater deterioration in the outcome. Compared with patients with AD, PPA had increased pathological outcomes in verbal (86.4% vs. 40.9%) and non-verbal apraxia (31.8% vs. 0%), while bvFTD had increased pathological outcomes in verbal apraxia (85.4% vs. 44.5%). Finally, apraxia is correlated with cognitive decline. Conclusions: Apraxia profile evaluation could contribute to the differentiation between AD and Frontotemporal Dementia (FTD). Both TULIA and ABA-2 are reliable tools that can be performed as bed-side tests in clinical practice.

Exploring praxia deficits in bipolar disorder: A cross-sectional analysis of functionality and quality of life

Background/Aim: Patients with bipolar disorder often experience praxia deficits, which might impede their functionality and quality of life. This study sought to delve into praxis defects in these patients, contrasting their praxia performance with healthy controls and illuminating the interrelation between praxia performance, functionality, and quality of life. Methods: In this cross-sectional study conducted from February to July 2023, we enrolled 203 patients diagnosed with bipolar disorder 1. Participants were recruited from the Ibni Sina and Sifa Community Mental Health Centers, both of which are affiliated with the Istanbul Tuzla State Hospital. Additionally, 201 healthy controls (HC) were recruited, primarily from the friends and relatives of the hospital staff. Patients diagnosed with bipolar disorder 1, between 18 and 65 years of age, were included based on their diagnosis as determined by the Structured Clinical Interview for DSM-5 Clinical Version (SCID-5-CV). Their right-handedness was ascertained via the Edinburgh Handedness Inventory. To minimize the confounding effects of acute mood episodes on praxia deficits, patients were required to score below 5 on the Young Mania Rating Scale (YMRS) and 7 or lower on the 17-item Hamilton Depression Rating Scale (HDRS). This criterion ensured the exclusion of individuals experiencing an active mood episode. Additionally, participants needed to have been in remission for at least six months. Healthy controls, aged 18-65 and confirmed as right-handed, were included, provided they had no personal or familial history of psychiatric conditions. A detailed interview using SCID-5-CV confirmed that the healthy controls had no history or suspicion of bipolar disorder (BD) or any other psychiatric disorder and no relatives with a psychiatric disorder. All participants (203 bipolar disorder patients and 201 healthy controls) underwent evaluations using the Test for Upper Limb Apraxia (TULIA), while the bipolar cohort received the Global Functioning Assessment-Functioning (GAF-F) and the World Health Organization Quality of Life-Brief Version (WHOQOL-BREF). Statistical analyses were conducted using SPSS 22.0. Results: We identified a critical TULIA score threshold of 217, which differentiates bipolar patients from healthy individuals with a sensitivity of 79.3% and a specificity of 77.1% (area under the curve (AUC) 0.799, P<0.001). TULIA scores in bipolar patients were significantly positively correlated with functionality (GAF-F; r=0.502, P<0.001) and quality of life-general health (WHOQOL; r=0.389, P<0.001). TULIA pantomime subscores (OR=0.92, 95% CI 0.86-0.99, P=0.022) and CPZ use of more than 250mg per day (OR=2.24, 95% CI 1.19-4.21, P=0.012) were independent predictors of impairment in functioning in bipolar patients. Conclusion: Praxia deficits in bipolar disorder patients may be intricately tied to specific clinical features that influence both their functionality and life quality. Comprehensive praxia deficit assessments can pave the way for devising tailored interventions, enhancing praxia and, by extension, the quality of life of bipolar patients.

Using virtual reality to assess gesture performance deficits in schizophrenia patients.

Gesture performance deficits are prevalent in schizophrenia patients and are strongly associated with poor social communication skills and community functioning, affecting their overall quality of life. Currently, video-recording technology is widely used in clinical settings to assess gesture production deficits in schizophrenia patients. Nevertheless, the subjective evaluation of video-recordings can encumber task assessment. The present study will aim to use virtual reality to examine its potential use as an alternative tool to objectively measure gesture performance accuracy in schizophrenia patients and healthy controls. Gesture performance in the virtual reality setting will be based on the well-established Test of Upper Limb Apraxia. Participants will be immersed in a virtual environment where they will experience themselves being embodied in a collocated virtual body seen from a first-person perspective. Motion trackers will be placed on participants' hands and elbows to track upper body movements in real-time, and to record gesture movement for later analysis. Participants will see a virtual agent sitting across from them, with a virtual table in between. The agent will perform various types of gestures and the participants' task will be to imitate those gestures as accurately as possible. Measurements from the tracking devices will be stored and analyzed to address gesture performance accuracy across groups. This study aims to provide objective measurements of gesture performance accuracy in schizophrenia patients. If successful, the results will provide new knowledge to the gesture literature and offer the potential for novel therapeutic interventions using virtual reality technologies. Such interventions can improve gesturing and thus advance social communication skills in schizophrenia patients.

Investigation of Apraxia in Patients with Schizophrenia and Bipolar Disorder Type I.

Almost 50% of patients with schizophrenia experience problems in their praxia performance, whereas executive function losses can be seen in patients with bipolar disorder. Although schizophrenia and bipolar disorder can be categorized as different disorders, in patient groups with similar symptom clusters, we aimed to determine whether there are common or disorder-specific praxia defects and to investigate the relationship between the sociodemographic and clinical features with apraxia. 52 Schizophrenia and 77 Bipolar Disorder Type I outpatients in remission for at least 6 months were included in our study. Test of Upper Limb Apraxia (TULIA) and Mayo Clinic Praxia Assessment Test (MCPAT) were used to evaluate praxia performance. Patients with Schizophrenia performed poorer on the TULIA and MCPAT than patients with Bipolar Disorder Type I. While impairment in personal and social functioning was higher in the apraxic schizophrenia group compared to the non-apraxic group, the mean age of disease onset was lower. Functioning in the Apraxic Bipolar Disorder Type I group was lower than in the group without apraxia; whereas the patient's age, duration of disease and number of hospitalizations were higher. Although apraxia, which have an important effect on the functioning and quality of life of the patient by causing impairment in daily activities, are seen at higher rates in patients with schizophrenia, might be also seen in patients with bipolar disorder type I. Decreasing diagnostic confusion and developing appropriate treatment strategies, evaluation of apraxia seems to be clinically important in terms of prognosis of diseases and functioning of patients.

Apraxia testing to distinguish early Alzheimer’s disease from psychiatric causes of cognitive impairment

Objective: Mood- and stress-related disorders commonly cause attentional and memory impairments in middle-aged individuals. In memory testing, these impairments can be mistakenly interpreted as symptoms of dementia; thus, more reliable diagnostic approaches are needed. The present work defines the discriminant accuracy of the Dementia Apraxia Test (DATE) between psychiatric conditions and early-onset Alzheimer’s disease (AD) on its own and in combination with memory tests. Method: The consecutive sample included 50–70-year-old patients referred to dementia investigations for recent cognitive and/or affective symptoms. The DATE was administered and scored as a blinded measurement, and a receiver operating curve analysis was used to define the optimal diagnostic cut-off score. Results: A total of 24 patients were diagnosed with probable AD (mean age 61 ± 4) and 23 with a psychiatric condition (mean age 57 ± 4). The AD patients showed remarkable limb apraxia, but the psychiatric patients mainly performed at a healthy level on the DATE. The test showed a total discriminant accuracy of 87% for a total sum cut-off of 47 (sensitivity 79% and specificity 96%). The limb subscale alone reached an accuracy of 91% for a cut-off of 20 (sensitivity 83% and specificity 100%). All memory tests were diagnostically less accurate, while the combination of the limb praxis subscale and a verbal episodic memory test suggested a correct diagnosis in all but one patient. Conclusions: Apraxia testing may improve the accuracy of differentiation between AD and psychiatric aetiologies. Its potential in severe and chronic psychiatric conditions should be examined in the future.

The dementia apraxia test can detect early-onset Alzheimer's disease.

Limb apraxia is a common early sign of Alzheimer's disease (AD) and is thought to occur specifically in early-onset (before the age of 65) AD. The Dementia Apraxia Test (DATE), a test of limb and face praxis developed to support the differential diagnosis of dementia, has shown good diagnostic accuracy in detecting AD in older patients, but it has not been validated for younger age groups. We investigated how accurately DATE can detect AD in middle-aged individuals and whether apraxia is a distinctive feature in early-onset AD. A sample of mild-stage AD patients (n = 24; Mage = 61, SD = 4) was drawn from a prospective consecutive series of individuals referred to our neurology clinic for dementia investigations. A healthy comparison group (HC) of comparable age (n = 22; Mage = 61, SD = 7), sex distribution, and education was recruited. DATE was administered as a blinded experimental measure, and a receiver operating characteristic (ROC) analysis was used to define the optimal diagnostic cutoff point. The DATE classified 93% of the participants correctly as AD or HC (sensitivity 0.88, specificity 1.00, area under curve 0.968). The optimal diagnostic cutoff point was higher (49 points) than in a previous sample of older patients (45 points). Early onset did not seem to be associated with worse praxis performance in AD. DATE is an accurate tool for detecting early-onset AD within 2 years of symptom onset. The diagnostic cutoff point should be higher for middle-aged populations than for late-onset AD. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Evaluation of the Dementia Apraxia Test in Parkinson’s Disease Patients

Introduction: Ideomotor apraxia, a disorder of skilled movements affecting limbs and/or face, can be seen in patients with Parkinson’s disease (PD), yet tests of apraxia in PD are rare. The aim of this project was to evaluate the psychometric properties and validity of the Dementia Apraxia Test (DATE) in a PD sample. Methods: 118 PD patients were included. Besides DATE performance, motor and non-motor burden, cognition, and activity of daily living (ADL) function were assessed. Patients were classified as cognitively impaired (n = 41) or non-cognitively impaired (n = 77). Results: Interrater reliability of the DATE (sub-)scores between video ratings and on-site ratings by the investigator was good (0.81 ≤ r_k ≤ 0.87). Items were mostly easy to perform, especially the buccofacial apraxia items, which had also low discriminatory power. DATE scores were associated with cognition and ADL function. DATE performance was confounded by motor impairment and patients’ age; however, when analysed for both cognitive groups separately, the correlation between DATE and motor performance was not significant. Discussion/Conclusion: The DATE seems to be an objective and predominantly valid apraxia screening tool for PD patients, with a few items needing revision. Due to the potential effect of motor impairment and age, standardized scores adjusting for these confounders are needed.

Effect of Oral Apraxia on Dysphagia in Patients with Subacute Stroke.

Aim of this study was to investigate the effect of post-stroke oral apraxia on dysphagia in patients with subacute stroke. We retrospectively analyzed the clinical data of 130 supratentorial stroke patients from January 2015 to February 2021 who underwent a formal limb and oral apraxia test and videofluoroscopic swallowing study (VFSS), and we compared the patients in two groups: the apraxia and non-apraxia (oral apraxia score > 45 and ≤ 45 points, respectively). All the patients participated in the standardized testing battery. The test variables were videofluoroscopic dysphagia scale (VDS), oral transit time (OTT), pharyngeal delay time (PDT), pharyngeal transit time, and penetration-aspiration scale (PAS); we conducted multivariable regression analysis with those parameters to confirm the significance of oral apraxia as a clinical determinant of post-stroke dysphagia. The mean oral apraxia scores were 38.4 and 47.6 points in the apraxia and non-apraxia groups, respectively (p < 0.001). The apraxia group had a higher proportion of delayed OTT for the 2-mL-thick liquid than the non-apraxia group (17.6% and 4.2%, respectively; p = 0.011). Oral apraxia was a significant determinant of VDS (p < 0.001), delayed OTT of 2-mL-thick liquids (p = 0.028), delayed PDT of cup drinking for thin liquid (p = 0.044), and PAS scores (p = 0.003). The presence of oral apraxia was significantly associated with dysphagia, especially with the VFSS parameters of the oral phase (thick liquid), pharyngeal phase (cup drinking for thin liquid) of swallowing, and increased risk of aspiration in subacute stroke patients. Thus, a formal assessment of oral apraxia is needed for stroke patients with dysphagia.

Validation of the Apraxia Screen TULIA (AST) in Schizophrenia

Introduction: Deficits in social interaction and community functioning, including impaired use, performance, and perception of hand gestures, are key features in schizophrenia. A well-established tool to assess gesture deficits is the test of upper limb apraxia (TULIA). However, given its time-consuming application based on video analyses, research has proposed the bedside apraxia screen of TULIA (AST). This study aims to test the validity and reliability of the AST to detect gesture abnormalities at bedside in a sample of 27 patients diagnosed with schizophrenia, schizotypal disorder, acute and transient psychotic disorders, or schizoaffective disorder. Methods: Patients completed the 48-item TULIA and the 12-item AST. Two different raters assessed the AST: one at bedside (online) and the other based on the video recordings. Results: The total AST scores demonstrated a high parallel reliability, moderate inter-rater reliability on a single-item level, and good construct validities. Conclusions: The psychometric properties of the AST suggest it can well be used for the clinical assessment of gesture deficits in schizophrenia. However, when detailed information is required, the AST rated from video or conducting the full TULIA is recommended. The findings call for refining the selection of the TULIA items for a psychosis-AST bedside test to increase specificity.

Psychometric properties of the apraxia of speech rating scale Thai version

Background: Thai speech-language pathologists lack appropriate tools to describe apraxia of speech (AOS) characteristics in Thai patients. Objectives: This study aimed to translate and adapt the most recent version of the Apraxia of Speech Rating Scale (ASRS) 3.3, the ASRS 3.3, into a Thai version and evaluate the psychometric properties of the Thai version (ASRS-Thai). Materials and methods: The original ASRS 3.3 has been translated into Thai using the backward-translation approach. The original developer was also included in the translation process to improve the translation accuracy. The resulting tool, ASRS-Thai, was administered to 28 adults with neurological speech or language disorders, along with another AOS test available in Thai, Apraxia Test for Thai Adults (ATTA). The recordings were rated independently by 5 experienced speech-language pathologists at different hospitals. The clinical assessment of patients’ performance on the ATTA was used as the reference standard to measure the sensitivity and specificity of ASRS-Thai for AOS diagnosis. Concurrent validity and reliability measures were also examined. Reliability was examined by evaluating intra-rater and inter-rater reliability. Results: Moderate-to-strong negative correlations were found between the ATTA and the ASRS-Thai (-0.575 to -0.900). Additionally, the sensitivity and specificity of the ASRS-Thai at a cut-off score of 16 were 100% and 86.7%, respectively. Reliability was computed by measuring the intraclass correlation (ICC) values. The intra-rater ICCs were 0.96, 0.968, and 0.976, and the inter-rater ICC was 0.927 for the total score. Conclusion: The ASRS-Thai is a reliable, valid instrument to describe the presence and severity of AOS characteristics in clinical settings and research. Additional data collection by testing a larger sample size with diverse severities, including cases of pure AOS, is warranted in future studies

The Incidence of Aphasia, Cognitive Deficits, Apraxia, Dysarthria, and Dysphagia in Acute Post Stroke Persian Speaking Adults.

Stroke is a major cause of serious disabilities in adults. While communication deficits post stroke are prevalent and disabling, early detection of them is important during acute phase. There is limited data published on the incidence of communication disorders in Persian speaking adults following post stroke to our knowledge. The present study aims to determine the incidence and associated factors of aphasia, cognitive deficits, motor speech disorders (apraxia and dysarthria) as well as dysphagia following acute post stroke in Persian speaking adults. 100 stroke patients were assessed using P-WAB, MMSE, Oral Apraxia test, Informal Dysarthria assessment, and MASA. The data was collected from 2 hospitals in Tehran using convenient sampling for the duration of 1year. Based on our findings, the incidence of aphasia, cognitive deficits, oral apraxia, dysarthria, and dysphagia was in respectively 61.8%, 76%, 30%, 61%, and 39% of stroke patients during the acute phase. Patients with aphasia were significantly older (mean age, 59.29 vs. 64.95), and had fewer education years (9.21 vs. 5.45) compared to individuals without aphasia (p < .05). Co-occurrence of aphasia and dysarthria, dysphasia, cognitive deficits, and apraxia was in respectively 40%, 31%, 55%, and 25%. Due to the high incidence of neurogenic communication disorders and dysphagia during the acute post stroke, especially in the elderly and the less educated patients, prompt and rapid detection of these deficits and rehabilitation is essential to ameliorate patients' quality of life and social participation, and reduce the comorbidities risk.

Distinct cognitive components and their neural substrates underlying praxis and language deficits following left hemisphere stroke

Apraxia is characterised by multiple deficits of higher motor functions, primarily caused by left hemisphere (LH) lesions to parietal-frontal praxis networks. While previous neuropsychological and lesion studies tried to relate the various apraxic deficits to specific lesion sites, a comprehensive analysis of the different apraxia profiles and the related (impaired) motor–cognitive processes as well as their differential neural substrates in LH stroke is lacking.To reveal the cognitive mechanisms that underlie the different patterns of praxis and (related) language deficits, we applied principal component analysis (PCA) to the scores of sub-acute LH stroke patients (n = 91) in several tests of apraxia and aphasia. Voxel-based lesion-symptom mapping (VLSM) analyses were then used to investigate the neural substrates of the identified components.The PCA yielded a first component related to language functions and three components related to praxis functions, with each component associated with specific lesion patterns. Regarding praxis functions, performance in imitating arm/hand gestures was accounted for by a second component related to the left precentral gyrus and the inferior parietal lobule. Imitating finger configurations, pantomiming the use of objects related to the face, and actually using objects loaded on component 3, related to the left anterior intraparietal sulcus and angular gyrus. The last component represented the imitation of bucco-facial gestures and was linked to the basal ganglia and LH white matter tracts. The results further revealed that pantomime of (limb-related) object use depended on both the component 2 and 3, which were shared with gesture imitation and actual object use.Data support and extend the notion that apraxia represents a multi-componential syndrome comprising different (impaired) motor–cognitive processes, which dissociate – at least partially – from language processes. The distinct components might be disturbed to a varying degree following LH stroke since they are associated with specific lesion patterns within the LH.

Sensorimotor tongue evaluation and rehabilitation in patients with sleep-disordered breathing: a novel approach.

To evaluate tone, apraxia and stereognosis dysfunctions in patients with SDB compared with healthy controls, and to monitor the effectiveness of Airway Gym® as an easy-to-use myofunctional therapy (MT) modality in terms of the tongue's motor and sensory responses, comparing results before and after therapy. This was a prospective, non-randomised pilot study of 25 patients with moderate to severe obstructive sleep apnoea-hypopnoea syndrome (OSAHS), 25 patients with primary snoring (PS) and 20healthy controls. Qualitative and quantitative instruments-Iowa Oral Performance Instrument (IOPI), lingual apraxia and stereognosis tests were used to assess tongue sensorimotor function. 22 patients with PS, 21 with OSAHS and all 20 controls ended the therapy. In OSAHS, the Epworth Sleepiness Scale score decreased from 16±7.3 to 12±4.5 after therapy (p=0.53). In PS and OSAHS groups, the IOPI scores increased significantly. These measures did not change significantly in the controls. Lingual apraxia testing showed that controls performed all the manoeuvres, whereas PS 5.6±1.4 and OSAHS 4.5±1.9 (p=0.14). In the stereognosis test, the mean number of figures recognised was 2.6±2.2 in OSAHS, 3.3±1.2 in PS and 5.7±0.9 in control group (p<0.05). Patients with OSAHS recognised circles and ovals less often. Using the Airway Gym® app produced improvements in sensorimotor tongue function in patients with SDB, due to continuous stimulation of the brain based on proprioceptive training required to localise responses when doing the exercises.

Back in control of intentional action: Improvement of ideomotor apraxia by mirror box treatment

ObjectivesA novel method of rehabilitation for ideomotor apraxia (IMA), using a modified version of the mirror box (MB), is proposed. The rationale is based on the theory that disrupted body representation occurs in IMA and that MB training may improve body representation. In the present MB training, patients observed and reproduced movements made by the experimenter in a mirror. The visual perspective gave the illusory sensation of seeing one's own affected hand in the mirror. MethodsThirteen patients were included in the study; apraxia was measured four times: i) at baseline; ii) after a week of unspecific poststroke rehabilitation (rest); iii) after a week of imitation training for apraxia, used as a control; and iv) after a week of MB training. Imitation and mirror box training were presented in counterbalanced order between participants. The effect of the mirror box on a measure of body representation was also assessed. ResultsThe results show that MB training improved apraxia when compared to the outcomes in both the imitation and rest conditions. The improvement correlates with the impact of the mirror box on the body representation (i.e., the degree of embodiment). ConclusionsMB training shows promising effects in promoting recovery from apraxia. The hypothesis is that the mirror box triggers a quickly generated sense of embodiment of the reflected moving arm into the observer's body representation. This embodiment of the visuomotor features of the observed movements would positively affect motor programming, promoting motor improvement. Crucially, this effect seems to extend to actions performed outside the mirror box setup, enhancing patients' performance on an apraxia test.

Motor sequence learning in patients with ideomotor apraxia: Effects of long-term training

Recent studies show that limb apraxia is a quite frequent, yet often underdiagnosed, higher motor impairment following stroke. Because it adversely affects every-day life and personal independence, successful rehabilitation of apraxia is essential for personal well-being. Nevertheless, evidence of long-term efficacy of training schemes and generalization to untrained actions is still scarce. One possible reason for the tendency of this neurological disorder to persist may be a deficit in planning, conceptualisation and storage of complex motor acts.This pilot study aims at investigating explicit motor learning in apractic stroke patients. In particular, we addressed the ability of apractic patients to learn and to retain new explicit sequential finger movements across 10 training sessions over a 3-week interval.Nine stroke patients with ideomotor apraxia in its chronic stage participated in a multi-session training regimen and were included in data analyses. Patients performed an explicit finger sequence learning task (MSLT – motor sequence learning task), which is a well-established paradigm to investigate motor learning and memory processes.Patients improved task performance in terms of speed and accuracy across sessions. Specifically, they showed a noticeable reduction in the mean time needed to perform a correct sequence and the number of erroneous sequences. We found also a trend for improved performance at the Goldenberg apraxia test protocol: “imitation of meaningless hand and finger gestures” relative to when assessed before the MSLT training.Patients with ideomotor apraxia demonstrated the ability to acquire and maintain a novel sequence of movements; and, this training was associated with hints towards improvement of apraxia symptoms.

Hand gesture performance is impaired in major depressive disorder: A matter of working memory performance?

ObjectiveIndividuals with depression exhibit numerous interpersonal deficits. As effective use of gestures is critical for social communication, it is possible that depressed individuals’ interpersonal deficits may be due to deficits in gesture performance. The present study thus compared gesture performance of depressed patients and controls and examined whether these deficits relate to cognitive and other domains of dysfunction. MethodsGesture performance was evaluated in 30 depressed patients and 30 controls using the Test of Upper Limb Apraxia (TULIA). Clinical rating scales were assessed to determine if gesture deficits were associated with motor, cognitive or functional outcomes. ResultsCompared to controls, depressed patients exhibited impaired gesture performance with 2/3 of the patients demonstrating gesture deficits. Within depressed patients, gesture performance was highly correlated with working memory abilities. In contrast, no association between gesture performance and gestural knowledge, psychomotor retardation, depression severity, or frontal dysfunction was observed in patients. LimitationsThis is a cross-sectional study and a larger size would have allowed for confident detection of more subtle, but potentially relevant effects. ConclusionGesture performance is impaired in depressed patients, and appears to be related to poor working memory abilities, suggesting a disruption in the retrieval of gestural cues indicative of a distinct clinical phenomenon that might be related to social functioning.

Proposing a new short screening test for upper limb apraxia

Background Apraxia has a major impact on activities of daily living in stroke patients. The proper assessment and treatment of apraxia is important for maintaining a good quality of life. We developed a short evaluation test for upper limb apraxia. Patients and Methods The present Screening Test of Gestures for Stroke consists of 10 items for each verbal instruction and imitation. Each item includes three meaningless gestures, three meaningful gestures and four pantomimes. The Screening Test of Gestures for Stroke is scored based on a 3-point system: 10, 5 or 0 (maximum score: 200). The test took approximately 2–5 min to complete. We recruited 65 patients admitted to our hospital with left hemisphere stroke and 50 healthy subjects. Results The reliability of the Screening Test of Gestures for Stroke was as follows: the intraclass correlation coefficient of intra-rater reliability was 0.93 for both verbal instructions and imitations, and the intraclass correlation coefficient total scores for inter-rater reliability for verbal instructions and for imitations were 0.97 and 0.95, respectively. The alpha coefficient was ≥0.80. Conclusions The Screening Test of Gestures for Stroke is a reliable and valid bedside test that has a short assessment time, does not require special equipment and can evaluate upper limb apraxia in stroke patients from the acute to the chronic phase.