Ideational Apraxia Research Articles

Neuropsychological deficits associated with a tumour in the posterior corpus callosum: A report of two cases

This study reports two patients with tumours arising from the splenium of the corpus callosum that caused a memory disturbance consistent with retrosplenial amnesia as well as a variety of cognitive deficits including agraphia, acalculia, constructional apraxia and ideomotor and ideational apraxia involving both hands, but not aphasia. Patients showed disorientation to time and place, impaired recent memory and memorizing capacity; immediate and remote memory were preserved. Despite impaired performance intelligence quotients (IQ), verbal IQ was relatively spared. Patients also showed disconnection symptoms including bilateral crossed visuomotor ataxia and alexia to stimuli presented in the right visual field. In both cases, the tumour of the splenium had provoked surrounding oedema extending to the left parietal and occipital lobes.

Apraxia in movement disorders

The definition of apraxia specifies that the disturbance of performed skilled movements cannot be explained by the more elemental motor disorders typical of patients with movement disorders. Generally this does not present a significant diagnostic problem when dealing with 'higher-level' praxic disturbances (e.g. ideational apraxia), but it can be a major confound in establishing the presence of limb-kinetic apraxia. Most motor disturbances characteristic of extrapyramidal disorders, particularly bradykinesia and dystonia, will compromise the ability to establish the presence of loss of dexterity and deftness that constitutes this subtype. The term 'apraxia' has also been applied to other motor disturbances, such as 'gait apraxia' and 'apraxia of eyelid opening', that perhaps are misnomers, demonstrating the lack of a coherent nomenclature in this field. Apraxia is a hallmark of corticobasal degeneration (CBD) and historically this has received the most attention among the movement disorders. Corticobasal degeneration is characterized by various forms of apraxia affecting limb function, particularly ideomotor apraxia and limb-kinetic apraxia, although buccofacial and oculomotor apraxia can be present as well. The syndrome of parkinsonism and prominent apraxia, designated the 'corticobasal syndrome' (CBS), may be caused by a variety of other central nervous system pathologies including progressive supranuclear palsy (PSP), Alzheimer's disease, dementia with Lewy bodies and frontotemporal dementias. Distinct from the CBS, PSP and Parkinson's disease can demonstrate varying degrees of apraxia on selected tests, especially in those patients with more severe cognitive dysfunction. Diseases that cause the combination of apraxia and a primary movement disorder most often involve a variety of cerebral cortical sites as well as basal ganglia structures. Clinical-pathological correlates and functional imaging studies are compromised by both this diffuse involvement and the confusion experienced in the clinical evaluation of apraxia in the face of the additional elemental movement disorders. Finally, although apraxia results in clear disability in patients with the CBS, it is not clear how milder ideomotor apraxia found on specific testing contributes to patients' overall day-to-day motor disability.

Neural basis of pantomiming the use of visually presented objects

Neuropsychological studies of patients suffering from apraxia strongly imply a left hemisphere basis for skilful object use, the neural mechanisms of which, however, remain to be elucidated. We therefore carried out a PET study in 14 healthy human volunteers with the aim to isolate the neural mechanisms underlying the sensorimotor transformation of object-triggers into skilled actions. We employed a factorial design with two factors (RESPONSE: naming, pantomiming; and TRIGGER: actions, objects) and four conditions (IA: imitating the observed pantomime; IO: pantomiming the use of the object shown; NA: naming the observed pantomime; NO: naming the object shown). The design thus mainly aims at investigating the interaction [i.e. (IO–IA)–(NO–NA)] which allows the assessment of increased neural activity specific to the sensorimotor transformation of object-triggers into skilled actions. The results ( P < 0.05, corrected) showed that producing a wide range of skilled actions triggered by objects (controlled for perceptual, motor, semantic, and lexical effects) activated left inferior parietal cortex. The data provide an explanation for why patients with lesions including left parietal cortex suffer from ideational apraxia as assessed by impaired object use and pontomining to visually presented objects (Brain 111 (1988) 1173; Cogn. Neuropsychol. 18 (2001) 671).

Apraxia is not associated to a disproportionate naming impairment for manipulable objects

The relevance of gesture knowledge for the semantic representation of manipulable objects was investigated in a series of 15 patients with a focal left-hemisphere lesion. The patients were classified according to the presence/absence of ideomotor and ideational apraxia. We investigated picture naming and word-picture matching (pointing to a picture on verbal command) with stimuli including items from three categories: manipulable objects, non-manipulable objects, and animals. The analysis was performed at group level and at single-patient level. Nine patients were affected by ideational apraxia and nine by ideomotor apraxia: two cases presented ideomotor but not ideational apraxia, and two cases presented the opposite dissociation. Patients affected by ideational apraxia were more severely impaired in all tasks, but did not show a disproportionate impairment with the category of manipulable objects in contrast to the other categories. The presence of ideomotor apraxia did not cause a greater impairment in any task or category. Finally, we observed a patient with ideational apraxia who performed flawlessly in naming and word-picture matching for all the stimuli, including manipulable objects. In conclusion, we did not find a relationship between ideational apraxia and a disproportionate impairment of the semantic knowledge of manipulable objects.

Ideomotor and Ideational Apraxia in Corticobasal Degeneration: A Case Study

Corticobasal degeneration (CBD) is a progressive disorder that can be characterised by asymmetrical akinetic rigidity, involuntary movements, cortical sensory loss, alien limb syndrome and asymmetrical apraxia (Gibb et al., 1989; Rinnie et al., 1994). Diagnosis of praxic disabilities is thought to be essential for distinguishing CBD, in its early stage, from other akinetic-rigid syndromes. However, the nature of apraxia in CBD, and the relations between ideomotor and ideational apraxia, are not well understood. For example, if there is an ideational deficit in a given patient, does this deficit occur independently of any ideomotor disorder, or are the two impairments linked in some manner? In the present paper we report a case study of a patient with apraxia due to CBD. We examine whether the disorder is confined to production tasks, or whether there is also a related deficit in recognising the correct actions performed with objects (an ideational deficit). We also evaluate whether a disorder found for action with single objects dissociates from the ability to link multiple actions into more complex, everyday tasks. The performance of our patient showed an impairment in both action production and action recognition system, suggesting a component of ideational as well as ideomotor apraxia in CBD.

Prognostic factors for ambulation and activities of daily living in the subacute phase after stroke. A systematic review of the literature.

To identify evidence-based prognostic factors in the subacute phase after stroke for activities of daily living (ADL) and ambulation at six months to one year after stroke. Systematic literature search designed in accordance with the Cochrane Collaboration criteria with the following data sources: (1) MEDLINE, EMBASE, CINAHL, Current Contents, Cochrane Database of Systematic Reviews, Psyclit, and Sociological Abstracts. (2) Reference lists, personal archives, and consultation of experts. (3) Guidelines. Inclusion criteria were: (1) cohort studies of patients with an ischaemic or haemorrhagic stroke; (2) inception cohort with assessment of prognostic factors within the first two weeks after stroke; (3) outcome measures for ADL and ambulation; and (4) a follow-up of six months to one year. Internal, statistical and external validity of the studies were assessed using a checklist with 11 methodological criteria in accordance with the recommendations of the Cochrane Collaboration. From 1,027 potentially relevant studies 26 studies involving a total of 7,850 patients met the inclusion criteria. Incontinence for urine is the only prognostic factor identified in three studies with a level A (i.e., a good level of scientific evidence according to the methodological score). The following factors were found in one level A study: initial ADL disability and ambulation, high age, severe paresis or paralysis, impaired swallowing, ideomotor apraxia, ideational apraxia, and visuospatial construction problems; as well as factors relating to complications of an ischaemic stroke, such as extraparenchymal bleeding, cerebral oedema and size of intraparenchymal haemorrhage. The present evidence concerning possible predictors in the subacute stage of stroke has insufficient quality to make an evidence-based prediction of ADL and ambulation after stroke because only one prognostic factor was demonstrated in at least two level A studies, our cut-off for sufficient scientific evidence.

A Framework for Developing Nursing Knowledge About the Effects of Dementia on Older Persons' Abilities

A dearth of nursing knowledge exists about the specific effects of the cognitive and other changes of dementia on older persons' abilities. Consequently, limited direction is available to guide nursing research and practice in this context. Thus, the authors designed a framework that directs the development of such knowledge. In this article, the assumptions and elements of the framework are detailed. An extensive illustration of the application of the framework is provided concerning ideational apraxia in dementia and self-care abilities related to feeding. It is shown how nurses can draw information from the scholarship of other disciplines and incorporate it into an understanding of the effects of dementia on abilities. The framework can be used to systematically focus research and practice concerning the care of people suffering fromdementia.

Ideational apraxia: Confusion that began with Liepmann

The paper entitled The relationship between performances on single and multiple-object tasks by left-hemisphere damaged aphasic patients (Nieman, Duffy, Belanger, & Coelho, 2000) focuses upon the issue of task complexity in apraxia by comparing single and multiple-object tests. In this study Neiman and colleagues discuss “complexity” and “disconnection” explanations as rival hypotheses about the potential explanations for performance variance on these two tasks. However, their findings fail fully to support either hypothesis and in turn provide the opportunity to discuss what might be a longstanding ambiguity about the relevance of these task variables under study. Specifically, in this paper we discuss our proposal that although the practice of testing multistage and multi-tool/object commands is longstanding and emanates from Liepmann's original descriptions of praxis assessment, the hypotheses and rationale for such assessment in the current study and related investigations are elusive, and that the lack of clarity has not evolved since the ambiguities were first instituted in the original clinical descriptions of Liepmann in 1900.

A Form of Ideational Apraxia as a Delective Deficit of Contention Scheduling

In this paper we studied three brain-damaged patients: the first two, DR and FG, had limb apraxia whilst the third was a control patient (WH2) with an executive function disorder but without limb apraxia. DR and FG were impaired in carrying out everyday actions, whilst they maintained the ability to sequence photographs representing those same activities. The failure in the action production task was not caused by visual agnosia for objects, as the patients could recognise them from sight. Nor was it produced by a loss of knowledge about their functions (De Renzi & Lucchelli, 1988), as DR and FG could identify objects from descriptions of their use. WH2's pattern of performance doubly dissociated from that of the apraxic patients, namely spared action production on the multiple object test, but faulty sequencing of photographs. WH2's difficulties in sequencing photographs were not due to a failure to understand the task, as she could sequence stimuli other than actions (e.g., shapes and numbers). Nor were the differences due to a loss of knowledge about the actions, since she could perform and identify them from photographs. These results show that the kind of apraxia observed in DR and FG is not produced by a degraded action sequence representation (Lehmkuhl & Poeck, 1981; Poeck & Lehmkuhl, 1980). We interpreted our results within a contention scheduling model (Cooper & Shallice, 2000; Norman & Shallice, 1986).

A Form of Ideational Apraxia as a Delective Deficit of Contention Scheduling

In this paper we studied three brain-damaged patients: the first two, DR and FG, had limb apraxia whilst the third was a control patient (WH2) with an executive function disorder but without limb apraxia. DR and FG were impaired in carrying out everyday actions, whilst they maintained the ability to sequence photographs representing those same activities. The failure in the action production task was not caused by visual agnosia for objects, as the patients could recognise them from sight. Nor was it produced by a loss of knowledge about their functions (De Renzi & Lucchelli, 1988), as DR and FG could identify objects from descriptions of their use. WH2's pattern of performance doubly dissociated from that of the apraxic patients, namely spared action production on the multiple object test, but faulty sequencing of photographs. WH2's difficulties in sequencing photographs were not due to a failure to understand the task, as she could sequence stimuli other than actions (e.g., shapes and numbers). Nor were the differences due to a loss of knowledge about the actions, since she could perform and identify them from photographs. These results show that the kind of apraxia observed in DR and FG is not produced by a degraded action sequence representation (Lehmkuhl & Poeck, 1981; Poeck & Lehmkuhl, 1980). We interpreted our results within a contention scheduling model (Cooper & Shallice, 2000; Norman & Shallice, 1986).

Ideomotor Apraxia: a Call to Action

Although ideomotor apraxia (IM) has been a topic of investigation since the early 20th century, progress in studying the models of various investigative groups. As a result, it is difficult to draw conclusions about the expected performance of IM patients on various tests of praxis (e.g. pantomime, single object use, gesture imitation, and naturalistic action); the relationship of IM to ideational apraxia (IA); the degree to which specific error types are diagnostic of one or the other disorder; the relationship of semantic knowledge to gesture representations; and the role of spatiomotor systems external to the stored gesture representation system. Here an updated model of IM is presented, informed by recent physiological and functional neuroimaging literature, as a step towards resolving some of these concerns. The model is intended to lay the groundwork for future investigations of specific performance patterns in different subtypes of IM.

Cognition in Action: Testing a Model of Limb Apraxia

Assessment of limb apraxia is still suffering from Liepmann's legacy and performance in gesture-processing tests is generally rendered by classifying patients' profile according to the classic clinical labels of ideomotor and ideational apraxia. At odds with other cognitive functions, interpretation of apraxia has suffered from a lack of a reliable model which does justice to its complexity. Recently such a model has been proposed (Rothi et al., 1991, 1997). In this article a modified version of this model is presented and predictions are made according to its functional architecture. Five different patterns of impairment of gesture processing are postulated. To validate the predicted performance profiles, 19 left-hemisphere-damaged patients were assessed by means of an ad hoc battery of four praxis tests. Four of the five predicted apraxia patterns were observed, the fifth being more equivocal. These results support the need to overcome the simplistic dichotomous view of apraxia and confirm the fruitfulness of a model of normal gesture processing in order to understand dissociations in apraxia.

Limb apraxias: higher-order disorders of sensorimotor integration.

Limb apraxia comprises a wide spectrum of higher-order motor disorders that result from acquired brain disease affecting the performance of skilled, learned movements. At present, limb apraxia is primarily classified by the nature of the errors made by the patient and the pathways through which these errors are elicited, based on a two-system model for the organization of action: a conceptual system and a production system. Dysfunction of the former would cause ideational (or conceptual) apraxia, whereas impairment of the latter would induce ideomotor and limb-kinetic apraxia. Currently, it is possible to approach several types of limb apraxia within the framework of our knowledge of the modular organization of the brain. Multiple parallel parietofrontal circuits, devoted to specific sensorimotor transformations, have been described in monkeys: visual and somatosensory transformations for reaching; transformation of information about the location of body parts necessary for the control of movements; somatosensory transformation for posture; visual transformation for grasping; and internal representation of actions. Evidence from anatomical and functional brain imaging studies suggests that the organization of the cortical motor system in humans is based on the same principles. Imitation of postures and movements also seems to be subserved by dedicated neural systems, according to the content of the gesture (meaningful versus meaningless) to be imitated. Damage to these systems would produce different types of ideomotor and limb-kinetic praxic deficits depending on the context in which the movement is performed and the cognitive demands of the action. On the other hand, ideational (or conceptual) apraxia would reflect an inability to select and use objects due to the disruption of normal integration between systems subserving the functional knowledge of actions and those involved in object knowledge.

The rehabilitation of limb apraxia: A study in left-brain–damaged patients

Smania N, Girardi F, Domenicali C, Lora E, Aglioti S. The rehabilitation of limb apraxia: a study in left-brain–damaged patients. Arch Phys Med Rehabil 2000;81:379-88. Objective: To assess the effectiveness of a rehabilitative training program for patients with limb apraxia. Design: Randomized, controlled trial. Setting: Neurologic rehabilitation unit of a university hospital. Patients: Thirteen patients with acquired brain injury and limb apraxia (lasting more than 2 months) as a result of lesions involving the left cerebral hemisphere. Patients were assigned to a study group or to a control group following a randomization scheme. The study group underwent an experimental training for limb apraxia. The control group received conventional treatment for aphasia. Intervention: A behavioral training program consisting of gesture-production exercises. The rehabilitative program was made up of 3 sections dedicated to the treatment of gestures with or without symbolic value and related or nonrelated to the use of objects. Thirty-five experimental sessions, each lasting 50 minutes, were given. Main Outcome Measures: Neuropsychologic tests for assessment of aphasia, verbal comprehension, “general intelligence,” oral apraxia, constructional apraxia, and 3 tests concerning limb praxic function (ideational apraxia, ideomotor apraxia, gesture recognition). Scores related to each test were used to measure the outcome. Video recordings of ideational and ideomotor apraxia tests allowed us to register type and number of praxic errors. All outcome measures, except the aphasia test, were recorded before and after the experimental (or control) treatment time interval. Results: The patients in the study group achieved a significant improvement of performance in both ideational (p =.039) and ideomotor (p =.043) apraxia tests. They also showed a significant reduction of errors in ideational (p =.001) and ideomotor (p <.001) apraxia tests. A trend toward improvement was found in the gesture comprehension test (p =.058), while other outcome measures did not show any significant amelioration. Control patients did not show any significant change in performance. Conclusions: The results show the possible effectiveness of a specific training program for the treatment of limb apraxia. © 2000 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation

Limb apraxia.

Limb apraxia is an impairment in the ability to perform skilled, purposive limb movements as the result of neurological dysfunction. In right-handed individuals, limb apraxia is associated with left hemisphere lesions. This article reviews the subtypes and neuroanatomic correlates of limb apraxia, including limb kinetic apraxia, ideomotor apraxia, ideational apraxia, and conceptual apraxia. The functional impact of limb apraxia on the individual is discussed. Strategies for the assessment and management of this disorder are reviewed.

Use of a content methodology process to enhance feeding abilities threatened by ideational apraxia in people with Alzheimer's-type dementia.

Self-feeding behavior is often the first of a chain of self-maintenance skills to deteriorate in people with Alzheimer's-type dementia and is a major determinant of institutionalization. Moreover, nurses working in geriatric settings report the feeding of patients as a most difficult management problem. Of the various features of Alzheimer's-type dementia that can affect a person's ability to feed him- or herself, ideational apraxia can explain the loss of ability to conceptualize, plan, and execute the complex sequence of motor actions involving the use of tools or objects necessary for feeding. In this article, a systematic process is used to review the research literature to develop substantive content for nurses caring for people with feeding problems related to ideational apraxia. Ideational apraxia is a condition in which an individual is unable to plan movement related to an object because he or she has lost the perception of the object's purpose. The specific abilities necessary for feeding that are threatened by ideational apraxia are identified. A tool to assess these abilities is described, and nursing interventions aimed at enhancing or preserving existing abilities, preventing excess disability, or compensating for lost abilities are presented.

IDEATIONAL APRAXIA AND NATURALISTIC ACTION

It is frequently claimed that ideational apraxia, an impairm ent of the performance of complex actions with objects, is a left-hemisphere syndrome. We assessed the consequences of lefthemisphere damage for naturalistic action performance in two studies. In Study 1, we compared the action errors of left-hemisphere stroke patients (LCVA) to previously reported patients with right-hemisphere stroke (RCVA) and closed head injury (CHI), and found that LCVA were no more vulnerable to errors of action than the other patient groups once differences in severity were controlled. In Study 2, we compared the naturalistic action performance of a patient with severe ideational apraxia and left-hemisphere damage to that of two RCVA patients of equal clinical severity. There was considerable quantitative and qualitative similarity in the errors of the three patients. From these and other findings, we argue that deficits in left-hem isphere systems do not compromise com plex action in a unique or transparent manner. We offer an alternative account based on nonspecific resource limitations that accommodates the data from all patient groups.

Intervention Effectiveness: Evidence from a Case Study of Ideomotor and Ideational Apraxia

This paper considers the characteristics of apraxia and presents a case study which explores the effectiveness of tactile and kinaesthetic stimulation as an intervention strategy, in addition to visual and verbal mediation input, in the rehabilitation of a man with ideomotor and ideational apraxia following a head injury. Using an ABA design, quantitative measures were used to monitor change in motor performance. The results indicated some significant differences in measured performances between baseline and intervention phases and provided limited evidence of the effectiveness of additional sensory input. The implications for occupational therapy are discussed as are the limitations of the study.

Gerstmann's Syndrome and Ideational Apraxia with a Right Cerebral Hemispheric Lesion: A Case Report

Abstract We report an ambidextrous patient with a right parieto-occipital subcortical haemorrhage who exhibited Gerstmann's syndrome, ideational apraxia, constructional apraxia, dressing apraxia, and left hemispatial neglect. Though Gerstmann's syndrome and ideational apraxia are generally caused by a left cerebral hemispheric lesion, we thought the right cerebral hemispheric lesion to be responsible for these symptoms. The features of the case provide important information regarding the laterality and localization of Gerstmann's syndrome and ideational apraxia, especially in this ambidextrous patient.

Gerstmann's syndrome and ideational apraxia with a right cerebral hemispheric lesion: a case report

Gerstmann's syndrome and ideational apraxia with a right cerebral hemispheric lesion: a case report