Ideational Apraxia Research Articles

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

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.

The basal ganglia and apraxia.

Ever since Liepmann's original descriptions at the beginning of the century apraxia has usually been attributed to damage confined to the cerebral cortex and/or cortico-cortical connecting pathways. However, there have been suggestions that apraxia can be due to deep subcortical lesions, which raises the question as to whether damage to the basal ganglia or thalamus can cause apraxia. We therefore analysed 82 cases of such 'deep' apraxias reported in the literature. These reports consisted of a small number (n=9) of cases studied neuropathologically, and a much larger group (n=73) in which CT or MRI was used to identify the size and extent of the lesion. The reports were subdivided into (i) those with small isolated lesions which involved nuclei of the basal ganglia or thalamus only, and not extending to involve periventricular or peristriatal white matter; (ii) those with large lesions which involved two or more of the nuclei, or one or more of these deep structures plus damage to closely adjacent areas including the internal capsule, periventricular or peristriatal white matter; and (iii) lesions sparing basal ganglia and thalamus but involving adjacent white matter. The main conclusions to be drawn from this meta-analysis are that lesions confined to the basal ganglia (putamen, caudate nucleus and globus pallidus) rarely, if ever, cause apraxia. Lesions affecting the lenticular nucleus or putamen nearly always intruded into the adjacent lateral white matter to involve association fibres, in particular those of the superior longitudinal fasciculus and frontostriatal connections. Apraxia occurred with deep lesions of the basal ganglia apparently sparing white matter in only eight out of the 82 cases. Apraxia was most commonly seen when there were lesions in the lenticular nucleus or putamen (58 out of 72 cases) with additional involvement of capsular, and particularly of periventricular or peristriatal, white matter. Lesions of the globus pallidus (no cases) or caudate nucleus (three cases) rarely caused apraxia. The caudate lesions also had white matter involvement. Indeed, involvement of periventricular white matter alone caused apraxia. The vast majority of cases described with apraxia associated with deep lesions were in the left, dominant hemisphere. Ideomotor apraxia was described in most reports (72 out of 82 cases). Orofacial apraxia was less common (37 cases), usually with ideomotor apraxia. Ideational apraxia was rare (five cases), all with ideomotor apraxia. Apraxia was either bilateral or involved the left hand if there was a right hemiparesis, in those cases where descriptions were available. Lesions of the thalamus can sometimes cause apraxia (26 cases), even if there is no apparent involvement of white matter (12 cases). Small lesions confined to the thalamus can also sometimes cause apraxia (eight cases). The role of the thalamus in higher order motor control and apraxia remains to be determined. It is suggested that the term limb-kinetic apraxia should be retained to describe motor deficits in planning 'what to do', 'how to do it' and 'when to do it'; decisions which appear to involve activation of a complex distributed network of dorsolateral prefrontal cortex, supplementary motor areas, anterior cingulate regions and lateral premotor cortex. Such deficits need to be quantified. If they are present in patients with basal ganglia disease, over and above classical akinesia, bradykinesia and hypokinesia, then such patients could be said to exhibit limb-kinetic apraxia.

Human motor planning, motor programming, and use of new task-relevant information with different apraxic syndromes.

Patients with ideomotor apraxia (n = 2) or ideational apraxia (n = 2) after left brain stroke and patients with constructional apraxia (n = 2) after cerebrovascular accident of the right hemisphere, as well as 16 non-brain-damaged control subjects, were given a standardized simple motor task: they were asked to make triangular arm movements of specific size, configuration and spatial orientation without visual control. Motion was analysed three-dimensionally in great detail prior to and after kinaesthetic training using a triangular stencil, and 1 day later. The experiment was conceptualized to assess three aspects of motor behaviour: (i) motor planning, operationalized as specification of content parameters of the movement as a whole; (ii) motor programming, the specification of spatiotemporal parameters of movement segments; and (iii) the ability to make use of task-relevant information provided by the training. Patients with ideational apraxia showed signs of impaired motor planning: they had difficulty in selecting the body parts to be moved, and movement concept and configurational aspects were deficient. The kinaesthetic sensorimotor training given seemed not adequate to reduce behavioural deficits. Kinematic peculiarities of patients with ideomotor apraxia can be understood as deficits in programming movement elements. Submovements were more segmented, showed irregularities as well as additional, not-requested elements. Their impairments could be reduced by task-specific sensorimotor training. Patients suffering from visuoconstructive apraxia after right brain damage might have difficulties in making use of new sensorimotor information relevant for spatial-motor aspects, as suggested by training-induced behavioural impairment with a severely constructional apraxic patient.

Stone tools and conceptual structure

AbstractUnderstanding how conceptual structures inform stone tool production and use would help us resolve the issue of a pongid-hominid dichotomy in brain organisation and cognitive ability. Evidence from ideational apraxia suggests that the planning of linguistic and manipulative behaviours is not colocalized in homologous circuits. An alternative account in terms of the evolutionary expansion of the whole prefrontal-premotor area may be more plausible.

Naturalistic action and praxis in callosal apraxia

Abstract We report a subject who, subsequent to closed head injury, demonstrated a severe left hand ideational apraxia and apraxic agraphia, consistent with callosal disconnection syndrome. In contrast to the left hand, performance of the right hand was unimpaired on traditional tests of gesture to command, sight of object, and with actual object use, but proved deficient on tests of spatial and constructional ability. We examined the consequences of these hand-specific deficits for the performance of naturalistic action tasks. The patient made errors with each hand; however, the right hand performed more poorly than the left hand. In addition, the types of errors made by each hand differed in a manner consistent with the results of neuropsychological testing and indicative of disconnection phenomena. We suggest that unlike gesture, naturalistic action requires the contribution of the specialized abilities of each hemisphere, integrated across callosal structures. Traditional testing of gesture may undere...

A case of ideational apraxia with impairment of object use and preservation of object pantomime

A case of ideational apraxia with impairment of object use and preservation of object pantomime

A Case of Ideational Apraxia with Impairment of Object Use and Preservation of Object Pantomime

A case of tool use disturbance without impairment of motor skills and of conceptual knowledge of how tool must be used is reported. The patient could not manipulate objects isolatedly or in succession but could pantomime their use on command and on imitation. This finding suggests that manipulation of objects may dissociate from pantomime without objects. We interpret this syndrome as a results of mismatch of tool and tool use.

Ideomotor and ideational apraxia in alzheimer's disease

AbstractIdeomotor apraxia (IMA) and ideational apraxia (IA) were studied in 32 Alzheimer's disease (AD) patients and in 30 non‐demented elderly controls using a standardized apraxia battery. AD patients performed significantly worse than controls on all apraxia tests, and were more impaired when pantomiming movements than when imitating movements. IMA and IA scores correlated with severity of dementia as measured by the Mini‐Mental State Examination. Analysis of individual performances revealed dissociated apraxic disorders in four patients, which may be interpreted as a manifestation of focal damage to left hemisphere cortical systems involved in praxis. Furthermore, these results suggest a greater ideational than ideomotor defect in apraxic AD patients.

Ideational and Ideomotor Apraxia: A Qualitative Analysis

This paper reviews research into both ideational and ideomotor apraxia focusing on the qualitative aspects of limb apraxia. The criteria based on a distinction between different type of movements which have been used to distinguish between ideational (IA) and ideomotor apraxia (IMA) are reviewed together with an evaluation of the most frequent methods of testing and their effects on patients responses. Finally a list of the types of response reported in the literature is presented and their relationship with IA and IMA is proposed.

Ideational and ideomotor apraxia: a qualitative analysis.

This paper reviews research into both ideational and ideomotor apraxia focusing on the qualitative aspects of limb apraxia. The criteria based on a distinction between different type of movements which have been used to distinguish between ideational (IA) and ideomotor apraxia (IMA) are reviewed together with an evaluation of the most frequent methods of testing and their effects on patients responses. Finally a list of the types of response reported in the literature is presented and their relationship with IA and IMA is proposed.

A Quantitative Analysis of Apraxia in Senile Dementia of the Alzheimer Type: Stage-Related Differences in Prevalence and Type

Apraxia is clinically separable from other cognitive dysfunctions and has the potential to interfere with motor performance in everyday living. To determine its prevalence and severity at each stage of senile dementia of the Alzheimer type (SDAT), a quantitative apraxia battery was used in conjunction with comprehensive quantitative cognitive assessments of 142 SDAT subjects who fell into four stages of dementia severity, and 113 elderly persons determined to be intellectually healthy by the same cognitive assessment. Thirty-five percent of the mildly, 58% of moderately, and 98% of severely demented SDAT subjects showed apraxia. When ideomotor and ideational apraxia were considered separately, ideomotor apraxia was apparent in mild dementia, while ideational apraxia was found only in moderate and severe dementia. When a covariate analysis was employed to test the influence of aphasia that is known to occur in SDAT, ideomotor (but not ideational) deficits were found to be statistically distinct from language impairment. Taken together the findings suggest that ideomotor apraxia may be tied to loss of functional independence in individuals with SDAT.

Associative agnosias and the functions of the left hemisphere

Associative agnosias are traditionally regarded as perceptual, and ideational apraxia as motor, deficits, but they can be understood as amnesias for generic knowledge, caused by bilateral or unilateral left-hemispheric cortical lesions. Current theories of hemispheric specialization explain these syndromes' mandatory link with left-hemispheric damage, and are validated by this link. This link reflects the multiple nature of generic, categorical representational systems, not all reducible to natural language, and the left hemisphere's principal role as their substrate, regardless of their dependence on language. The distinction between processing novel information, and processing based on well-established, routinized representations, captures a fundamental difference between the functions of the right and left hemispheres. The complementary link of apperceptive agnosias with right-and associative agnosias with left-hemisphere lesions is an expression of this general principle in the posterior cortex. Future studies of the neuroanatomy of agnosias in animals may offer insights into the evolutionary continuities of hemispheric specialization.

Apraxia in Alzheimer's disease.

We studied apraxia in 28 patients with senile dementia of the Alzheimer type (SDAT). Although SDAT patients were impaired compared with age-matched controls on tests of ideomotor and ideational apraxia, not all types of movements were affected to the same degree. Limb transitive movements were especially vulnerable, while limb intransitive, buccofacial, and axial movements were relatively spared. When pantomiming limb transitive movements, SDAT patients made frequent body part as object and spatial errors. There was no significant difference between performance on verbal command and imitation, but there was considerable improvement with the use of actual objects. Disorders of skilled movement in SDAT were qualitatively similar to the apraxic syndromes following left parietal damage. Apraxia in SDAT suggests posterior left hemisphere cortical involvement and may be apparent even in patients with good language functions.

Ideational apraxia: A deficit in tool selection and use

We report a 67-year-old left-handed man who exhibited an ideational apraxia in both clinical and nonclinical natural settings following a right hemisphere infarction. His inability to use tools could not be explained by a motor production deficit (ideomotor apraxia), because he made content errors and could not match tools with objects. His deficit could not be attributed to an agnosia or language comprehension deficit, because he could name tools and point to tools on command. Based on our testing, it appeared that this patient had a loss of knowledge related to tool use.

Performance on a Fine Motor Task by Dominant Hemiplegics

The left and right hand performance of 321 right-dominant older unimpaired persons on a timed test of fine motor planning was compared with that of 244 right-dominant patients with unilatereral brain damage following stroke, using the unaffected hand. The test task, a cost- and time-efficient measure of manipulative ability, differentiated between older unimpaired persons and hemiplegic patients but did not discriminate side affected. The significant effects of right and left hemisphere stroke, aphasia, advancing age, and sex differences on manipulative ability, and their implications, are discussed in relation to the literature on ideational apraxia.

A Review of Apraxia

Constructional, ideomotor and ideational apraxia are described in order to demonstrate their distinguishing characteristics. Tests were constructed to be able to distinguish between constructional apraxia and spatial problems in patients suffering from a CVA. The results of evaluating 15 right hemisphere CVA patients on the tests were analysed to determine the patient's problem. The test scores and test taking behaviour of two patients are presented to demonstrate that the difference between constructional apraxia and spatial problems cannot be diagnosed through test scores alone. Further, some of the effects of apraxia on the everyday function of the patient is described.

Kepiński's functional structures, Kohonen's topological structures, aphasia and apraxia.

The concept of functional structures was introduced by Kepiński. At the Second Scandinavian Congress on Image Analysis in 1981 Kohonen provided evidence that the map of signals has the same topological order as the map of reactions. These topological concepts can be applied also to logical structures. The same is true also of functional structures described by Kepiński in schizophrenia, which may be created or destroyed, but their topological order remains unaltered. Functional structures change in obscuration and in hallucinogen-induced psychodelic states. Fixed pathological structures characterized by an altered topological order occur in paranoia. In the case of amnestic aphasia single elements of the topological functional structures fall out-these elements represent terms which patient is unable to recall. In motor aphasia, on the other hand, damage concerns the topological functional structures of speech related movements. In sensory aphasia damage concerns topological functional structures in the sensory area. In Goldstein's amnestic apraxia there is a loss of some elements of the topological functional structures governing the movements. In ideational apraxia the damage concerns topological functional structures representing entire sets of motor function and especially their creation. In ideomotor apraxia the respective topological functional structures are retained, albeit inaccessible, due to a disturbance in the motor association. In motor apraxia the damage seems to concern the topological functional structures governing precise movements and located at a lower level, i.e., closer to the effector. Constructive apraxia seems to result from the disturbed creation of the respective functional structures. Similarly the hypermotility of a maniacal type has a smooth and purposeful character, as far as the relation to a particular situation is concerned, which suggests that the respective topological functional structures are preserved. On the other hand, in the hyperkinetic phase of catatonic schizophrenia, in which the patient performs sequences of incoherent aimless movements without any relation to the current situation and environment, these structures are supposedly altered.

Neuropsychological Symptoms in Cases Suspected of Alzheimer's Disease

Neuropsychological symptoms were studied in 9 cases of presenile dementia suspected of Alzheimer's disease. The patients were diagnosed according to their clinical symptoms, CT-scans and EEGs. (1) Major clinical symptoms included memory disturbance (9 cases), visuo-spatial agnosia (8 cases), constructional apraxia (7 cases), and difficulty in the use of implements (5 cases). (2) In symptoms of visuo-spatial agnosia, disorders of spatial perception and loss of topographical memory were frequent; however, no unilateral visual neglect was observed. (3) Ideomotor apraxia (1 case) and ideational apraxia (2 cases) were observed. Five cases showed difficulty or clumsiness in the use of implements, such as gas or oil heaters, telephones, cultivators, etc. (4) Eight cases showed fluent speech and mild word amnesia. They also showed mild disturbance in language comprehension, especially in word meaning comprehension. Writing to dictation in Kanji characters was more impaired than that in Kana syllabary. (5) From CT-scan studies, the relationship between the location of prominent cerebral atrophy and the neuropsychological symptoms was investigated.

The clinical examination for motor apraxia

The signs and symptoms of motor apraxia are described both for ideomotor and ideational apraxia. Typical errors are described. For ideomotor apraxia a list of tasks is given. The many conceptual and psychometric problems that still await an answer are briefly discussed.

Ideational apraxia.

Ideational apraxia is a rare behavioural disturbance observed in patients with a lesion in the posterior part of the hemisphere dominant for language. The main feature is an impairment in carrying out sequences of actions requiring the use of various objects in the correct order necessary to achieve an intended purpose. The syndrome cannot be explained as being due to paresis, aphasia, impaired visual recognition, mental deterioration or a combination of these disorders. It must be considered as a higher order motor disturbance. Perservation plays an important role but can not explain the syndrome. Evidence is presented to suggest that ideational apraxia is a disturbance in the conceptual organization of actions. Lines of future research are indicated.