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A 70-year-old man presented with slow gait and a clumsy hand on the right side. Neurological examination revealed dystonia and ideomotor apraxia in the right hand. A mask-like face, rigidity in the right arm, and shuffling gait were noticed. Treatment with L-dopa had no effect. He was ......

Rationale: We report the possible therapeutic efficacy of immersive virtual reality (VR) rehabilitation for the treatment of ideomotor apraxia in a patient with stroke. Patient concerns: A 56-year-old man with sudden weakness of his left side caused by right frontal, parietal, and corpus callosal infarction was transferred to rehabilitation medicine center for intensive rehabilitation. Although his left-sided weakness had almost subsided 10 days after the onset of symptoms, he presented difficulty using his left hand and required assistance in most activities of daily living. Diagnoses: Ideomotor apraxia in a patient with right hemispheric infarction. Interventions: VR content was displayed to the study participants using a head-mounted display that involved catching of moving fish in the sea by grasping. Before and after of rehabilitative intervention including VR, functional measurements incorporating the Test of Upper Limb Apraxia (TULIA) were conducted. To directly compare therapeutic potencies under different conditions, success rates of consecutive grasping gesture performance were observed in VR, conventional occupational therapy setting, and augmented reality intervention. Outcomes: The patient demonstrated remarkable amelioration of apraxic symptoms while performing the task in the VR environment. At 1 and 3 months after the training, he showed significant improvement in most functions, and the TULIA score increased to 176 from 121 at the initiation of therapy. The number of successful grasps during 30 trials of each grasp trial was 28 in VR, 8 in the occupational therapy setting, and 20 in augmented reality. Lessons: This case report suggests the possible therapeutic efficacy of immersive VR training as a rehabilitative measure for ideomotor apraxia.

Background Neurodegenerative disorders are characterized by insidious progression with poorly-delineated long latent period. Antecedent clinical insult could rarely unmask latent neurodegenerative disorders. Here, we report an autopsy-proven case of corticobasal degeneration which was preceded by a lacunar infarction. Case presentation A 58-year-old man presented with acute ataxia associated with a lacunar infarction in the right paramedian pons. His ataxia persisted with additional progressive gait difficulty and left arm clumsiness. Six months later, a follow-up neurological examination showed asymmetrical bradykinesia, apraxia, dystonic posturing, postural instability, and mild ataxia of the left limbs. Cognitive examination revealed frontal executive dysfunction and visuospatial difficulties. Dopamine transporter imaging scan demonstrated bilateral reduced uptakes in mid-to-posterior putamen, more prominent on the right side. Levodopa-unresponsive parkinsonism, asymmetric limb dystonia, and ideomotor apraxia became more conspicuous, while limb ataxia gradually vanished. The patient became unable to walk without assistance after 1 year, and died 4 years after the symptom onset. Autopsy findings showed frontoparietal cortical atrophy, ballooned neurons, and phosphorylated tau-positive astrocytic plaques and neuropil threads with gliosis and neuronal loss, confirming the corticobasal degeneration. Conclusions The case illustrates that precedent clinical events such as stroke might tip a patient with subclinical CBS into overt clinical manifestations.

Neuropsychologia : an international journal in behavioural and cognitive neuroscience 159, 107921 (2021). doi:10.1016/j.neuropsychologia.2021.107921, Published by Elsevier Science, Amsterdam [u.a.]

A 59-year-old right-handed hypertensive diabetic and previously alcoholic man presented acute confusional state followed by apathy, dysexecutive syndrome, clumsy left hand, and apraxic gait. A year later, his wife noticed impaired hearing. Neurologic examination revealed marked callosal apraxia (nondominant limb ideomotor apraxia, disconnection variant) and left stereoagnosis due to callosal disconnection (video). Left hand agraphia was present without aphasia. MRI showed punched out holes through corpus callosum, sparing the calloso-septal interface (figure 1). Audiometry revealed left neurosensorial loss. Fluorescein retinography demonstrated hyperfluorescence of arterial vessel wall (figure 2), confirming the hypothesis of Susac syndrome.1

Background: Left hemisphere stroke often causes a severe communication disorder that is usually attributed to aphasia. While aphasia refers to linguistic problems, communication is also accomplished by voluntarily articulate and gestural movements, which may be compromised due to apraxia. Along with aphasia, apraxia is a common disorder in left hemisphere stroke, which in severe cases can limit the use of verbal and nonverbal communication methods. The discussion about apraxia from a communicative perspective is still scarce, although the disorder is regularly experienced among left hemisphere stroke patients with aphasia. The rehabilitation of the disorder in severe apraxia-aphasia is challenging and recovery is slow. Aims: The purpose of this study is to provide an overview of the research on long-term recovery from apraxia and to discuss the meaning of these findings in observing the recovery of communication abilities in a person with a severe apraxia-aphasia. The search was not restricted to any specific type of apraxia, as this review assumes that communication may be influenced by apraxia in its different manifestations. The review is based on a systematic literature search, which includes English-language studies retrieved from the databases of Ovid Medline, PsycINFO, and Scopus. Main Contribution: Seven long-term follow-up studies of apraxia were found; one case study of apraxia of speech (AOS), four group studies of ideomotor apraxia (IMA), one case study of IMA (and aphasia), and one group study of limb apraxia. Conclusions: The reviewed group studies of patients with left hemisphere stroke indicate that apraxia is a persistent disorder, but the steepest recovery occurs within the first few months post-stroke. Imitation skills and actions involving real-tool use in activities of daily functions show the best recovery. Real-tool use also continues to improve longer, while recovery of gesturing after verbal command may not show clear signs of recovery in the chronic stage post-stroke. There is some evidence that the pace of recovery from oral apraxia and limb apraxia is comparable, and recovery from apraxia and aphasia would not correlate. Some of the studies used only imitation to assess changes in gesturing, which cannot be regarded as an ecologically valid measure to compare gesturing in natural communicative situations or even gesturing after verbal command. Finally, no follow-up studies were found that would have discussed apraxia from a communicative perspective. Overall, the field is lacking research on long-term follow-up of patients with apraxic-aphasic disorder.

Objectives A 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. Methods Thirteen 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. Results The 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). Conclusions MB 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.

BACKGROUND: Many patients with early-onset Alzheimer’s disease (EOAD; age of onset

OBJECTIVEApraxia is a cognitive-motor deficit affecting the execution of skilled movements, termed praxis gestures, in the absence of primary sensory or motor disorders. In patients affected by stroke, apraxia is associated with lesions of the lateral parietofrontal stream, connecting the posterior parietal areas with the ventrolateral premotor area and subserving sensory-motor integration for the hand movements. In the neurosurgical literature to date, there are few reports regarding the incidence of apraxia after glioma surgery. A retrospective analysis of patients who harbored a glioma around the central sulcus and close to the parietofrontal circuits in depth showed a high incidence of long-term postoperative hand apraxia, impairing the patients’ quality of life. To avoid the occurrence of postoperative apraxia, the authors sought to develop an innovative intraoperative hand manipulation task (HMt) that can be used in association with the brain mapping technique to identify and preserve the cortical and subcortical structures belonging to the praxis network.METHODSThe intraoperative efficacy of the HMt was investigated by comparing the incidence of postoperative ideomotor apraxia between patients undergoing mapping with (n = 79) and without (n = 41) the HMt. Patient groups were balanced for all demographic and clinical features.RESULTSIn patients with lesions in the dominant hemisphere, the HMt dramatically reduced the incidence of apraxia, with a higher sensitivity for the ideomotor than for the constructional abilities; patients with lesions in the nondominant hemisphere benefitted from the HMt for both ideomotor and constructional abilities. The administration of the test did not reduce the extent of resection.CONCLUSIONSThe HMt is a safe and feasible intraoperative tool that allowed surgeons to prevent the occurrence of long-term hand apraxia while attaining resection goals for the surgical treatment of glioma.

A 61-year-old woman was admitted to our hospital due to memory difficulties, visual hallucinations, and slowly progressing motor difficulties in the limbs. A clinical examination revealed bradykinesia, gait disturbance, left-side-dominant rigidity, ideomotor apraxia, dressing apraxia, left-sided spatial agnosia, impaired visuospatial ability, and executive dysfunction. Her symptoms were unresponsive to levodopa, and corticobasal syndrome (CBS) was diagnosed. One year later, amyloid positron emission tomography revealed amyloid beta accumulation in the bilateral cerebral cortices; at this point, CBS with underlying Alzheimer's disease pathology (CBS-AD) was diagnosed. Visual hallucinations may help differentiate CBS with corticobasal degeneration (CBS-CBD) from other pathologies, including CBS-AD.

Rationale We report the possible therapeutic efficacy of immersive virtual reality (VR) rehabilitation for the treatment of ideomotor apraxia in a patient with stroke. Patient concerns A 56-year-old man with sudden weakness of his left side caused by right frontal, parietal, and corpus callosal infarction was transferred to rehabilitation medicine center for intensive rehabilitation. Although his left-sided weakness had almost subsided 10 days after the onset of symptoms, he presented difficulty using his left hand and required assistance in most activities of daily living. Diagnoses Ideomotor apraxia in a patient with right hemispheric infarction. Interventions VR content was displayed to the study participants using a head-mounted display that involved catching of moving fish in the sea by grasping. Before and after of rehabilitative intervention including VR, functional measurements incorporating the Test of Upper Limb Apraxia (TULIA) were conducted. To directly compare therapeutic potencies under different conditions, success rates of consecutive grasping gesture performance were observed in VR, conventional occupational therapy setting, and augmented reality intervention. Outcomes The patient demonstrated remarkable amelioration of apraxic symptoms while performing the task in the VR environment. At 1 and 3 months after the training, he showed significant improvement in most functions, and the TULIA score increased to 176 from 121 at the initiation of therapy. The number of successful grasps during 30 trials of each grasp trial was 28 in VR, 8 in the occupational therapy setting, and 20 in augmented reality. Lessons This case report suggests the possible therapeutic efficacy of immersive VR training as a rehabilitative measure for ideomotor apraxia.

Objectives: The potential value of gestures needs to be evaluated as an unaided alternative and augmentative communication (AAC) method to improve the naming ability of persons with Alzheimer's disease (AD). Considering the possible effect of ideomotor apraxia (IMA) in AD patients, the current study...

Objectives: The cardinal motor deficits seen in ideomotor limb apraxia are thought to arise from damage to internal representations for actions developed through learning and experience. However, whether apraxic patients learn to develop new representations with training is not well understood. We studied the capacity of apraxic patients for motor adaptation, a process associated with the development of a new internal representation of the relationship between movements and their sensory effects. Methods: Thirteen healthy adults and 23 patients with left hemisphere stroke (12 apraxic, 11 nonapraxic) adapted to a 30-degree visuomotor rotation. Results: While healthy and nonapraxic participants successfully adapted, apraxics did not. Rather, they showed a rapid decrease in error early but no further improvement thereafter, suggesting a deficit in the slow, but not the fast component of a dual-process model of adaptation. The magnitude of this late learning deficit was predicted by the degree of apraxia, and was correlated with the volume of damage in parietal cortex. Apraxics also demonstrated an initial after-effect similar to the other groups likely reflecting the early learning, but this after-effect was not sustained and performance returned to baseline levels more rapidly, consistent with a disrupted slow learning process. Conclusions: These findings suggest that the early phase of learning may be intact in apraxia, but this leads to the development of a fragile representation that is rapidly forgotten. The association between this deficit and left parietal damage points to a key role for this region in learning to form stable internal representations. (JINS, 2017, 23, 139–149)

Previous neuropsychological studies of ideomotor apraxia (IMA) indicated impairments in pantomime actions for tool use for both right and left hands following lesions of parieto-premotor cortices in the left hemisphere. Using functional magnetic resonance imaging (fMRI) with multi-voxel pattern analysis (MVPA), we tested the hypothesis that the left parieto-premotor cortices are involved in the storage or retrieval of hand-independent representation of tool-use actions. In the fMRI scanner, one of three kinds of tools was displayed in pictures or letters, and the participants made pantomimes of the use of these tools using the right hand for the picture stimuli or with the left hand for the letters. We then used MVPA to classify which kind of tool the subjects were pantomiming. Whole-brain searchlight analysis revealed successful decoding using the activities largely in the contralateral primary sensorimotor region, ipsilateral cerebellum, and bilateral early visual area, which may reflect differences in low-level sensorimotor components for three types of pantomimes. Furthermore, a successful cross-classification between the right and left hands was possible using the activities of the left inferior parietal lobule (IPL) near the junction of the anterior intraparietal sulcus. Our finding indicates that the left anterior intraparietal cortex plays an important role in the production of tool-use pantomimes in a hand-independent manner, and independent of stimuli modality.

Stroke patients with ideomotor apraxia (IMA) have difficulties controlling voluntary motor actions, as clearly seen when asked to imitate simple gestures performed by the examiner. Despite extensive research, the neurophysiological mechanisms underlying failure to imitate gestures in IMA remain controversial. The aim of the current study was to explore the relationship between imitation failure in IMA and mirror neuron system (MNS) functioning. Mirror neurons were found to play a crucial role in movement imitation and in imitation-based motor learning. Their recruitment during movement observation and execution is signaled in EEG recordings by suppression of the lower (8–10 Hz) mu range. We examined the modulation of EEG in this range in stroke patients with left (n = 21) and right (n = 15) hemisphere damage during observation of video clips showing different manual movements. IMA severity was assessed by the DeRenzi standardized diagnostic test. Results showed that failure to imitate observed manual movements correlated with diminished mu suppression in patients with damage to the right inferior parietal lobule and in patients with damage to the right inferior frontal gyrus pars opercularis—areas where major components of the human MNS are assumed to reside. Voxel-based lesion symptom mapping revealed a significant impact on imitation capacity for the left inferior and superior parietal lobules and the left post central gyrus. Both left and right hemisphere damages were associated with imitation failure typical of IMA, yet a clear demonstration of relationship to the MNS was obtained only in the right hemisphere damage group. Suppression of the 8–10 Hz range was stronger in central compared with occipital sites, pointing to a dominant implication of mu rather than alpha rhythms. However, the suppression correlated with De Renzi's apraxia test scores not only in central but also in occipital sites, suggesting a multifactorial mechanism for IMA, with a possible impact for deranged visual attention (alpha suppression) beyond the effect of MNS damage (mu suppression).

We report a rare case of a patient with corticobasal degeneration (CBD) who was also diagnosed with complex regional pain syndrome type I (CRPS I), which has similar clinical characteristics. A 76-year-old man who had been diagnosed with CBD several years prior presented with asymmetric severe pain, postural instability, limb rigidity, limb dystonia, tremor, ideomotor apraxia, and bradykinesia especially on his left upper extremity on admission at our rehabilitation center. Additional physical examination showed darkened skin color change, edema, reduced skin elasticity, cold skin temperature, wet skin, and limited range of motion (ROM) of the left side compared to the right side. A three-phase bone scan was done resulting CRPS I. Therefore, we initiated treatment for CRPS I, including steroid pulse therapies and non-steroidal anti-inflammatory drugs (NSAID); subsequently, his left extremity pain reduced from a visual analogue scale (VAS) score of 8-9 to 3 and his functional level also improved. To the best of our knowledge, this is the first case report of a CBD patient being also diagnosed with CRPS I. Due to the similar clinical characteristics that two diseases share, we would like to inform the physicians the importance of differentiating the CRPS I from CBD for the quick proper management.

Clinical history A 57-year old woman presented with left hand pain, periodic leg movement during sleep, gradual onset of stiffness, clumsiness, and falls. Neurological examination showed: generalized rigidity and bradykinesia. There was left hand dystonic posturing and ideomotor apraxia, as well as mirror movements of upper limbs and stimulus-sensitive myoclonus. The patient had a high-pitched voice and hypophonia (Video S1). Discussion Experts discuss localization and the syndromic diagnosis and predict the underlying pathology. The pathological diagnosis is then provided and clinical learning points are considered.

Limb apraxia is a heterogeneous disorder of skilled action and tool use that has long perplexed clinicians and researchers. It occurs after damage to various loci in a densely interconnected network of regions in the left temporal, parietal, and frontal lobes. Historically, a highly classificatory approach to the study of apraxia documented numerous patterns of performance related to two major apraxia subtypes: ideational and ideomotor apraxia. More recently, there have been advances in our understanding of the functional neuroanatomy and connectivity of the left-hemisphere “tool use network,” and the patterns of performance that emerge from lesions to different loci within this network. This chapter focuses on the left inferior parietal lobe, and its role in tool and body representation, action prediction, and action selection, and how these functions relate to the deficits seen in patients with apraxia subsequent to parietal lesions. Finally, suggestions are offered for several future directions that will benefit the study of apraxia, including increased attention to research on rehabilitation of this disabling disorder.

We propose STIMA, a short test for ideo-motor apraxia, allowing us to quantify the apraxic deficit according to action meaning and affected body segment. STIMA is based on a neurocognitive model holding that there are two processes involved in action imitation (i.e., a semantic route for recognizing and imitating known gestures, and a direct route for reproducing new gestures). The test allows to identify which imitative process has been selectively impaired by brain damage (direct vs. semantic route) and possible deficits depending on the body segment involved (hand/limb vs. hand/fingers). N = 111 healthy participants were administered with an imitation task in two separated blocks of known and new gestures. In each block, half of the gestures were performed mainly with the proximal part of the upper limb and the remaining half with the distal one. It resulted in 18 known gestures (nine proximal and nine distal) and 18 new gestures (nine proximal and nine distal) for a total of 36. Each gesture was presented up to a maximum of two times. Detailed criteria are used to assign the final imitation score. Cut offs, equivalent scores and main percentile scores were computed for each subscale. Participants imitated better known than new gestures, and proximal better than distal gestures. Age influenced performance on all subscales, while education only affected one subscale. STIMA is easy and quick to administer, and compared to previous tests, it offers important information for planning adequate rehabilitation programs based on the functional locus of the deficit.

A 74-year-old right-handed woman without cognitive impairment suddenly developed nonfluent aphasia. Brain MRI showed acute infarction in the right frontal lobe and insula without involvement of the corpus callosum. A neurological examination demonstrated not only transcortical motor aphasia, but also ideomotor apraxia and right hand predominant constructional apraxia (CA). To date, right hand predominant CA has only been reported in patients with corpus callosum lesions. The right hand predominant CA observed in our patient may be associated with the failure to transfer information on the spatial structure from the right hemisphere to the motor cortex of the left hemisphere.

A 62-year-old woman, previously healthy, presented with 3 weeks of progressive short-term memory loss, dyscalculia, dysgraphia, appetite loss, and frequent episodic left arm dystonic posturing and eyebrow elevation. On examination, she also had finger agnosia, dysarthria, agraphesthesia, and astereognosis bilaterally, with myoclonus, ideomotor apraxia (left worse), and wide-based gait. EEG showed slowing and periodic lateralized discharges over the right hemisphere with triphasic morphology, less often involving the left, reflecting clinical asymmetry (figure 1).1 MRI brain showed diffusion restriction in the bilateral basal ganglia with cortical ribboning more prominent on the right involving several gyri, consistent with Creutzfeldt-Jakob disease (figure 2).2

Studies of patients with brain lesions have demonstrated that language and praxis are mediated by dissociable networks. However, language has the capacity to influence the selection of purposeful actions. The abilities to use language and to program purposeful movements are often mediated by networks that have anatomic proximity. With hemispheric injury, the diagnosis of apraxia is often confounded by the specific influence of language impairments on the ability to select and produce transitive gestures. We report a patient who illustrates this confound. This patient is a right-handed man who developed global aphasia and neglect after a right hemispheric stroke. His right hand remained deft, and when asked to produce specific transitive gestures (pantomimes), he often performed normally but did make some body part as object and perseverative errors. However, he did not demonstrate the temporal or spatial errors typical of ideomotor apraxia. He also had a perseverative agraphia. Our patient’s left hemisphere praxis system appeared to be intact, and the error types demonstrated during production of transitive gestures cannot be attributed to a degradation of postural and movement (praxis) programs mediated by his left hemisphere. The praxis errors types are most consistent with a deficit in the ability to select the necessary praxis programs. Thus, our patient appeared to have dissociation between language and praxis programs that resulted in body part as object and perseverative errors.

Introduction: Apraxia is defined as a disorder of learned skilled movements, in the absence of elementary motor or sensory deficits and general cognitive impairment, such as inattention to commands, object-recognition deficits or poor oral comprehension. Limb apraxia has long been a challenge for clinical assessment and understanding and covers a wide spectrum of disorders, all involving motor cognition and the inability to perform previously learned actions. Demographic variables such as gender, age, and education can influence the performance of individuals on different neuropsychological tests. Objective: The present study aimed to evaluate the performance of healthy subjects on a limb apraxia battery and to determine the influence of gender, age, and education on the praxis skills assessed. Methods: Forty-four subjects underwent a limb apraxia battery, which was composed of numerous subtests for assessing both the semantic aspects of gestural production as well as motor performance itself. The tasks encompassed lexical-semantic aspects related to gestural production and motor activity in response to verbal commands and imitation. Results: We observed no gender effects on any of the subtests. Only the subtest involving visual recognition of transitive gestures showed a correlation between performance and age. However, we observed that education level influenced subject performance for all sub tests involving motor actions, and for most of these, moderate correlations were observed between education level and performance of the praxis tasks. Conclusion: We conclude that the education level of participants can have an important influence on the outcome of limb apraxia tests. RESUMO Introdução: A apraxia é definida como sendo um distúrbio na realização de gestos ou atos motores aprendidos. Há poucos estudos sobre a avaliação da praxia de membros incluindo o controle de variáveis sócio-demográficas. Objetivo: O presente estudo teve por objetivo avaliar o desempenho de indivíduos saudáveis em uma bateria de praxia de membros, analisando-se a influência das variáveis sexo, idade e escolaridade nas habilidades práxicas avaliadas. Métodos: Quarenta e quatro indivíduos foram submetidos à aplicação de uma bateria de praxia de membros, composta de subtestes que avaliaram tanto aspectos semânticos relacionados à produção gestual, quanto a produção motora propriamente dita. Resultados: Não houve influência do sexo em nenhum dos subtestes. Apenas o subteste que envolvia o reconhecimento visual da correta realização de gestos transitivos, mostrou-se sensível à variação da idade. Já a escolaridade influenciou o desempenho dos participantes em todos os testes que envolviam a realização de atos motores, sendo que para a maior parte deles foram encontradas correlações moderadas entre a escolaridade e o desempenho nas tarefas práxicas. Conclusão: Variáveis sócio demográficas, principalmente a escolaridade, podem interferir no desempenho de indivíduos em testes que avaliam a praxia de membros e devem ser consideradas na avaliação clínica.

We report data from a group of patients with mild Alzheimer's disease on a range of tasks requiring either stored semantic knowledge about objects (e.g., naming object use) or the execution of action to objects (e.g., miming and using objects). We found that the patients were impaired at miming in response to objects, even when they could describe the object's function. On the other hand, copying gestures was not impaired relative to naming gestures, indicating that an ideomotor deficit in action execution, per se, was unlikely to explain the impairments in object use. We suggest instead that the patients had an impairment in stored motor programmes for action, over and above their deficits in semantic knowledge. Despite this, the patients were better at using than at miming to objects, consistent with the view that proprioceptive input (when using objects) can directly constrain selection of the appropriate motor programme for action.

The posterior parietal cortex, particularly in the right hemisphere, is crucially important for covert orienting; lesions impair the ability to disengage the focus of covert orienting attention from one potential saccade target to another (Posner, M. I. et al., Journal of Neuroscience, 1984, 4, 1863-1874). We have developed a task where precues allow subjects to covertly prepare subsequent cued hand movements, as opposed to an orienting or eye movement. We refer to this process as motor attention to distinguish it from orienting attention. Nine subjects with lesions that included the left parietal cortex and nine subjects with lesions including the right parietal cortex were compared with control subjects on the task. The left hemisphere subjects showed the same ability as controls to engage attention to a movement when they were forewarned by a valid precue. The left hemisphere subjects, however, were impaired in their ability to disengage the focus of motor attention from one movement to another when the precue was incorrect. The results support the existence of two distinct attentional systems allied to the orienting and limb motor systems. Damage to either system causes analogous problems in disengaging from one orienting/movement target to another. The left parietal cortex, particularly the supramarginal gyrus, is associated with motor attention. All the left hemisphere subjects had ideomotor apraxia and had particular problems performing sequences of movements. We suggest that the well documented left hemisphere and apraxic impairment in movement sequencing is the consequence of a difficulty in shifting the focus of motor attention from one movement in a sequence to the next.

Neurologists are familiar with the standard definition of apraxia: ‘an inability to perform a motor task that cannot be adequately explained by motor weakness, sensory loss or a lack of understanding’. Being a definition of exclusion, this has led to a bewildering number of motor disorders being described as forms of apraxia, despite many of these failing to capture the essence of what apraxia really is: a disorder of motor cognition. Apraxia reflects an impairment of the storage and transformation of motor representations in the brain, either through degradation of the semantic knowledge of gestures and tool use or through inability to translate the neural representations of higher level goals accurately into lower level patterns of muscle activation and inhibition. Our current clinical approach to apraxia is similar to that proposed by Liepman in the early 20th century.1 He recognised that left hemispheric lesions tend to cause bilateral upper limb apraxia and suggested a model of motor control in which the left parietal lobe stores a ‘space–time form picture’ of a movement. For a movement to be executed, its picture must be retrieved and activated and then be associated via cortical projections with the relevant motor engrams in the prefrontal regions. From here the information passes to the primary motor cortex before being fed down the corticospinal tracts. For the right upper limb to move the information remains contained within the left hemisphere, but for the left upper limb to move the information from the left parietal lobe must first be sent to the right prefrontal and frontal regions through the corpus callosum. Using this scheme, Liepman delineated three forms of apraxia. He described ideational apraxia as a disruption of the space–time picture, in which the idea of the movement itself is lost or degraded. In ideomotor apraxia , …

We aimed to investigate the effect of hand effector and handedness on the cerebral lateralization of pantomiming learned movements. Fourteen right‐handed and 14 left‐handed volunteers performed unimanual and bimanual tool‐use pantomimes with their dominant or nondominant hand during fMRI. A left hemispheric lateralization was observed in the right‐ and left‐handed group regardless of which hand(s) performed the task. Asymmetry was most marked in the dorsolateral prefrontal cortex (DLPFC), premotor cortex (PMC), and superior and inferior parietal lobules (SPL and IPL). Unimanual pantomimes did not reveal any significant differences in asymmetric cerebral activation patterns between left‐ and right‐handers. Bimanual pantomimes showed increased left premotor and posterior parietal activation in left‐ and right‐handers. Lateralization indices (LI) of the 10% most active voxels in DLPFC, PMC, SPL, and IPL were calculated for each individual in a contrast that compared all tool versus all control conditions. Left‐handers showed a significantly reduced overall LI compared with right‐handers. This was mainly due to diminished asymmetry in the IPL and SPL. We conclude that the recollection and pantomiming of learned gestures recruits a similar left lateralized activation pattern in right and left‐handed individuals. Handedness only influences the strength (not the side) of the lateralization, with left‐handers showing a reduced degree of asymmetry that is most readily observed over the posterior parietal region. Together with similar findings in language and visual processing, these results point to a lesser hemispheric specialization in left‐handers that may be considered in the cost/benefit assessment to explain the disproportionate handedness polymorphism in humans. Hum Brain Mapp, 2012. © 2011 Wiley Periodicals, Inc.

[Purpose] Pusher syndrome, which is a disorder of postural balance that occurs in hemiparetic stroke patients, is characterized by a particular tendency to strongly push toward the hemiparetic side. The purpose of this study was to investigate whether stroke patients with pusher syndrome have ideomotor apraxic behavior. [Subjects] Fifteen stroke patients with pusher syndrome and 31 stroke patients without pusher syndrome were recruited. [Methods] All subjects were tested with two tests assessing ideomotor apraxia of movements of the upper and lower limbs. Each test included 12 items of movements, which required the subjects to reproduce movements by imitation after presentation. [Results] Patients with pusher syndrome had significantly lower ideomotor apraxia scores in all of the upper and lower limbs than patients without pusher syndrome. A significant difference was observed between the two groups in the existence of neglect. [Conclusion] We found that patients with pusher syndrome had more severe apraxic disorder in all of the upper and lower limbs than patients without pusher syndrome. Pusher syndrome may be attributable to disabilities in motor planning and execution, which are required to compensate for the partial damage to the postural control system.

Rationale Reversible splenial lesion syndrome (RESLES) is a reversible condition with an excellent prognosis in most patients. The clinical features include altered states of consciousness, delirium, headache, and seizures, but no callosal disconnection syndromes have been described in RESLES. Patient concerns We presented a 57-year-old patient with alien hand syndrome, autotopagnosia, gait disorders, and left ideomotor apraxia after blood transfusion. The brain magnetic resonance imaging (MRI) showed a few regions with high signal intensity in the genu, body, and splenium of the right corpus callosum on diffusion weighted images. Cerebrovascular examination was unremarkable. Diagnoses He was diagnosed with RESLES and callosal disconnection syndrome. Interventions The patient received symptomatic and supportive treatment in our hospital. Outcomes He recovered to baseline on following up of 6 months and abnormalities on brain MRI completely disappeared. Lessons Neurologists should be aware of the symptoms of callosal disconnection syndrome in RESLES. In addition, caution should be taken when transfusing blood products in patients with gastrointestinal bleeding.

This study aims to reveal the neural correlates of planning and executing tool use pantomimes and explores the brain's response to pantomiming the use of unfamiliar tools. Sixteen right‐handed volunteers planned and executed pantomimes of equally graspable familiar and unfamiliar tools while undergoing fMRI. During the planning of these pantomimes, we found bilateral temporo‐occipital and predominantly left hemispheric frontal and parietal activation. The execution of the pantomimes produced additional activation in frontal and sensorimotor regions. In the left posterior parietal region both familiar and unfamiliar tool pantomimes elicit peak activity in the anterior portion of the lateral bank of the intraparietal sulcus—A region associated with the representation of action goals. The cerebral activation during these pantomimes is remarkably similar for familiar and unfamiliar tools, and direct comparisons revealed only few differences. First, the left cuneus is significantly active during the planning of pantomimes of unfamiliar tools, reflecting increased visual processing of the novel objects. Second, executing (but not planning) familiar tool pantomimes showed significant activation on the convex portion of the inferior parietal lobule, a region believed to serve as a repository for skilled object‐related gestures. Given the striking similarity in brain activation while pantomiming familiar and unfamiliar tools, we argue that normal subjects use both action semantics and function from structure inferences simultaneously and interactively to give rise to flexible object‐to‐goal directed behavior. Hum Brain Mapp, 2011. © 2010 Wiley‐Liss, Inc.

The functional components of the human motor system that are used to retrieve and execute simple intransitive hand gestures were identified with a repetition suppression (RS) paradigm. Participants performed movements with the right hand to text instructions in a rapid event related design with a pseudo‐random stimulus order. Brain areas associated with action retrieval were identified by comparing trials where an action was repeated to trials that involved a new action. Performance of a novel action, collapsed across individual actions, resulted in significantly greater activity in a left hemisphere predominant fronto‐parietal circuit involving inferior frontal gyrus and inferior parietal cortex (supramarginal gyrus). This is consistent with previous action retrieval tasks using go, no‐go paradigms and lesion studies of patients with apraxia that emphasize a role of these areas in action organization. In addition, RS effects were present in left primary sensorimotor cortex. These effects cannot be ascribed to kinematic differences, simple action related activity or differences of cognitive set. Significant RS effects for action retrieval could be identified with as little as 5 min of fMRI data and underscores the potential of using RS to characterize representational structure within the motor system. Hum Brain Mapp, 2009. © 2008 Wiley‐Liss, Inc.

Made available in DSpace on 2019-09-12T16:53:45Z (GMT). No. of bitstreams: 0 Previous issue date: 2009 Limb praxis can be influenced by age, gender, and education. The present Study investigated the influence of these variables on gesture production by healthy elderly Subjects. We evaluated 96 individuals divided into two age groups (60-74 and 75-88 years). Each group contained 48 men and 48 women and was subdivided into four groups according to education: illiterates and 1-3, 4-7, and 8 or more years of education. Individuals were requested to carry Out tasks oil verbal command and imitation. There were no differences between the performance of men and women, while older individuals performed worse than their younger counterparts. Regarding educational level, three major groups emerged: illiterates, individuals with 1-7 years of education, and those with 8 or more years of education. In conclusion, age and education significantly influenced the performance of individuals in limb praxis tests. (JINS, 2009, 157 618-622.) [Caramelli, Paulo] Univ Fed Minas Gerais, Fac Med, Dept Internal Med, Behav & Cognit Neurol Unit, BR-30130000 Belo Horizonte, MG, Brazil [Cavalcante, Karla Rodrigues] Universidade de Taubaté (Unitau), Dept Phys Therapy [Cavalcante, Karla Rodrigues; Caramelli, Paulo] Univ Sao Paulo, Sch Med, Dept Neurol, Sao Paulo, Brazil

We sought to determine whether coherent networks which circumvent lesioned cortex are seen in patients with ideomotor apraxia (IMA) while performing tool use pantomimes. Five normal subjects and five patients with IMA (three patients with corticobasal degeneration and two with left hemisphere stroke) underwent 64-channel EEG recording while performing three tool-use pantomimes with their left hand in a self-paced manner. Beta band (20–22 Hz) coherence indicates that normal subjects have a dominant left hemisphere network responsible for praxis preparation, which was absent in patients. Corticobasal degeneration patients showed significant coherence increase between left parietal - right premotor areas. Left hemisphere stroke patients showed significant coherence increases in a right parietofrontal network. The right hemisphere appears to store useable praxis representations in IMA patients with left hemisphere damage.

The objective of this study was to evaluate transfer effects of cognitive strategy training for stroke patients with apraxia. During 8 weeks, 29 apraxic patients received cognitive strategy training to teach them how to perform activities of daily living (ADL) as independently as possible. ADL functioning was assessed at the rehabilitation centre at baseline and after 8 weeks of training. In addition, assessment took place at the patients' own homes after 8 weeks of training and 5 months after the start of the training. The performance of both trained and nontrained tasks was observed. Patients performed trained tasks and nontrained tasks at the same level of independency at the rehabilitation centre as well as at home, indicating transfer of training effects. These effects turned out to be stable over time.

Background Upper limb apraxia is a common disorder associated with stroke that can reduce patients’ independence levels in activities of daily living and increase levels of disability. Traditional rehabilitation programs designed to promote the recovery of upper limb function have mainly focused on restorative or compensatory approaches. However, no previous studies have been completed that evaluate a combined intervention method approach, where patients concurrently receive cognitive training and learn compensatory strategies for enhancing daily living activities. Methods/Design This study will use a two-arm, assessor-blinded, parallel, randomized controlled trial design, involving 40 patients who present a left- or right-sided unilateral vascular lesion poststroke and a clinical diagnosis of upper limb apraxia. Participants will be randomized to either a combined functional rehabilitation or a traditional health education group. The experimental group will receive an 8-week combined functional program at home, including physical and occupational therapy focused on restorative and compensatory techniques for upper limb apraxia, 3 days per week in 30-min intervention periods. The control group will receive a conventional health education program once a month over 8 weeks, based on improving awareness of physical and functional limitations and facilitating the adaptation of patients to the home. Study outcomes will be assessed immediately postintervention and at the 2-month follow-up. The primary outcome measure will be basic activities of daily living skills as assessed with the Barthel Index. Secondary outcome measures will include the following: 1) the Lawton and Brody Instrumental Activities of Daily Living Scale, 2) the Observation and Scoring of ADL-Activities, 3) the De Renzi Test for Ideational Apraxia, 4) the De Renzi Test for Ideomotor Apraxia, 5) Recognition of Gestures, 6) the Test of Upper Limb Apraxia (TULIA), and 7) the Quality of Life Scale For Stroke (ECVI-38). Discussion This trial is expected to clarify the effectiveness of a combined functional rehabilitation approach compared to a conservative intervention for improving upper limb movement and function in poststroke patients. Trial registration Clinical Trial Gov number NCT02199093. The protocol registration was received 23 July 2014. Participant enrollment began on 1 May 2014. The trial is expected to be completed in March 2016. Electronic supplementary material The online version of this article (doi:10.1186/s13063-015-1034-1) contains supplementary material, which is available to authorized users.

Ideomotor apraxia (IMA) of lower limbs has rarely been investigated systematically. This is the aim of the current study. Thirty-five patients with a unilateral stroke in the left hemisphere were tested within 30 days from onset with an upper limb IMA test and with a newly devised test assessing leg IMA. Seventeen patients presented with arm apraxia, six of them also showed severe leg apraxia. Results suggest that IMA of lower limbs emerges in association with severe arm IMA in patients with large lesions, and is a sign of general severity of the patient's conditions.

Objective: This aim of this study was to determine the reliability and validity of an established ideomotor apraxia test when applied to a Turkish stroke patient population and to healthy controls. Subjects: The study group comprised 50 patients with right hemiplegia and 36 with left hemiplegia, who had developed the condition as a result of a cerebrovascular accident, and 33 agematched healthy subjects. Methods: The subjects were evaluated for apraxia using an established ideomotor apraxia test. The cut-off value of the test and the reliability coefficient between observers were determined. Results: Apraxia was found in 54% patients with right hemiplegia (most being severe) and in 25% of left hemiplegic patients (most being mild). The apraxia scores for patients with right hemiplegia were found to be significantly lower than for those with left hemiplegia and for healthy subjects. There was no statistically significant difference between patients with left hemiplegia and healthy subjects. Conclusion: It was shown that the ideomotor apraxia test could distinguish apraxic from non-apraxic subjects. The reliability coefficient among observers in the study was high and a reliability study of the ideomotor apraxia test was therefore performed.

Contains fulltext : 54642.pdf (Publisher’s version ) (Closed access) The present study compared imitation performance in patients with ideomotor apraxia (IMA), eight right hemispheric-damaged patients, and eight control participants without neurological damage in three experiments. Experiment 1 confirmed in the Goldenberg test that IMA patients were particularly impaired in hand gestures and combined finger and hand gestures, but not in the imitation of finger gestures, compared to the other two groups. Experiment 2, however, demonstrated that finger selection is not per se preserved in imitative behaviour in patients with IMA. Experiment 3 confirmed this finding in an experiment under visual control. Together, the results add evidence to the idea that imitation should be viewed from a goal-directed rather than a body-mapping perspective, and that highest priority is given to more distal aspects of imitation as reaching for the correct object, rather than the means used to achieve the goal of a modelled action.