Apraxia

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What is the meaning of praxis?: To do or action.
Define apraxia:: An acquired disorder of purposeful, skilled movements.
How would apraxia be ruled out as the cause of the motor disturbance?: The motor disturbance would not be caused by paresis, abnormal tone or posture, akinesia, ataxia, sensory loss, inattention, poor comprehension, or other cognitive problems.
What is the most common type of apraxia?: Ideomotor apraxia.
Who distinguished apraxia as a distinct disorder?: Hugo Liepmann
Liepman's neuroanatomical model of apraxia implicates which brain regions?: Left parietal area for control of complex movement, mediated by the left frontal lobe and area4 for the right side of the body.
What are some problems with Liepman's theory?: He does not take into account the basal ganglia and thalamus.
Describe Limb-Kinetic Apraxia:: The loss of kinetic memories for a single limb, which can be related to small lesions in motor cortex which are not enough to produce paresis.
What functions are affected in limb-kinetic apraxia?: Fine motor movements, particularly finger movements. Gross motor skills are fine.
What are some ways of testing for limb-kinetic apraxia?: Simple manual acts, such as playing cards, picking up coin from the table, or buttoning a shirt. On formal tests, problems would be seen on the grooved pegboard and finger tapping test.
Where would be lesion site be located in l-k apraxia?: Limited lesions of contralateral premotor area or subjacent white matter.
What is ideomotor apraxia?: Problems with the execution of individual components of actions A separation occurs between idea of an act and it's performance.
In ideomotor apraxia, can spontaneous movement be performed okay?: Yes. Comprehension is ok, the motor system is intact, and the activity can be performed spontaneously.
In ideomotor apraxia, can the patient perform the movements when they are using tools?: No. There is both transitive (using tool) & intransitive (not involving tools, like waving goodbye, cougin) issues, though moreso with transitive.
Does im apraxia refer to single actions or sequential motor performance?: Single action.
What is the best way to test for ideomotor apraxia?: Ask patient to pantomime actions to verbal commands..then imitation...then use of actual object.
Are there typically unilateral or bilateral deficits in ideomotor apraxia?: Bilateral (although unilateral can exist). Problems can be seen in oral, limb, or axial musculature.
Described progressive commands that can be administered to assess buccofacial apraxia:: Gesture - kiss the air or say "pa"
Imagined - pretend to blow out match, such straw, etc.
Real - blow out match, etc.
Buccofacial apraxia is common in which disorder?: Broca's aphasia.
What are some steps to assess limb apraxia?: Gesture - salute, wave goodbye
Imagined - pretend to use comb
Real- comb hair, write w/pencil
What can be done to assess axial apraxia?: Have them look up, close eyes
Neck - bend head down
Trunk - stand, kneel, walk backwards
What would one see in a spatial error?: Correct core movement, but the limb moving through space is incorrect - like sawing horizontally rather than vertically.
What would a verbalization error look like?: Saying the action, like "cough," instead of performing the action.
Identify one common error in ideomotor apraxia?: Using body as part of the object. Sequencing errors and timing errors can also occur.
In ideomotor apraxia, where is the lesion site?: Left-hemisphere dominance for praxis. It can occur with lesions surrounding the perisylvian region.
What would happen with a lesion to the left parietal lobe?: Can damage arcuate fasciculus, which can disrupt information from traveling anteriorly and prevents the motor system from receiving direction to act (can see w/conduction aphasia)
What can occur with a large lesion to the left premotor area?: It can interfere with motor execution (can be seen in nonfluent aphasia & hemiparesis).
What is ideational apraxia?: Failure to perform sequential motor movements. Each component part can be performed alone, but not in sequence.
Do you see unilateral or bilateral deficits in ideational apraxia?: Bilateral deficits. There is lots of conceptual confusion.
How can one test ideational apraxia?: Have patient perform series of component (e.g., fold letter, insert in envelope, seal it, etc.).
Where is the lesion site in ideational apraxia?: Can be seen in extensive damage to the left parietal lobe. It most often occurs with diffuse cortical involvement in dementia.
Describe one hypothesis that has been proposed first by Liepmann and then by Geschwind.: The disconnection hypothesis, suggesting disconnect btwn critical left cortical areas from regions of execution. It's the inability to make correct motor sequences in response to language.
Describe another hypothesis proposed by Heilman.: The visuo-kinesthetic engrams supposedly exist in the inferior parietal lobe, which premises that the nervous system learns & stores skilled movements.
If the "praxicons" exist in the parietal lobe, what would cause the apraxia?: Disconnection between the area that stores this information and the premotor/motor regions will cause problems with skilled movements.
Are the basal ganglia and/or cerebellum associated with apraxia?: No. They are typically associated with nonapraxic movements, such as postural change, tone, tremor, etc.
Why are many apraxic patients also aphasic?: Because of lesions near or overlapping the speech centers.
Define constructional apraxia:: Problems with building things, assembling, or drawing. Testing can include copying - house, cube, clock, etc. Has been thought be be associated with parietal lesions.
In dressing apraxia, where are the lesions typically?: Right hemisphere lesions. Most common in demential or confusional states.
Where are the lesions typically in dressing apraxia?: Can be caused by a number of different lesions, including left-sided neglect, Balint's syndrome.
What type of apraxia leads to inability to perform purposeful ocular movements?: Ocular apraxia, which is a component of Balint's syndrome.
What are the common deficits in ocular apraxia?: Visual scanning deficits, inability to shift gaze at will towards a novel target & problems maintaining fixation.
What are the characteristics of optic ataxia or optic apraxia?: Problems with searching movements that affects visually guided hand movements.
Where are the lesions typically in optic apraxia?: Bilateral posterior parietal lesions. This is seen in Balint's syndrome.
What brain region is typically affected in gait dyspraxia?: Frontal lobe, and is a first and most prominent symptom of NPH.
What are the characteristics of gait dyspraxia?: Failing to alternate leg movements, not shifting weight forward, picking up same leg 2x in a row, foot magnetized to floor. Good stepping reflex though.
What are the characteristics associated with apraxia of speech?: Articulation disorder resulting from brain damage - programming problem of the musculature & sequencing of muscle movements.
What is callosal apraxia?: It's a type of ideomotor apraxia associated with problems executing motor sequencing of the left hand following lesions of the corpus callosum.
What are the underying problems associated with frontal apraxia?: Temporal or sequential disorganization, where verbal mediation does not improve performance (actions are series of isolated fragments).

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