Task demands and limb apraxia in stroke

Production of co-speech gestures in the right hemisphere: Evidence from individuals with complete or anterior callosotomy

INTRODUCTION

A right-hand preference for co-speech gestures in right-handed neurotypical individuals as well as the co-occurrence of speech and gesture has induced neuropsychological research to primarily target the left hemisphere when investigating co-speech gesture production. However, the substantial number of spontaneous left-hand gestures in right-handed individuals has, thus far, been unexplained. Recent studies in individuals with complete callosotomy and exclusive left hemisphere speech production show a reliable left-hand preference for co-speech gestures, indicating a right hemispheric generation. However, the findings raise the issue if the separate right hemisphere is able to also generate representational gestures. The present study challenges the proposition of a specific right hemispheric contribution to gesture production by differentiating gesture types including representational ones in individuals with complete callosotomy and by including individuals with anterior callosotomy in whom neural reorganization is less extensive.

METHODS

Three right-handed individuals with complete commissurotomy (A.A., N.G., G.C.) and three right-handed individuals with anterior callosotomy (C.E., S.R., L. D), all with left hemisphere language dominance, and a matched right-handed neurotypical control group (n = 10) were examined in an experimental setting, including re-narration of a nonverbal animated cartoon and responding to intelligence questions. The participants' video-taped hand movement behavior was analyzed by two independent certified raters with the NEUROGES-ELAN system for nonverbal behavior and gesture. Unimanual right-hand and left-hand gestures were classified into eight gesture types.

RESULTS

The individuals with complete and anterior callosotomy performed unimanual co-speech gestures with the left as well as the right hand, with no significant preference of one hand for gestures overall. Concerning the specific gesture types, the group with complete callosotomy showed a significant right-hand preference for pantomime gestures, which also applied to the callosotomy total group. The group with anterior callosotomy displayed a significant left-hand preference for form presentation gestures. As a trend, the callosotomy total group differed from the neurotypical group as they performed more left-hand egocentric deictic and left-hand form presentation gestures.

DISCUSSION

The present study replicates the finding of a substantial left-hand use for unimanual co-speech gestures in individuals with complete callosotomy. The proposition of a right hemispheric contribution to gesture production independent from left hemispheric language production is corroborated by the finding that individuals with anterior callosotomy show a similar pattern of hand use for gestures. Representational gestures were displayed with either hand, suggesting that in particular right hemispheric spatial cognition can be directly expressed in gesture. The significant right-hand preference for pantomime gesture was outstanding and compatible with the established left hemispheric specialization for tool use praxis. The findings shed a new light on the left-hand gestures in neurotypical individuals, suggesting that these can be generated in the right hemisphere.

Electrophysiological correlates of action monitoring in brain-damaged patients: A systematic review

Action monitoring is crucial to the successful execution of an action and understanding the actions of others. It is often impaired due to brain lesions, in particular after stroke. This systematic review aims to map the literature on the neurophysiological correlates of action monitoring in patients with brain lesions. Eighteen studies were identified and divided into two groups: studies on monitoring of one's own actions and studies on monitoring of the actions of others. The first group included EEG studies on monitoring of self-performed erroneous and correct actions. Impaired error detection (decreased error-related negativity) was observed in patients with lesions in the performance-monitoring network, as compared to healthy controls. Less consistent results were shown for error positivity and behavioral error monitoring performance. The second group of studies on monitoring of others' actions reported decreased mu frequency suppression, impaired readiness potential in the affected hemisphere and decreased EEG indices of error observation (observed error positivity and theta power) in stroke patients. As a whole, these results indicate distinct patterns of impaired neurophysiological activity related to monitoring one's own versus others' actions in patients with brain lesions. EEG recordings of this dissociation in the same patients might be a useful index of motor recovery, and therefore, potentially also beneficial in rehabilitation protocols.

Bilateral functional connectivity at rest predicts apraxic symptoms after left hemisphere stroke

Increasing evidence indicates that focal lesions following stroke cause alterations in connectivity among functional brain networks. Functional connectivity between hemispheres has been shown to be particularly critical for predicting stroke-related behavioral deficits and recovery of motor function and attention. Much less is known, however, about the relevance of interhemispheric functional connectivity for cognitive abilities like praxis that rely on strongly lateralized brain networks. In the current study, we examine correlations between symptoms of apraxia-a disorder of skilled action that cannot be attributed to lower-level sensory or motor impairments-and spontaneous, resting brain activity in functional MRI in chronic left hemisphere stroke patients and neurologically-intact control participants. Using a data-driven approach, we identified 32 regions-of-interest in which pairwise functional connectivity correlated with two distinct measures of apraxia, even when controlling for age, head motion, lesion volume, and other artifacts: overall ability to pantomime the typical use of a tool, and disproportionate difficulty pantomiming the use of tools associated with different, competing use and grasp-to-move actions (e.g., setting a kitchen timer versus picking it up). Better performance on both measures correlated with stronger interhemispheric functional connectivity. Relevant regions in the right hemisphere were often homologous to left hemisphere areas associated with tool use and action. Additionally, relative to overall pantomime accuracy, disproportionate difficulty pantomiming the use of tools associated with competing use and grasp actions was associated with weakened functional connectivity among a more strongly left-lateralized and peri-Sylvian set of brain regions. Finally, patient performance on both measures of apraxia was best predicted by a model that incorporated information about lesion location and functional connectivity, and functional connectivity continued to explain unique variance in behavior even after accounting for lesion loci. These results indicate that interhemispheric functional connectivity is relevant even for a strongly lateralized cognitive ability like praxis and emphasize the importance of the right hemisphere in skilled action.

Limb apraxia in aphasic patients

ABSTRACT Limb apraxia is usually associated with left cerebral hemisphere damage, with numerous case studies involving aphasic patients. The aim of this study was to verify the occurrence of limb apraxia in aphasic patients and analyze its nature. This study involved 44 healthy volunteers and 28 aphasic patients matched for age and education. AH participants were assessed using a limb apraxia battery comprising subtests evaluating lexical-semantic aspects related to the comprehension/production of gestures as well as motor movements. Aphasics had worse performances on many tasks related to conceptual components of gestures. The difficulty found on the imitation of dynamic gesture tasks also indicated that there were specific motor difficulties in gesture planning. These results reinforce the importance of conducting limb apraxia assessment in aphasic patients and also highlight pantomime difficulties as a good predictor for semantic disturbances.

Pantomime-Grasping: Advance Knowledge of Haptic Feedback Availability Supports an Absolute Visuo-Haptic Calibration

An emerging issue in movement neurosciences is whether haptic feedback influences the nature of the information supporting a simulated grasping response (i.e., pantomime-grasping). In particular, recent work by our group contrasted pantomime-grasping responses performed with (i.e., PH+ trials) and without (i.e., PH− trials) terminal haptic feedback in separate blocks of trials. Results showed that PH− trials were mediated via relative visual information. In contrast, PH+ trials showed evidence of an absolute visuo-haptic calibration—a finding attributed to an error signal derived from a comparison between expected and actual haptic feedback (i.e., an internal forward model). The present study examined whether advanced knowledge of haptic feedback availability influences the aforementioned calibration process. To that end, PH− and PH+ trials were completed in separate blocks (i.e., the feedback schedule used in our group’s previous study) and a block wherein PH− and PH+ trials were randomly interleaved on a trial-by-trial basis (i.e., random feedback schedule). In other words, the random feedback schedule precluded participants from predicting whether haptic feedback would be available at the movement goal location. We computed just-noticeable-difference (JND) values to determine whether responses adhered to, or violated, the relative psychophysical principles of Weber’s law. Results for the blocked feedback schedule replicated our group’s previous work, whereas in the random feedback schedule PH− and PH+ trials were supported via relative visual information. Accordingly, we propose that a priori knowledge of haptic feedback is necessary to support an absolute visuo-haptic calibration. Moreover, our results demonstrate that the presence and expectancy of haptic feedback is an important consideration in contrasting the behavioral and neural properties of natural and simulated grasping.

Dysfunction of the Human Mirror Neuron System in Ideomotor Apraxia: Evidence from Mu Suppression

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).

The influence of action execution on end-state comfort and underlying movement kinematics: An examination of right and left handed participants

People typically move in an anticipatory manner, planning the intended action in advance to minimize the energy costs associated with producing the action (e.g., Rosenbaum et al., 2009). This is exemplified behaviorally in the end-state comfort effect, which is characterized by the selection of an uncomfortable initial posture to enable a comfortable posture upon completion of the movement (Rosenbaum et al., 1990). The main objective of this study was to further investigate the end-state comfort effect in left- and right-handers (N=20). More specifically, to: (a) understand the influence of mode of action execution; and (b) delineate the role of handedness. The overturned glass task (Fischman, 1997) was used as means of assessment, where participants were asked to demonstrate picking up a glass to pour water in four modes of execution: (1) pantomime without a stimulus; (2) pantomime with image of the glass as a guide; (3) pantomime with glass as a guide; and (4) grasping the glass. End-state comfort was displayed regardless of mode of execution, hand used to complete the task or handedness group. However, kinematic analysis revealed distinct differences, highlighting how movement parameters are altered as a result the mode of action execution.

Association of ideomotor apraxia with lesion site, etiology, neglect, and functional independence in patients with first ever stroke

BACKGROUND

Ideomotor apraxia (IMA) is characterized by the inability to correctly imitate hand gestures and voluntarily pantomime tool use. The relationship between IMA and characteristics of stroke has not been totally elucidated.

OBJECTIVE

This study aimed to find out associations between presence of IMA and stroke etiology, site of the lesions, neglect, and temporal and functional parameters of stroke in patients with first ever stroke.

METHODS

Thirty-nine patients with first ever stroke were included. Patients with severe cognitive deficits were excluded. Assessment tools included Ideomotor Apraxia Test, Functional Independence Measure (FIM), Brunnstrom recovery stages, Mini Mental Test (MMT), and star cancellation test. Etiology (hemorrhagic or ischemic) and site of stroke was assessed through brain imaging methods. Location and size of ischemic lesion was determined by using the Oxfordshire Community Stroke Project system.

RESULTS

IMA was identified in 35.9% of the patients. Patients with IMA had significantly lower FIM scores both on admission and discharge (P = 0.001, P = 0.001). Presence of IMA was significantly associated with the presence of neglect (P = 0.004), total anterior circulation ischemia (TACI) (P < 0.001), and lower MMT scores (P < 0.001). Lesion site, patient age, time since onset, and stroke etiology had no impact on the presence of IMA.

CONCLUSION

IMA was in concordance with poor cognitive and functional state and was not limited to left hemisphere lesions. The study revealed strong associations between IMA, neglect, and TACI. Every patient with stroke should be evaluated for the presence of IMA on admission to rehabilitation unit.

Tool use disorders after left brain damage

In this paper we review studies that investigated tool use disorders in left-brain damaged (LBD) patients over the last 30 years. Four tasks are classically used in the field of apraxia: Pantomime of tool use, single tool use, real tool use and mechanical problem solving. Our aim was to address two issues, namely, (1) the role of mechanical knowledge in real tool use and (2) the cognitive mechanisms underlying pantomime of tool use, a task widely employed by clinicians and researchers. To do so, we extracted data from 36 papers and computed the difference between healthy subjects and LBD patients. On the whole, pantomime of tool use is the most difficult task and real tool use is the easiest one. Moreover, associations seem to appear between pantomime of tool use, real tool use and mechanical problem solving. These results suggest that the loss of mechanical knowledge is critical in LBD patients, even if all of those tasks (and particularly pantomime of tool use) might put differential demands on semantic memory and working memory.

A model-based approach to long-term recovery of limb apraxia after stroke

Limb apraxia is a disorder affecting performance of gestures on verbal command (pantomime), on imitation, and/or in tool and action recognition. We aimed to examine recovery on tasks assessing both conceptual and production aspects of limb praxis in left (n = 22) and right (n = 15) stroke patients. Patients were assessed longitudinally on four conceptual tasks (action identification, tool naming by action, tool identification, and tool naming) and five production tasks (pantomime, pantomime by picture, concurrent imitation, delayed imitation, and tool use). They were grouped as impaired or not relative to the performance of a control sample (n = 27) and as acute-subacute (first assessment within 3 months post stroke) or chronic (over 3 months post stroke). Hierarchical linear modeling was used to analyze the data. Acute-subacute and chronic patients had similar average performance. All tasks, except action identification, showed evidence of recovery in both acute and chronic impaired patients. A faster rate of recovery among acute-subacute patients was observed only in the two pantomime tasks (action identification and tool identification were not compared on this factor).

Associations and dissociations of transitive and intransitive gestures in left and right hemisphere stroke patients

The study investigated performance on pantomime and imitation of transitive and intransitive gestures in 80 stroke patients, 42 with left (LHD) and 38 with right (RHD) hemisphere damage. Patients were also categorized in two groups based on the time that has elapsed between their stroke and the apraxia assessment: acute-subacute (n=42) and chronic (n=38). In addition, patterns of performance in apraxia were examined. We expected that acute-subacute patients would be more impaired than chronic patients and that LHD patients would be more impaired than RHD patients, relative to controls. The hemisphere prediction was confirmed, replicating previous findings. The frequency of apraxia was also higher in all LHD time post-stroke groups. The most common impairment after LHD was impairment in both pantomime and imitation in both transitive and intransitive gestures. Selective deficits in imitation were more frequent after RHD for transitive gestures but for intransitive gestures they were more frequent after LHD. Patients were more impaired on imitation than pantomime, relative to controls. In addition, after looking at both gesture types concurrently, we have described cases of patients who suffered deficits in pantomime of intransitive gestures with preserved performance on transitive gestures. Such cases show that the right hemisphere may be in some cases critical for the successful pantomime of intransitive gestures and the neural networks subserving them may be distinct. Chronic patients were also less impaired than acute-subacute patients, even though the difference did not reach significance. A longitudinal study is needed to examine the recovery patterns in both LHD and RHD patients.

The importance of object similarity in the production and identification of actions associated with objects

Past research suggests that the similarity between the objects associated with actions impacts visual action identification and action production. Indeed, people often confuse actions that are visually similar, as well as actions that are associated with visually similar objects. However, because the action errors often involve actions that are visually similar and are associated with visually similar objects, it is difficult to disambiguate between the influences of object similarity and action similarity. In our experiments, healthy participants were asked to learn to associate nonword names and actions with novel objects. Participants were first shown each object and its action and were then asked to visually identify each object. In Experiment 1, participants were then asked to produce the action associated with each object, and in Experiment 2, they were asked to visually identify the action associated with each object. Actions were confused more often when they were associated with similar objects than when they were associated with dissimilar objects. Furthermore, following an object naming error, participants were more likely to produce the action associated with the erroneous name than any other erroneous action. The results suggest that the visual characteristics of the objects influenced action production and action identification.

An experimental investigation of the automatic/voluntary dissociation in limb apraxia

The ability of apraxic patients to perform gestures in everyday life is a controversial issue. In this paper, we aimed to evaluate the automatic/voluntary dissociation (AVD) in four patients affected by clinically relevant limb apraxia. For this purpose, we sampled different kinds of gestures belonging to patients' motor repertoire and then assessed their production in a testing session. Our experimental procedure consisted of two steps: in the first phase, we recorded gestures produced by patients in two natural conditions; in the second phase, we assessed production of correctly produced tool-actions, and of spontaneous non tool-actions and meaningless conversational (cohesive and beats) gestures under different modalities. AVD was observed for all types of gestures, albeit to different degree in single patients. The present findings demonstrate that the context provides strong bottom-up cues for the retrieval of motor patterns, while artificial testing conditions impose an additional cognitive load.

Ideomotor apraxia: A review

Ideomotor apraxia (IMA) is a disorder traditionally characterized by deficits in properly performing tool-use pantomimes (e.g., pretending to use a hammer) and communicative gestures (e.g., waving goodbye). These deficits are typically identified with movements made to verbal command or imitation. Questions about this disorder relate to its diagnosis, anatomical correlates, physiological mechanisms involved, and the patients in whom IMA is best characterized. In this review, utilizing information presented at an international workshop, we summarize the present state of knowledge about IMA. We include insights on how to distinguish IMA from the other motor apraxias and confounding disorders. We discuss testing for IMA and the need for more rigorous tests that examine more elements, such as imitation, actual use, task selection, and recognizing proper use. From neurophysiological insights, we propose hypotheses of the necessity of networks in praxis performance. We also point out that more neurophysiological knowledge in humans might lead to a better understanding of how different brain structures may aid in the rehabilitation of praxis. While little is known about exactly how rehabilitation may be pursued, biological evidence warrants the further exploration of this issue.

Apraxia: a review

Praxic functions are frequently altered following brain lesion, giving rise to apraxia - a complex pattern of impairments that is difficult to assess or interpret. In this chapter, we review the current taxonomies of apraxia and related cognitive and neuropsychological models. We also address the questions of the neuroanatomical correlates of apraxia, the relation between apraxia and aphasia and the analysis of apraxic errors. We provide a possible explanation for the difficulties encountered in investigating apraxia and also several approaches to overcome them, such as systematic investigation and modeling studies. Finally, we argue for a multidisciplinary approach. For example, apraxia should be studied in consideration with and could contribute to other fields such as normal motor control, neuroimaging and neurophysiology.

Left Hemisphere Dominance for Movement

Clinical neuropsychology's dependence upon a core scientific background in clinical neuropsychology, and clinical psychology, neurology, and neuroanatomy, as well as biopsychology, cognitive neuroscience, and cognitive science is the basis of its designation as an APA-approved clinical specialty. This dependence highlights the importance of these scientific underpinnings and the scientist-practitioner model of training, detailed in the Houston Guidelines. This presentation is meant to demonstrate that cognitive neuroscience research should influence our conception of brain behavior relationships, which, in turn, should influence our clinical work. In addition, I want to illustrate how the utilization of converging methods, which is an increasingly popular approach to research, can ensure more valid conclusions about the neuroanatomical substrates for complex skills. Limb apraxia will be used as an example of a deficit that has functional implications and whose cognitive mechanisms and neuroanatomical correlates are better understood as a result of research that combines neuroanatomical imaging of brain damaged patients, functional imaging, and cognitive paradigms. This work demonstrates that left frontoparietal circuits control limb praxis and motor sequencing, suggesting that these complex motor skills should be examined in patients with such damage.

The significance of clumsy gestures in apraxia following a left hemisphere stroke

Individuals who sustain a cerebrovascular accident (CVA) in the dominant (typically left) hemisphere, are at increased risk of developing motor skill deficits due to motor-sensory impairments, as well as cognitive impairments (e.g., apraxia). Clumsiness is a central component affecting motor skills in individuals with a left hemisphere CVA (LCVA). The term "clumsiness" however, has not been adequately operationalised in the apraxia literature in clinical terms, thereby making diagnosis difficult and its contribution to apraxic disorders uncertain. Accordingly, in this study "clumsiness" was explicitly defined by establishing a set of four criteria. The non-dominant (left) hand movements of three groups of participants were examined: 10 individuals with limb-apraxia (APX); 8 individuals without limb apraxia who had sustained a LCVA (NAPX); and 19 healthy individuals without a history of brain impairment (NBD). Performance was examined on four sets of motor tasks, including a conventional praxis test, basic perceptual-motor co-ordination and fine movement tasks, and a naturalistic actions test. A striking finding that emerged was that clumsy errors occurred frequently in all groups, including the NBD group, particularly on the praxis and fine motor tasks. In terms of quantity of clumsy errors emitted, the APX group made significantly more clumsy gestures across all four tasks in comparison to the NBD group. No differences emerged between the two clinical groups, however, in terms of total clumsy gestures emitted on the naturalistic action tasks, or the type of clumsy errors emitted on the fine motor tasks. Thus, frequency and types of clumsy gestures were partly determined by task demands. These results highlight the need to consider the contribution of clumsy gestures in limb functioning following hemispheric brain damage. In broad terms, these findings emphasise the importance of adopting more detailed analyses of movement errors in apraxia and assessments of cognitive-based motor functioning following brain impairment.

Spatial and kinematic features of apraxic movement depend on the mode of execution

Knowledge about the dependency of apraxic movements on the mode of execution may enhance the understanding of apraxia and of the cerebral representation of actions. We examined a common tool-use action in nine patients with left hemisphere damage and apraxia. Arm movements during the use of a handsaw were measured and tested in three different modes of execution: pantomime, pantomime with a bar shaped like the handle of the saw, and actual sawing. Analysis concentrated on spatial and kinematic features of the wrist trajectories during these repetitive movements. In healthy control subjects, both pantomime conditions differed from actual use mainly by larger amplitudes during miming. Apraxic patients executed large proportions of their pantomiming movements in an incorrect direction away from the appropriate anteroposterior direction, while other movement features were normal. The availability of the handle-like bar did not improve performance. During actual use, movement direction was constraint by mechanical demands. In this condition patients moved with moderately decreased velocity. However, this deficit was not related to the errors in movement direction characteristic of pantomiming. These data suggest that pantomiming and actual execution of an action are dictated by different external requirements and constraints, pantomiming serves to convey information, while actual use has to obey the mechanical demands of the task. Due to these differences, spatial and kinematic movement features in healthy subjects vary between the modes of execution, movements are differently vulnerable to apraxia, and deficits in patients may dissociate.

Hemispheric specialisation for imitation of hand–head positions and finger configurations: a controlled study in patients with complete callosotomy

Several studies of patients with unilateral brain damage and a patient with spontaneous callosal disconnection [Journal of Neurology, Neurosurgery, and Psychiatry 61 (1996) 176; Neuropsychologia 37 (1999) 559; Neuropsychologia 39 (2001) 1432] suggest that the imitation of positions of the hand relative to the head is a strongly lateralised left hemispheric function. In contrast, the imitation of finger configurations draws on resources of both hemispheres with a predominance of the right hemisphere. While these findings suggest a specific pattern of imitation impairment in split-brain patients, thus far, no imitation deficits have been reported in split-brain patients. Three patients with complete callosotomy and two control groups, four patients with partial callosotomy and 10 healthy subjects, imitated hand-head positions and finger configurations with non-lateralised and tachistoscopic stimulus presentation. In addition, the influence of visual control on the imitation performance was examined. One split-brain patient showed the predicted dissociation as she had severe right hemispheric deficit in imitating hand-head positions, while finger configuration imitation was preserved. The other two split-brain patients had no impairment in hand-head position imitation. Withdrawal of visual control significantly deteriorated imitation of finger configurations in the split-brain group, but not in the controls, demonstrating that the split-brain patients relied heavily on visual control as a compensatory strategy indicating an imitation deficit in the separate hemispheres. The findings question the previously held belief that in split-brain patients both hemispheres are perfectly capable of imitating gestures and that imitation is not dependent on hemispherically specialised functions.

Patterns of limb apraxia in primary progressive aphasia

Primary progressive aphasia (PPA) is a syndrome characterized by a progressive language deficit without other dementia features for at least two years (). Other deficits that are likely to co-exist with aphasia, such as apraxia, have only been investigated in a few case studies and only at a rudimentary level for the most part. In this study we investigate the frequency and severity of apraxic deficits in PPA patients. Ten PPA patients and twelve aged-matched healthy adults performed eight transitive gestures to pantomime and to imitation. Gesture performance was measured along five movement dimensions and a composite score based on the arithmetic mean of the five dimensions was calculated. Overall, PPA patients performed worse than controls with both pantomime and imitation. Furthermore, individual comparisons revealed that out of the three apraxia patterns described by (pantomime alone, imitation alone, or apraxia in both conditions), the most frequent pattern in PPA patients was apraxia in both conditions. This result corresponds with previous findings in populations of stroke and Alzheimer's patients. Considering the occurrence of apraxia in this population, this study supports the idea that a comprehensive apraxia assessment should be administered in cases of PPA.

Defective pantomime of object use in left brain damage: apraxia or asymbolia?

Disturbance of pantomime of object use in patients with left brain damage (LBD) and aphasia has been firmly established but its nature remains controversial. It may be due to an inability to perform movements from memory without external support by objects (apraxia) or to an inability to produce signs referring to absent objects and actions (asymbolia). The need to perform movements without external support is shared with imitation of gestures, and the demand to designate absent objects with drawing from memory. Both of these tasks have been found to be impaired in LBD. We examined pantomime of object use, drawing objects from memory, imitation of meaningless gestures, and aphasia in 40 patients with LBD and aphasia and compared them to healthy controls and to patients with right brain damage (RBD). Whereas drawing showed comparable sensitivity to LBD and RBD, pantomime was distinctly more disturbed in LBD than in RBD patients. Pantomime was worse than drawing in LBD but better than drawing in RBD. In the LBD group scores on pantomime showed significant correlations of very similar strength to drawing, imitation, and all language tests. Multidimensional scaling of the correlational structure placed pantomime in an intermediate position between verbal and non-verbal tests. We conclude that neither apraxia nor asymbolia can satisfactorily explain our results. It seems as if pantomime of object use taps a central aspect of left hemisphere function which is compromised by any LBD. We propose that this may be the ability to select and combine distinctive features of objects and actions.

Manual asymmetries in tool-use: Implications for apraxia

Previous examinations of manual performance asymmetries have utilised relatively simple movements such as goal-directed aiming and rapid finger-tapping. In the present research, three-dimensional kinematic analyses were employed to examine manual asymmetries in the production of transitive limb gestures. Transitive limb gestures involve the use of tools and/or objects and are complex movements used in the evaluation of limb apraxia. Ten healthy right hand dominant participants produced two transitive limb gestures in response to verbal command both with (tool-use) and without (pantomime) the appropriate tool. Analyses revealed a dominant (right) hand advantage, although the magnitude of this advantage was influenced by movement context (pantomime vs tool-use). This study provides the first evidence that manual asymmetries are elicited during the production of transitive limb gestures, and mandates that future kinematic analyses of limb apraxia consider the impact of pre-morbid manual asymmetries when contrasting the performance of left and right hemisphere damaged patients.

Deconstructing apraxia: understanding disorders of intentional movement after stroke

Impairments in praxic functioning are common after stroke, most frequently when the left hemisphere is affected. Several recent studies of apraxia after stroke have made advances in understanding the right hemisphere contribution to praxis, particularly for the performance of novel actions. Moreover, quantitative lesion analysis in stroke patients indicates the importance of cortical regions such as the intraparietal sulcus and the middle frontal gyrus for subserving praxic function. Complex neuropsychological models have been developed to account for the many dissociations observed in the types of errors observed in stroke patients. Relatively lacking, however, are models that attempt to relate the neurological data to what is known about praxis from functional neuroimaging in normal subjects and from physiological studies in the monkey. Moreover, a coherent interpretation of the results of apraxia studies remains hampered by the lack of a standard testing instrument to assess the nature and severity of apraxic impairments in the groups tested.