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Bischof GN, Jaeger E, Giehl K, Jessen F, Onur OA, O'Bryant S, Kara E, Weiss PH, Drzezga A. Cortical Tau Aggregation Patterns associated with Apraxia in Alzheimer's Disease. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.04.09.24305535. [PMID: 38645131 PMCID: PMC11030486 DOI: 10.1101/2024.04.09.24305535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/23/2024]
Abstract
Objectives Apraxia is a core feature of Alzheimer's disease, but the pathomechanism of this characteristic symptom is not well understood. Here, we systematically investigated apraxia profiles in a well-defined group of patients with Alzheimer's disease (AD; N=32) who additionally underwent PET imaging with the second-generation tau PET tracer [18F]PI-2620. We hypothesized that specific patterns of tau pathology might be related to apraxic deficits. Methods Patients (N=32) with a biomarker-confirmed diagnosis of Alzheimer's disease were recruited in addition to a sample cognitively unimpaired controls (CU 1 ; N=41). Both groups underwent in-depth neuropsychological assessment of apraxia (Dementia Apraxia Screening Test; DATE and the Cologne Apraxia Screening; KAS). In addition, static PET imaging with [18F]PI-2620 was performed to assess tau pathology in the AD patients. To specifically investigate the association of apraxia with regional tau-pathology, we compared the PET-data from this group with an independent sample of amyloid-negative cognitively intact participants (CU 2; N=54) by generation of z-score-deviation maps as well as voxel- based multiple regression analyses. Results We identified significant clusters of tau-aggregation in praxis-related regions (e.g., supramarginal gyrus, angular gyrus, temporal, parietal and occipital regions) that were associated with apraxia. These regions were similar between the two apraxia assessments. No correlations between tau-tracer uptake in primary motor cortical or subcortical brain regions and apraxia were observed. Conclusions These results suggest that tau deposition in specific cortical brain regions may induce local neuronal dysfunction leading to a dose-dependent functional decline in praxis performance.
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Baumard J, Laniepce A, Lesourd M, Guezouli L, Beaucousin V, Gehin M, Osiurak F, Bartolo A. The Neurocognitive Bases of Meaningful Intransitive Gestures: A Systematic Review and Meta-analysis of Neuropsychological Studies. Neuropsychol Rev 2024:10.1007/s11065-024-09634-6. [PMID: 38448754 DOI: 10.1007/s11065-024-09634-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 01/26/2024] [Indexed: 03/08/2024]
Abstract
Researchers and clinicians have long used meaningful intransitive (i.e., not tool-related; MFI) gestures to assess apraxia-a complex and frequent motor-cognitive disorder. Nevertheless, the neurocognitive bases of these gestures remain incompletely understood. Models of apraxia have assumed that meaningful intransitive gestures depend on either long-term memory (i.e., semantic memory and action lexicons) stored in the left hemisphere, or social cognition and the right hemisphere. This meta-analysis of 42 studies reports the performance of 2659 patients with either left or right hemisphere damage in tests of meaningful intransitive gestures, as compared to other gestures (i.e., MFT or meaningful transitive and MLI or meaningless intransitive) and cognitive tests. The key findings are as follows: (1) deficits of meaningful intransitive gestures are more frequent and severe after left than right hemisphere lesions, but they have been reported in both groups; (2) we found a transitivity effect in patients with lesions of the left hemisphere (i.e., meaningful transitive gestures more difficult than meaningful intransitive gestures) but a "reverse" transitivity effect in patients with lesions of the right hemisphere (i.e., meaningful transitive gestures easier than meaningful intransitive gestures); (3) there is a strong association between meaningful intransitive and transitive (but not meaningless) gestures; (4) isolated deficits of meaningful intransitive gestures are more frequent in cases with right than left hemisphere lesions; (5) these deficits may occur in the absence of language and semantic memory impairments; (6) meaningful intransitive gesture performance seems to vary according to the emotional content of gestures (i.e., body-centered gestures and emotional valence-intensity). These findings are partially consistent with the social cognition hypothesis. Methodological recommendations are given for future studies.
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Affiliation(s)
| | | | - Mathieu Lesourd
- UMR INSERM 1322 LINC, Université Bourgogne Franche-Comté, Besancon, France
| | - Léna Guezouli
- Normandie Univ, UNIROUEN, CRFDP, 76000, Rouen, France
| | | | - Maureen Gehin
- Normandie Univ, UNIROUEN, CRFDP, 76000, Rouen, France
| | - François Osiurak
- Laboratoire d'Étude des Mécanismes Cognitifs (UR 3082), Université Lyon 2, Bron, France
- Institut Universitaire de France (IUF), Paris, France
| | - Angela Bartolo
- Institut Universitaire de France (IUF), Paris, France
- CNRS, UMR 9193 - SCALab - Sciences Cognitives et Sciences Affectives, Univ. Lille, F-59000, Lille, France
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Sánchez-Bermejo L, Milla-Ortega PJ, Pérez-Mármol JM. The Impact of Upper Limb Apraxia on General and Domain-Specific Self-Efficacy in Post-Stroke Patients. Healthcare (Basel) 2023; 11:2252. [PMID: 37628450 PMCID: PMC10454387 DOI: 10.3390/healthcare11162252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 07/29/2023] [Accepted: 08/08/2023] [Indexed: 08/27/2023] Open
Abstract
BACKGROUND Upper limb apraxia (ULA) is a neurological syndrome characterized by the inability to perform purposeful movements. ULA could impact individuals' perceptions, including perceived self-efficacy. The aim of this study is to investigate whether ULA is related to general self-efficacy and self-efficacy for managing symptoms in post-stroke patients. METHODS A cross-sectional study was conducted involving 82 post-stroke patients. Regression analyses were implemented using a stepwise model including seven dimensions of ULA: imitation (non-symbolic, intransitive, and transitive), pantomime (non-symbolic, intransitive, and transitive), and dimension of apraxic performance in activities of daily living. These dimensions were independent variables, while general self-efficacy and symptom management self-efficacy dimensions were dependent variables. RESULTS The findings revealed that intransitive imitation accounted for 14% of the variance in general self-efficacy and 10% of self-efficacy for managing emotional symptoms. Transitive imitation explained 10% of the variance in self-efficacy for managing global symptoms and 5% for social-home integration symptoms. The combination of intransitive imitation, non-symbolic pantomime, and alterations in activities of daily living performance associated with ULA explained 24% of the variance in cognitive self-efficacy. CONCLUSIONS Hence, ULA dimensions seem to be related to the levels of general perceived self-efficacy and self-efficacy for managing symptoms among post-stroke patients.
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Affiliation(s)
- Laura Sánchez-Bermejo
- Department of Physiotherapy, Faculty of Health Sciences, University of Granada, 18071 Granada, Spain;
- Instituto de Investigación Biosanitaria ibs.GRANADA, 18012 Granada, Spain;
| | - Pedro Jesús Milla-Ortega
- Instituto de Investigación Biosanitaria ibs.GRANADA, 18012 Granada, Spain;
- Emergencies Primary Care Service, Granada Health District, 18012 Granada, Spain
| | - José Manuel Pérez-Mármol
- Department of Physiotherapy, Faculty of Health Sciences, University of Granada, 18071 Granada, Spain;
- Instituto de Investigación Biosanitaria ibs.GRANADA, 18012 Granada, Spain;
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Bradley C, Wilbur R. Visual Form and Event Semantics Predict Transitivity in Silent Gestures: Evidence for Compositionality. Cogn Sci 2023; 47:e13331. [PMID: 37635624 DOI: 10.1111/cogs.13331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 07/18/2023] [Accepted: 08/08/2023] [Indexed: 08/29/2023]
Abstract
Silent gesture is not considered to be linguistic, on par with spoken and sign languages. It is claimed that silent gestures, unlike language, represent events holistically, without compositional structure. However, recent research has demonstrated that gesturers use consistent strategies when representing objects and events, and that there are behavioral and clinically relevant limits on what form a gesture may take to effect a particular meaning. This systematicity challenges a holistic interpretation of silent gesture, which predicts that there should be no stable form-meaning correspondence across event representations. Here, we demonstrate to the contrary that untrained gesturers systematically manipulate the form of their gestures when representing events with and without a theme (e.g., Someone popped the balloon vs. Someone walked), that is, transitive and intransitive events. We elicited silent gestures and annotated them for manual features active in coding transitivity distinctions in sign languages. We trained linear support vector machines to make item-by-item transitivity predictions based on these features. Prediction accuracy was good across the entire dataset, thus demonstrating that systematicity in silent gesture can be explained with recourse to subunits. We argue that handshape features are constructs co-opted from cognitive systems subserving manual action production and comprehension for communicative purposes, which may integrate into the linguistic system of emerging sign languages. We further suggest that nonsigners tend to map event participants to each hand, a strategy found across genetically and geographically distinct sign languages, suggesting the strategy's cognitive foundation.
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Affiliation(s)
| | - Ronnie Wilbur
- Department of Linguistics, Purdue University
- Department of Speech, Language, and Hearing Sciences, Purdue University
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Lotan M, Downs J, Stahlhut M, Romano A. Evaluation Tools Developed for Rett Syndrome. Diagnostics (Basel) 2023; 13:diagnostics13101708. [PMID: 37238191 DOI: 10.3390/diagnostics13101708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 05/08/2023] [Accepted: 05/08/2023] [Indexed: 05/28/2023] Open
Abstract
Rett syndrome (RTT) is a complex neurodevelopmental X-linked disorder associated with severe functional impairments and multiple comorbidities. There is wide variation in the clinical presentation, and because of its unique characteristics, several evaluation tools of clinical severity, behavior, and functional motor abilities have been proposed specifically for it. This opinion paper aims to present up-to date evaluation tools which have specifically been adapted for individuals with RTT often used by the authors in their clinical and research practice and to provide the reader with essential considerations and suggestions regarding their use. Due to the rarity of Rett syndrome, we found it important to present these scales in order to improve and professionalize their clinical work. The current article will review the following evaluation tools: (a) the Rett Assessment Rating Scale; (b) the Rett Syndrome Gross Motor Scale; (c) the Rett Syndrome Functional Scale; (d) the Functional Mobility Scale-Rett Syndrome; (e) the Two-Minute Walking Test modified for Rett syndrome; (f) the Rett Syndrome Hand Function Scale; (g) the StepWatch Activity Monitor; (h) the activPALTM; (i) the Modified Bouchard Activity Record; (j) the Rett Syndrome Behavioral Questionnaire; and (k) the Rett Syndrome Fear of Movement Scale. The authors recommend that service providers consider evaluation tools validated for RTT for evaluation and monitoring to guide their clinical recommendations and management. In this article, the authors suggest factors that should be considered when using these evaluation tools to assist in interpreting scores.
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Affiliation(s)
- Meir Lotan
- Department of Physiotherapy, Ariel University, Ariel 4070000, Israel
- Israeli Rett Syndrome National Evaluation Team, Ramat Gan 5211401, Israel
| | - Jenny Downs
- Telethon Kids Institute, Centre for Child Health Research, The University of Western Australia, Nedlands, WA 6009, Australia
- School of Allied Health, Curtin University, Perth, WA 6102, Australia
| | - Michelle Stahlhut
- Department of Paediatrics and Adolescent Medicine, Center for Rett Syndrome, Rigshospitalet, 2100 Copenhagen, Denmark
| | - Alberto Romano
- Department of Health System Management, Ariel University, Ariel 4070000, Israel
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Kleineberg NN, Schmidt CC, Richter MK, Bolte K, Schloss N, Fink GR, Weiss PH. Gesture meaning modulates the neural correlates of effector-specific imitation deficits in left hemisphere stroke. Neuroimage Clin 2023; 37:103331. [PMID: 36716655 PMCID: PMC9900453 DOI: 10.1016/j.nicl.2023.103331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 12/30/2022] [Accepted: 01/19/2023] [Indexed: 01/23/2023]
Abstract
BACKGROUND Previous studies on left hemisphere (LH) stroke patients reported effector-specific (hand, fingers, bucco-facial) differences in imitation performance. Furthermore, imitation performance differed between meaningless (ML) and meaningful (MF) gestures. Recent work suggests that a gesture's meaning impacts the body-part specificity of gesture imitation. METHODS We tested the hypothesis that the gesture's meaning (ML vs MF) affects the lesion correlates of effector-specific imitation deficits (here: bucco-facial vs arm/hand gestures) using behavioural data and support vector regression-based lesion-symptom mapping (SVR-LSM) in a large sample of 194 sub-acute LH stroke patients. RESULTS Behavioural data revealed a significant interaction between the effector used for imitation and the meaning of the imitated gesture. SVR-LSM analyses revealed shared lesion correlates for impaired imitation independent of effector or gesture meaning in the left supramarginal (SMG) and superior temporal gyri (STG). Besides, within the territory of the left middle cerebral artery, impaired imitation of bucco-facial gestures was associated with more anterior lesions, while arm/hand imitation deficits were associated with more posterior lesions. MF gestures were specifically associated with lesions in the left inferior frontal gyrus and the left insular region. Notably, an interaction of effector-specificity and gesture meaning was also present at the lesion level: A more pronounced difference in imitation performance between the effectors for ML (versus MF) gestures was associated with left-hemispheric lesions in the STG, SMG, putamen, precentral gyrus and white matter tracts. CONCLUSION The current behavioural data show that ML gestures are particularly sensitive in assessing effector-specific imitation deficits in LH stroke patients. Moreover, a gesture's meaning modulated the effector-specific lesion correlates of bucco-facial and arm/hand gesture imitation. Hence, it is crucial to consider gesture meaning in apraxia assessments.
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Affiliation(s)
- Nina N Kleineberg
- Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-3), Research Centre Jülich, Leo-Brandt-Str. 5, 52425 Jülich, Germany; Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Str. 62, 50937 Cologne, Germany.
| | - Claudia C Schmidt
- Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-3), Research Centre Jülich, Leo-Brandt-Str. 5, 52425 Jülich, Germany
| | - Monika K Richter
- Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-3), Research Centre Jülich, Leo-Brandt-Str. 5, 52425 Jülich, Germany; Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Str. 62, 50937 Cologne, Germany
| | - Katharina Bolte
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Str. 62, 50937 Cologne, Germany
| | - Natalie Schloss
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Str. 62, 50937 Cologne, Germany
| | - Gereon R Fink
- Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-3), Research Centre Jülich, Leo-Brandt-Str. 5, 52425 Jülich, Germany; Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Str. 62, 50937 Cologne, Germany
| | - Peter H Weiss
- Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-3), Research Centre Jülich, Leo-Brandt-Str. 5, 52425 Jülich, Germany; Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Str. 62, 50937 Cologne, Germany
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Pastore-Wapp M, Gyurkó DM, Vanbellingen T, Lehnick D, Cazzoli D, Pflugshaupt T, Pflugi S, Nyffeler T, Walther S, Bohlhalter S. Improved gesturing in left-hemispheric stroke by right inferior parietal theta burst stimulation. Front Neurosci 2022; 16:998729. [PMID: 36590287 PMCID: PMC9800932 DOI: 10.3389/fnins.2022.998729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 11/29/2022] [Indexed: 12/23/2022] Open
Abstract
Objectives Apraxia is a common syndrome of left hemispheric stroke. A parieto-premotor-prefrontal network has been associated with apraxia, in which the left inferior parietal lobe (IPL-L) plays a major role. We hypothesized that transcranial continuous theta burst stimulation (cTBS) over the right inferior parietal lobe (IPL-R) improves gesturing by reducing its inhibition on the contralateral IPL in left hemispheric stroke patients. It was assumed that this effect is independent of lesion volume and that transcallosal connectivity is predictive for gestural effect after stimulation. Materials and methods Nineteen stroke patients were recruited. Lesion volume and fractional anisotropy of the corpus callosum were acquired with structural magnetic resonance imaging (MRI) and diffusion tensor imaging (DTI). Each patient had pseudorandomised sessions with sham or with stimulation over the IPL-R or over the right inferior frontal gyrus IFG-R. Gesturing was assessed in a double-blinded manner before and after each session. We tested the effects of stimulation on gesture performance using a linear mixed-effects model. Results Pairwise treatment contrasts showed, that, compared to sham, the behavioral effect was higher after stimulation over IPL-R (12.08, 95% CI 6.04 - 18.13, p < 0.001). This treatment effect was approximately twice as high as the contrasts for IFG-R vs. sham (6.25, 95% CI -0.20 - 12.70, p = 0.058) and IPL-R vs. IFG-R vs. sham (5.83, 95% CI -0.49 - 12.15, p = 0.071). Furthermore, higher fractional anisotropy in the splenium (connecting the left and right IPL) were associated with higher behavioral effect. Relative lesion volume did not affect the changes after sham or stimulation over IPL-R or IFG-R. Conclusion One single session of cTBS over the IPL-R improved gesturing after left hemispheric stroke. Denser microstructure in the corpus callosum correlated with favorable gestural response. We therefore propose the indirect transcallosal modulation of the IPL-L as a promising model of restoring interhemispheric balance, which may be useful in rehabilitation of apraxia.
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Affiliation(s)
- Manuela Pastore-Wapp
- Neurocenter, Luzerner Kantonsspital, Lucerne, Switzerland,ARTORG Center for Biomedical Engineering Research, Gerontechnology and Rehabilitation Group, University of Bern, Bern, Switzerland
| | | | - Tim Vanbellingen
- Neurocenter, Luzerner Kantonsspital, Lucerne, Switzerland,ARTORG Center for Biomedical Engineering Research, Gerontechnology and Rehabilitation Group, University of Bern, Bern, Switzerland
| | - Dirk Lehnick
- Biostatistics and Methodology, Clinical Trials Unit Central Switzerland, Lucerne, Switzerland,Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Dario Cazzoli
- Neurocenter, Luzerner Kantonsspital, Lucerne, Switzerland,ARTORG Center for Biomedical Engineering Research, Gerontechnology and Rehabilitation Group, University of Bern, Bern, Switzerland,Department of Psychology, University of Bern, Bern, Switzerland
| | | | | | - Thomas Nyffeler
- Neurocenter, Luzerner Kantonsspital, Lucerne, Switzerland,ARTORG Center for Biomedical Engineering Research, Gerontechnology and Rehabilitation Group, University of Bern, Bern, Switzerland,Biostatistics and Methodology, Clinical Trials Unit Central Switzerland, Lucerne, Switzerland,Department of Neurology, University Hospital of Bern, Bern, Switzerland
| | - Sebastian Walther
- Translational Research Center, University Hospital of Psychiatry and Psychotherapy of Bern, Bern, Switzerland
| | - Stephan Bohlhalter
- Neurocenter, Luzerner Kantonsspital, Lucerne, Switzerland,Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland,Department of Neurology, University of Zurich, Zurich, Switzerland,*Correspondence: Stephan Bohlhalter,
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Yıldız Z, Doymaz F, Özden F. The reliability and validity of the Turkish version of the apraxia screen of TULIA in multiple sclerosis patients. Disabil Rehabil 2022; 44:8042-8047. [PMID: 34898347 DOI: 10.1080/09638288.2021.2003447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
PURPOSE The study was aimed to analyze the psychometric properties of the Turkish version of the Apraxia Screen of TULIA (T-AST). METHODS A total of 112 patients with multiple sclerosis (MS) were included in the study. T-AST tasks were performed once while recording with a video camera. Two physiotherapists scored T-AST, independently. Rater(1) performed a second assessment of apraxia with AST one week later. The disability was evaluated by Expanded Disability Status Scale (EDSS). Cognitive assessment was carried out with Mini-Mental State Examination (MMSE). Depression was evaluated with Hamilton Depression Rating Scale (HAM-D). Multiple Sclerosis International Quality of Life (MusiQoL) was used to assess the quality of life. In addition, fatigue was evaluated with Fatigue Severity Scale (FSS). RESULTS The mean age of the patients was 42.3 ± 11.0 years. The Cronbach's alpha coefficient of the rater(1)'s and rater(2)'s evaluation was 0.820 and 0.800, respectively. ICC score of the intra-rater reliability was 0.960. ICC score of the inter-rater reliability was 0.971. The Spearman correlation coefficients between T-AST and MMSE, EDSS, MusiQoL, HAM-D, FSS were low to excellent, respectively (r = 0.863; p < 0.001, r = -0.768; p < 0.001, r = -0.560; p < 0.001, r = -0.393, p < 0.001, r = -0.324, p < 0.001). CONCLUSION The Turkish version of the AST is a reliable and valid tool for assessing upper limb apraxia in patients with MS.Implications for RehabilitationThe Turkish version of the Apraxia Screen of TULIA (T-AST) is a reliable and valid test for assessing apraxia in patients with multiple sclerosis.Considering the short structure, high reliability, and validity, T-AST could be used in clinical practice and clinical trials.
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Affiliation(s)
- Zeynep Yıldız
- Department of Occupational Therapy, Artvin Çoruh University, Vocational School of Health Services, Artvin, Turkey
| | - Fadime Doymaz
- Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Kıbrıs İlim University, Kyrenia, North Cyprus
| | - Fatih Özden
- Elderly Care Department, Muğla Sıtkı Koçman University, Köyceğiz Vocational School of Health Services, Muğla, Turkey
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Glinac A, Sinanović O, Sinanović S. Multicomponent Educational-Rehabilitation Approach in Rehabilitation of Patients After Stroke. Eurasian J Med 2022; 54:292-298. [PMID: 35950824 PMCID: PMC9797835 DOI: 10.5152/eurasianjmed.2022.20330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Rehabilitation must be based on the individual needs and specific goals of the person and must be adapted to his abilities. According to the recommendation of the World Stroke Organization, the team involved in conducting rehabilitation should be multidisciplinary. One of the treatments that are applied within the multidisciplinary approach to a neurological patient is educational-rehabilitation treatment, which is multicomponent in nature. Before starting educational-rehabilitation treatment, an educational-rehabilitation clinical assessment is necessary, which aims to detect difficulties caused by impairment; identify potentials and constraints in these areas; determine the specifics, course, and forecasts of difficulties; formulate clear treatment recommendations; form a watch list that will be available to all team members in the process of diagnosis, treatment, education, and to evaluate the effectiveness of treatment; and continuously monitor the ability and adaptive behavior of the person. Educational-rehabilitation clinical treatment includes treatment of cognitive abilities, treatment of motor skills, relaxation, treatment of adaptive skills, as well as informing the person about the disease and counseling. This review focuses on some aspects of rehabilitation such as treatment of cognitive and motor disorders, treatment of adaptive skills, relaxation issues, and informing and counseling patients from the perspective of an educational rehabilitator with practical experiences in this area of rehabilitation.
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Affiliation(s)
- Alma Glinac
- University Clinical Center Tuzla, Ulica prof. dr. Ibre Pašića, Tuzla, Bosnia and Herzegovina,Facullty of Education and Rehabilitation, University of Tuzla, Univerzitetska 1, Tuzla, Bosnia and Herzegovina,Corresponding author: Alma Glinac E-mail: glinacalma©gmail.com
| | - Osman Sinanović
- Medical Faculty, Univeristy of Tuzla, Univerzitetska 1, Tuzla, Bosnia and Herzegovina,Sarajevo School of Medcine, University of Sarajevo Scool of Science and Technology, Ilidža, Sarajevo, Bosnia and Herzegovina
| | - Selma Sinanović
- University Clinical Center Tuzla, Ulica prof. dr. Ibre Pašića, Tuzla, Bosnia and Herzegovina
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Latarnik S, Stahl J, Vossel S, Grefkes C, Fink GR, Weiss PH. The impact of apraxia and neglect on early rehabilitation outcome after stroke. Neurol Res Pract 2022; 4:46. [PMID: 36154935 PMCID: PMC9511731 DOI: 10.1186/s42466-022-00211-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 08/03/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
This study aims to characterize the impact of apraxia and visuospatial neglect on stroke patients’ cognitive and functional outcomes during early rehabilitation. Prior work implies an unfavorable effect of visuospatial neglect on rehabilitation; however, previous findings remain ambiguous and primarily considered long-term effects. Even less is known about the impact of apraxia on rehabilitation outcomes. Although clinicians agree on the significance of the first few weeks after stroke for the course of rehabilitation, studies exploring the impact of neglect and apraxia in this early rehabilitation period remain scarce.
Methods
Based on a screening of 515 hospitalized stroke patients from an early rehabilitation ward, 150 stroke patients (75 left-hemispheric strokes, 75 right hemispheric strokes) fulfilled the inclusion criteria and were enrolled in this observational, longitudinal study. The patients’ cognitive and functional statuses were documented at admission to the early rehabilitation ward and discharge. Also, detailed apraxia and neglect assessments were performed at midterm. The predictive values of age and apraxia and neglect severity (as reflected in two components from a principal component analysis of the neglect and apraxia assessments) for cognitive and functional outcomes at discharge were evaluated by multiple regression analyses.
Results
Besides the expected influence of the respective variables at admission, we observed a significant effect of apraxia severity on the cognitive outcome at discharge. Moreover, neglect severity predicted the Early Rehabilitation Barthel Index (Frühreha-Barthel-Index) at discharge. Supplementary moderator analysis revealed a differential effect of neglect severity on the cognitive outcome depending on the affected hemisphere.
Conclusion
Data indicate a strong association between apraxia and visuospatial neglect and early rehabilitation outcomes after stroke.
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11
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Kleineberg NN, Tscherpel C, Fink GR, Grefkes C, Weiss PH. Different facets of object-use pantomime: online TMS evidence on the role of the supramarginal gyrus. Cortex 2022; 156:13-25. [DOI: 10.1016/j.cortex.2022.06.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 03/31/2022] [Accepted: 06/22/2022] [Indexed: 11/24/2022]
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12
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Baumard J, Lesourd M, Guézouli L, Osiurak F. Physical understanding in neurodegenerative diseases. Cogn Neuropsychol 2022; 38:490-514. [PMID: 35549825 DOI: 10.1080/02643294.2022.2071152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
This quantitative review gives an overview of physical understanding (i.e., the ability to represent and use the laws of physics to interact with the physical world) impairments in Alzheimer's disease (AD), semantic dementia (SD), and corticobasal syndrome (CBS), as assessed mainly with mechanical problem-solving and tool use tests. This review shows that: (1) SD patients have apraxia of tool use because of semantic tool knowledge deficits, but normal performance in tests of physical understanding; (2) AD and CBS patients show impaired performance in mechanical problem-solving tests, probably not because of intrinsic deficits of physical understanding, but rather because of additional cognitive (AD) or motor impairments (CBS); (3) As a result, the performance in mechanical problem-solving tests is not a good predictor of familiar tool use in dementia; (4) Actual deficits of physical understanding are probably observed only in late stages of neurodegenerative diseases, and associated with functional loss.
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Affiliation(s)
- Josselin Baumard
- Normandie Univ, UNIROUEN, CRFDP (EA 7475), 76000 Rouen, France.,Centre de Recherche sur les Fonctionnements et Dysfonctionnements Psychologiques (EA 7475), Mont-Saint-Aignan Cedex, France
| | - Mathieu Lesourd
- Laboratoire de Recherches Intégratives en Neurosciences et Psychologie Cognitive, Université Bourgogne Franche-Comté Besançon, France.,MSHE Ledoux, CNRS, Université de Bourgogne Franche-Comté, Besançon, France
| | - Léna Guézouli
- Normandie Univ, UNIROUEN, CRFDP (EA 7475), 76000 Rouen, France.,Centre de Recherche sur les Fonctionnements et Dysfonctionnements Psychologiques (EA 7475), Mont-Saint-Aignan Cedex, France
| | - François Osiurak
- Laboratoire d'Etude des Mécanismes Cognitifs (EA 3082), Université de Lyon, Bron Cedex, France.,Institut Universitaire de France, Paris, France
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13
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Schmidt CC, Achilles EIS, Fink GR, Weiss PH. Distinct cognitive components and their neural substrates underlying praxis and language deficits following left hemisphere stroke. Cortex 2021; 146:200-215. [PMID: 34896806 DOI: 10.1016/j.cortex.2021.11.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 08/30/2021] [Accepted: 11/11/2021] [Indexed: 11/25/2022]
Abstract
Apraxia is characterised by multiple deficits of higher motor functions, primarily caused by left hemisphere (LH) lesions to parietal-frontal praxis networks. While previous neuropsychological and lesion studies tried to relate the various apraxic deficits to specific lesion sites, a comprehensive analysis of the different apraxia profiles and the related (impaired) motor-cognitive processes as well as their differential neural substrates in LH stroke is lacking. To reveal the cognitive mechanisms that underlie the different patterns of praxis and (related) language deficits, we applied principal component analysis (PCA) to the scores of sub-acute LH stroke patients (n = 91) in several tests of apraxia and aphasia. Voxel-based lesion-symptom mapping (VLSM) analyses were then used to investigate the neural substrates of the identified components. The PCA yielded a first component related to language functions and three components related to praxis functions, with each component associated with specific lesion patterns. Regarding praxis functions, performance in imitating arm/hand gestures was accounted for by a second component related to the left precentral gyrus and the inferior parietal lobule. Imitating finger configurations, pantomiming the use of objects related to the face, and actually using objects loaded on component 3, related to the left anterior intraparietal sulcus and angular gyrus. The last component represented the imitation of bucco-facial gestures and was linked to the basal ganglia and LH white matter tracts. The results further revealed that pantomime of (limb-related) object use depended on both the component 2 and 3, which were shared with gesture imitation and actual object use. Data support and extend the notion that apraxia represents a multi-componential syndrome comprising different (impaired) motor-cognitive processes, which dissociate - at least partially - from language processes. The distinct components might be disturbed to a varying degree following LH stroke since they are associated with specific lesion patterns within the LH.
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Affiliation(s)
- Claudia C Schmidt
- Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-3), Forschungszentrum Jülich, Jülich, Germany.
| | - Elisabeth I S Achilles
- Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-3), Forschungszentrum Jülich, Jülich, Germany; University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Neurology, Cologne, Germany
| | - Gereon R Fink
- Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-3), Forschungszentrum Jülich, Jülich, Germany; University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Neurology, Cologne, Germany
| | - Peter H Weiss
- Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-3), Forschungszentrum Jülich, Jülich, Germany; University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Neurology, Cologne, Germany
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14
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Stoll H, de Wit MM, Middleton EL, Buxbaum LJ. Treating limb apraxia via action semantics: a preliminary study. Neuropsychol Rehabil 2021; 31:1145-1162. [PMID: 32429797 PMCID: PMC7674248 DOI: 10.1080/09602011.2020.1762672] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 04/15/2020] [Indexed: 10/24/2022]
Abstract
Limb apraxia is evident in approximately 50% of patients after left hemisphere cerebral vascular accident (LCVA) and increases disability and caregiver dependence. Individuals with apraxia exhibit abnormalities in spatio-temporal aspects of gesture production and/or in knowledge of tool-related actions (action semantics). This preliminary study of three LCVA participants aimed to (i) explore the efficacy of a novel Action Network Treatment (ANT) that focused on improving the semantic association between tool actions and other types of tool knowledge, an intervention inspired by successful semantic network treatments in aphasia (e.g., Edmonds et al., 2009), and (ii) explore whether there are individuals with apraxia who benefit from ANT relative to a version of a comparatively well-studied existing apraxia treatment (Smania et al., 2006; Smania et al., 2000) that shapes gesture via focus on practicing the spatio-temporal aspects of gesture production (Tool Use Treatment or TUT). One participant demonstrated treatment benefits from both ANT and TUT, while another only benefited from TUT. These findings indicate that our novel semantic network strengthening approach to gesture training may be efficacious in at least some individuals with apraxia, and provide a foundation for future study of the characteristics of people with apraxia who benefit from each approach.
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Affiliation(s)
| | | | | | - Laurel J. Buxbaum
- Moss Rehabilitation Research Institute, Elkins Park, PA
- Department of Rehabilitation Medicine, Thomas Jefferson University, Philadelphia, PA
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15
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Bluett B, Pantelyat AY, Litvan I, Ali F, Apetauerova D, Bega D, Bloom L, Bower J, Boxer AL, Dale ML, Dhall R, Duquette A, Fernandez HH, Fleisher JE, Grossman M, Howell M, Kerwin DR, Leegwater-Kim J, Lepage C, Ljubenkov PA, Mancini M, McFarland NR, Moretti P, Myrick E, Patel P, Plummer LS, Rodriguez-Porcel F, Rojas J, Sidiropoulos C, Sklerov M, Sokol LL, Tuite PJ, VandeVrede L, Wilhelm J, Wills AMA, Xie T, Golbe LI. Best Practices in the Clinical Management of Progressive Supranuclear Palsy and Corticobasal Syndrome: A Consensus Statement of the CurePSP Centers of Care. Front Neurol 2021; 12:694872. [PMID: 34276544 PMCID: PMC8284317 DOI: 10.3389/fneur.2021.694872] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 06/10/2021] [Indexed: 11/16/2022] Open
Abstract
Progressive supranuclear palsy (PSP) and corticobasal syndrome (CBS; the most common phenotype of corticobasal degeneration) are tauopathies with a relentless course, usually starting in the mid-60s and leading to death after an average of 7 years. There is as yet no specific or disease-modifying treatment. Clinical deficits in PSP are numerous, involve the entire neuraxis, and present as several discrete phenotypes. They center on rigidity, bradykinesia, postural instability, gait freezing, supranuclear ocular motor impairment, dysarthria, dysphagia, incontinence, sleep disorders, frontal cognitive dysfunction, and a variety of behavioral changes. CBS presents with prominent and usually asymmetric dystonia, apraxia, myoclonus, pyramidal signs, and cortical sensory loss. The symptoms and deficits of PSP and CBS are amenable to a variety of treatment strategies but most physicians, including many neurologists, are reluctant to care for patients with these conditions because of unfamiliarity with their multiplicity of interacting symptoms and deficits. CurePSP, the organization devoted to support, research, and education for PSP and CBS, created its CurePSP Centers of Care network in North America in 2017 to improve patient access to clinical expertise and develop collaborations. The directors of the 25 centers have created this consensus document outlining best practices in the management of PSP and CBS. They formed a writing committee for each of 12 sub-topics. A 4-member Steering Committee collated and edited the contributions. The result was returned to the entire cohort of authors for further comments, which were considered for incorporation by the Steering Committee. The authors hope that this publication will serve as a convenient guide for all clinicians caring for patients with PSP and CBS and that it will improve care for patients with these devastating but manageable disorders.
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Affiliation(s)
- Brent Bluett
- Neurology, Pacific Central Coast Health Center, Dignity Health, San Luis Obispo, CA, United States
- Neurology, Stanford University, Stanford, CA, United States
| | - Alexander Y. Pantelyat
- Neurology, The Johns Hopkins Hospital, Johns Hopkins Medicine, Baltimore, MD, United States
| | - Irene Litvan
- Neurology, University of California, San Diego, San Diego, CA, United States
| | - Farwa Ali
- Neurology, Mayo Clinic, Rochester, MN, United States
| | - Diana Apetauerova
- Neurology, Lahey Hospital and Medical Center, Burlington, MA, United States
| | - Danny Bega
- Ken and Ruth Davee Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Lisa Bloom
- Neurology, Surgery, University of Chicago, Chicago, IL, United States
| | - James Bower
- Neurology, Mayo Clinic, Rochester, MN, United States
| | - Adam L. Boxer
- Neurology, University of California, San Francisco, San Francisco, CA, United States
| | - Marian L. Dale
- Neurology, Oregon Health and Science University, Portland, OR, United States
| | - Rohit Dhall
- Neurology, University of Arkansas for Medical Sciences, Little Rock, AK, United States
| | - Antoine Duquette
- Service de Neurologie, Département de Médecine, Unité de Troubles du Mouvement André-Barbeau, Centre Hospitalier de l'Université de Service de Neurologie, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, QC, Canada
| | - Hubert H. Fernandez
- Center for Neurological Restoration, Neurological Institute, Cleveland Clinic, Cleveland, OH, United States
| | - Jori E. Fleisher
- Neurological Sciences, Rush Medical College, Rush University, Chicago, IL, United States
| | - Murray Grossman
- Neurology, University of Pennsylvania, Philadelphia, PA, United States
| | - Michael Howell
- Neurology, Medical School, University of Minnesota, Minneapolis, MN, United States
| | - Diana R. Kerwin
- Geriatrics, Presbyterian Hospital of Dallas, Dallas, TX, United States
| | | | - Christiane Lepage
- Service de Neurologie, Département de Médecine, Unité de Troubles du Mouvement André-Barbeau, Centre Hospitalier de l'Université de Service de Neurologie, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, QC, Canada
| | | | - Martina Mancini
- Neurology, Oregon Health and Science University, Portland, OR, United States
| | - Nikolaus R. McFarland
- Neurology, College of Medicine, University of Florida, Gainesville, FL, United States
| | - Paolo Moretti
- Neurology, The University of Utah, Salt Lake City, UT, United States
| | - Erica Myrick
- Neurological Sciences, Rush Medical College, Rush University, Chicago, IL, United States
| | - Pritika Patel
- Neurology, Lahey Hospital and Medical Center, Burlington, MA, United States
| | - Laura S. Plummer
- Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | | | - Julio Rojas
- Neurology, University of California, San Francisco, San Francisco, CA, United States
| | | | - Miriam Sklerov
- Neurology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Leonard L. Sokol
- Ken and Ruth Davee Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Paul J. Tuite
- Neurology, Medical School, University of Minnesota, Minneapolis, MN, United States
| | - Lawren VandeVrede
- Neurology, School of Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Jennifer Wilhelm
- Neurology, Oregon Health and Science University, Portland, OR, United States
| | - Anne-Marie A. Wills
- Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - Tao Xie
- Neurology, Surgery, University of Chicago, Chicago, IL, United States
| | - Lawrence I. Golbe
- Neurology, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, United States
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16
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Yamada M, Koyanagi M, Kawaguchi M, Sato Y, Tsujihata M, Higashi T. Proposing a new short screening test for upper limb apraxia. Br J Occup Ther 2021. [DOI: 10.1177/0308022621998564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background Apraxia has a major impact on activities of daily living in stroke patients. The proper assessment and treatment of apraxia is important for maintaining a good quality of life. We developed a short evaluation test for upper limb apraxia. Patients and Methods The present Screening Test of Gestures for Stroke consists of 10 items for each verbal instruction and imitation. Each item includes three meaningless gestures, three meaningful gestures and four pantomimes. The Screening Test of Gestures for Stroke is scored based on a 3-point system: 10, 5 or 0 (maximum score: 200). The test took approximately 2–5 min to complete. We recruited 65 patients admitted to our hospital with left hemisphere stroke and 50 healthy subjects. Results The reliability of the Screening Test of Gestures for Stroke was as follows: the intraclass correlation coefficient of intra-rater reliability was 0.93 for both verbal instructions and imitations, and the intraclass correlation coefficient total scores for inter-rater reliability for verbal instructions and for imitations were 0.97 and 0.95, respectively. The alpha coefficient was ≥0.80. Conclusions The Screening Test of Gestures for Stroke is a reliable and valid bedside test that has a short assessment time, does not require special equipment and can evaluate upper limb apraxia in stroke patients from the acute to the chronic phase.
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Affiliation(s)
- Mai Yamada
- Department of Health Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
- Department of Rehabilitation, Nagasaki Kita Hospital, Togitsuchou, Nishisonogigun, Nagasaki, Japan
| | - Masahiko Koyanagi
- Department of Health Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
- Department of Rehabilitation, Nagasaki Kita Hospital, Togitsuchou, Nishisonogigun, Nagasaki, Japan
| | - Miyo Kawaguchi
- Department of Rehabilitation, Nagasaki Kita Hospital, Togitsuchou, Nishisonogigun, Nagasaki, Japan
| | - Yuki Sato
- Department of Rehabilitation, Nagasaki Kita Hospital, Togitsuchou, Nishisonogigun, Nagasaki, Japan
| | - Mitsuhiro Tsujihata
- Department of Neurology, Nagasaki Kita Hospital, Togitsuchou, Nishisonogigun, Nagasaki, Japan
| | - Toshio Higashi
- Department of Health Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
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17
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Effectiveness of a Functional Rehabilitation Program for Upper Limb Apraxia in Poststroke Patients: A Randomized Controlled Trial. Arch Phys Med Rehabil 2021; 102:940-950. [PMID: 33485836 DOI: 10.1016/j.apmr.2020.12.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 12/12/2020] [Accepted: 12/21/2020] [Indexed: 01/10/2023]
Abstract
OBJECTIVE To analyze the effectiveness of a home-based restorative and compensatory upper limb apraxia (ULA) rehabilitation program. DESIGN Randomized controlled trial. SETTING Neurology Unit of San Cecilio Hospital and 2 private and specialized health care centers. PARTICIPANTS Community dwelling participants (N=38) between the ages of 25 and 95 years old (sex ratio, 1:1) with unilateral mild-to-moderate poststroke lesions (time of evolution since stroke, 12.03±8.98mo) and secondary ULA. INTERVENTIONS Participants were randomly assigned to an 8-week combined ULA functional rehabilitation group (n=19) 3 days per week for 30 minutes or to a traditional health care education protocol group (n=19) once a month for 8 weeks. Both interventions were conducted at home. MAIN OUTCOME MEASURES Sociodemographic and clinical data, Barthel Index (primary outcome), Lawton and Brody Scale, observation and scoring activities of daily living, the De Renzi tests for ideational and ideomotor apraxia and imitating gestures test, recognition of gestures, test for upper limb apraxia , and stroke-specific quality of life scale were assessed at 3 time points: baseline, posttreatment (8wk), and follow-up (8wk). RESULTS There were statistically significant differences among the groups regarding ideomotor apraxia, imitating gestures, global recognition of gestures, intransitive gestures, and comprehension of gesture production (P<.05) in favor of the experimental group. However, no statistically significant differences were found between the groups regarding functionality or quality of life (P>.05). Regarding the within-group effect, statistically significant differences were found in all neuropsychological outcomes at posttreatment and follow-up (P<.05). CONCLUSION A functional rehabilitation program was found to be superior to a traditional health care education program and resulted in improvements in neuropsychological functioning in ULA poststroke. Conventional education showed an insufficient effect on apraxia recovery. Further studies with larger sample sizes are needed to determine the effect of rehabilitation strategies on functionality and quality of life of poststroke ULA patients.
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18
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Rowe PJ, Haenschel C, Khachatoorian N, Yarrow K. Post-stroke object affordances: An EEG investigation. Brain Cogn 2020; 146:105639. [PMID: 33171344 DOI: 10.1016/j.bandc.2020.105639] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Revised: 09/20/2020] [Accepted: 10/19/2020] [Indexed: 11/17/2022]
Abstract
Rehabilitating upper limb function after stroke is a key therapeutic goal. In healthy brains, objects, especially tools, are said to cause automatic motoric 'affordances'; affecting our preparation to handle objects. For example, the N2 event-related potential has been shown to correlate with the functional properties of objects in healthy adults during passive viewing. We posited that such an affordance effect might also be observed in chronic-stage stroke survivors. With either dominant or non-dominant hand forward, we presented three kinds of stimuli in stereoscopic depth; grasp objects affording a power-grip, pinch objects affording a thumb and forefinger precision-grip and an empty desk, affording no action. EEG data from 10 stroke survivors and 15 neurologically healthy subjects were analysed for the N1 and N2 ERP components. Both components revealed differences between the two object stimuli categories and the empty desk for both groups, suggesting the presence of affordance-related motor priming from around 100 to 370 ms after stimulus onset. Hence, we speculate that stroke survivors with loss of upper limb function may benefit from object presentation regimes designed to maximise motor priming when attempting movements with manipulable objects. However, further investigation would be necessary with acute stage patients, especially those diagnosed with apraxia.
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Affiliation(s)
- Paula J Rowe
- Cognitive Neuroscience Research Unit, Department of Psychology, City, University of London, United Kingdom.
| | - Corinna Haenschel
- Cognitive Neuroscience Research Unit, Department of Psychology, City, University of London, United Kingdom
| | - Nareg Khachatoorian
- Cognitive Neuroscience Research Unit, Department of Psychology, City, University of London, United Kingdom
| | - Kielan Yarrow
- Cognitive Neuroscience Research Unit, Department of Psychology, City, University of London, United Kingdom
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19
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Kleineberg NN, Richter MK, Becker I, Weiss PH, Fink GR. Verum versus sham tDCS in the treatment of stroke-induced apraxia: study protocol of the randomized controlled trial RAdiCS -"Rehabilitating (stroke-induced) Apraxia with direct Current Stimulation". Neurol Res Pract 2020; 2:7. [PMID: 33324913 PMCID: PMC7650086 DOI: 10.1186/s42466-020-0052-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 02/03/2020] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION Stroke is the leading cause of acquired disability in western societies. (Motor) cognitive deficits like apraxia significantly contribute to disability after stroke, harming activities of daily living and rehabilitation outcome. To date, efficient therapeutic options for apraxia remain sparse. Thus, randomized controlled trials (RCTs) are warranted. METHODS Based on promising results of a pilot study, the on-going RAdiCS (Rehabilitating stroke-induced Apraxia with direct Current Stimulation) study is a randomized controlled trial, which follows a double-blinded (investigator and patient), two-arm parallel interventional model. It is designed to include 110 apraxic patients (as diagnosed by the Cologne Apraxia Screening, KAS) in the subacute phase after a left hemisphere (LH) stroke. The University of Cologne initiated the trial, which is conducted in two German Neurorehabilitation Centers.The study aims to evaluate the effect of anodal (versus sham) transcranial direct current stimulation (tDCS) applied over the left posterior parietal cortex (PPC) with an intensity of 2 mA for 10 min on five consecutive days on apraxic deficits. In addition to anodal or sham tDCS, all LH stroke patients undergo a motor (cognitive) training that is performed before and after the stimulation (off-line stimulation).The primary outcome measure is the (differential) change in the overall KAS score after five daily sessions of anodal versus sham tDCS when compared to the baseline assessment before tDCS. Secondary study outcomes include further apraxia scores, aphasia severity, and measures of motor performance and disability after stroke. All outcome measures are obtained in the post-stimulation assessment as well as during follow-up (3-4 months after tDCS). PERSPECTIVE The RCT RAdiCS shall evaluate in a large number of LH stroke patients whether anodal tDCS (compared to sham tDCS) expedites the rehabilitation of apraxia - over and above additional motor (cognitive) training and standard care. A positive study outcome would provide a new strategy for the treatment of apraxia, which hopefully ameliorates the negative impact of apraxia on daily living and long-term outcome. TRIAL REGISTRATION Clinical Trials Gov: NCT03185234, registered 14 June 2017 ; Deutsches Register für Klinische Studien: DRKS00012292, registered 01 June 2017. TRIAL STATUS Participant enrollment began on 22 June 2017. The trial is expected to be completed on 30 June 2022.
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Affiliation(s)
- Nina N. Kleineberg
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
- Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-3), Research Center Jülich, Jülich, Germany
| | - Monika K. Richter
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
- Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-3), Research Center Jülich, Jülich, Germany
| | - Ingrid Becker
- Institute of Medical Statistics and Computational Biology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Peter H. Weiss
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
- Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-3), Research Center Jülich, Jülich, Germany
| | - Gereon R. Fink
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
- Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-3), Research Center Jülich, Jülich, Germany
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20
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Scandola M, Canzano L, Avesani R, Leder M, Bertagnoli S, Gobbetto V, Aglioti SM, Moro V. Anosognosia for limb and bucco-facial apraxia as inferred from the recognition of gestural errors. J Neuropsychol 2020; 15:20-45. [PMID: 32080980 DOI: 10.1111/jnp.12203] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 01/27/2020] [Indexed: 12/12/2022]
Abstract
Anosognosia is a multifaceted syndrome characterized by a lack of awareness of motor, cognitive, or emotional deficits. While most studies have focused on basic motor disorders such as hemiplegia, only recently, the issue of whether anosognosia also concerns higher-order motor disorders like apraxia has been addressed. Here, we explore the existence of a specific form of anosognosia for apraxia in forty patients with uni-hemispheric vascular lesions. The patients were requested to imitate actions involving upper limb or bucco-facial body parts and then judge their performance. Successively, they were also asked to observe video recordings of the same actions performed by themselves or by other patients and judge the accuracy of the displayed actions. The comparison of participants versus examiner judgement and between error recognition of others' versus self's actions was considered as an index of awareness deficit for the online and offline conditions, respectively. Evidence was found that awareness deficits occurred both immediately after action execution (online anosognosia) and in the video recording task (offline anosognosia). Moreover, bucco-facial and limb apraxic patients were specifically unaware of their errors in bucco-facial and limb actions, respectively, indicating for the first time a topographical organization of the syndrome. Our approach allowed us to distinguish awareness deficits from more general disorders in error recognition; indeed, anosognosic patients were able to identify errors when the same action was executed by another patient but not when the video showed their own actions. Finally, we provide evidence that anosognosia for apraxia might be associated with frontal cortical and subcortical networks.
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Affiliation(s)
- Michele Scandola
- NPSY.Lab-VR, Department of Human Sciences, University of Verona, Italy
| | | | - Renato Avesani
- IRCSS Sacro Cuore - Don Calabria Hospital, Verona, Italy
| | - Mara Leder
- IRCSS Sacro Cuore - Don Calabria Hospital, Verona, Italy
| | - Sara Bertagnoli
- NPSY.Lab-VR, Department of Human Sciences, University of Verona, Italy
| | - Valeria Gobbetto
- NPSY.Lab-VR, Department of Human Sciences, University of Verona, Italy.,Verona Memory Center, CEMS, Verona, Italy
| | - Salvatore M Aglioti
- IRCCS Santa Lucia Foundation, Rome, Italy.,Department of Psychology, University "La Sapienza" of Rome and Istituto Italiano di Tecnologia, Italy
| | - Valentina Moro
- NPSY.Lab-VR, Department of Human Sciences, University of Verona, Italy.,Verona Memory Center, CEMS, Verona, Italy
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21
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Ant JM, Niessen E, Achilles EIS, Saliger J, Karbe H, Weiss PH, Fink GR. Anodal tDCS over left parietal cortex expedites recovery from stroke-induced apraxic imitation deficits: a pilot study. Neurol Res Pract 2019; 1:38. [PMID: 33324903 PMCID: PMC7650120 DOI: 10.1186/s42466-019-0042-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Accepted: 09/26/2019] [Indexed: 12/20/2022] Open
Abstract
Background To date, specific therapeutic approaches to expedite recovery from apraxic deficits after left hemisphere (LH) stroke remain sparse. Thus, in this pilot study we evaluated the effect of anodal transcranial direct current stimulation (tDCS) in addition to a standardized motor training on apraxic imitation deficits. Methods In a rehabilitation hospital, we assessed apraxic, aphasic, and motor deficits in 30 LH stroke patients before and after a five-day standard programme of motor training combined with either anodal (10 min, 2 mA; n = 14) or sham (10 min, 0 mA, n = 16) tDCS applied in a double-blind fashion over left posterior parietal cortex (PPC). Where appropriate, data were analyzed with either t-test, Fisher’s exact test, or univariate/ repeated measures ANOVA. Results Compared to sham tDCS, five sessions of anodal tDCS expedited recovery from apraxic imitation deficits (p < 0.05): Already after 5 days, the anodal tDCS group showed levels of imitation performance that were achieved in the sham tDCS group after 3 months. However, the primary outcome of the study (i.e., anodal tDCS induced improvement of the total apraxia score) failed significance, and there was no significant tDCS effect on apraxia after 3 months. Anodal tDCS improved grip force (of the contra-lesional, i.e., right hand), but had no effect on aphasia. Conclusions Data from this pilot study show that repetitive, anodal tDCS over left PPC combined with a standardized motor training expedites recovery from imitation deficits in LH stroke patients with apraxia (relative to sham stimulation). Results suggest that in patients suffering from apraxic imitation deficits a randomized controlled trial (RCT) is warranted that investigates the effects of tDCS applied over PPC in addition to a standardized motor training.
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Affiliation(s)
- Jana M Ant
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Eva Niessen
- Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-3), Research Center Jülich, 52425 Jülich, Germany
| | - Elisabeth I S Achilles
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.,Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-3), Research Center Jülich, 52425 Jülich, Germany
| | - Jochen Saliger
- Neurological Rehabilitation Centre Godeshöhe, Bonn, Germany
| | - Hans Karbe
- Neurological Rehabilitation Centre Godeshöhe, Bonn, Germany
| | - Peter H Weiss
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.,Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-3), Research Center Jülich, 52425 Jülich, Germany
| | - Gereon R Fink
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.,Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-3), Research Center Jülich, 52425 Jülich, Germany
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23
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Pyun SB, Hwang YM, Jo SY, Ha JW. Reliability and Validity of the Comprehensive Limb and Oral Apraxia Test: Standardization and Clinical Application in Korean Patients With Stroke. Ann Rehabil Med 2019; 43:544-554. [PMID: 31693844 PMCID: PMC6835135 DOI: 10.5535/arm.2019.43.5.544] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Accepted: 05/28/2019] [Indexed: 11/29/2022] Open
Abstract
Objective To develop and standardize the Limb and Oral Apraxia Test (LOAT) for Korean patients and investigate its reliability, validity, and clinical usefulness for patients with stroke. Methods We developed the LOAT according to a cognitive neuropsychological model of limb and oral praxis. The test included meaningless, intransitive, transitive, and oral praxis composed of 72 items (56 items on limb praxis and 16 items on oral praxis; maximum score 216). We standardized the LOAT in a nationwide sample of 324 healthy adults. Intra-rater and inter-rater reliability and concurrent validity tests were performed in patients with stroke. We prospectively applied the LOAT in 80 patients and analyzed the incidence of apraxia. We also compared the clinical characteristics between the apraxia and non-apraxia groups. Results The internal consistency was high (Cronbach’s alpha=0.952). The inter-rater and intra-rater reliability and concurrent validity were also high (r=0.924–0.992, 0.961–0.999, and 0.830, respectively; p<0.001). The mean total, limb, and oral scores were not significantly different according to age and education (p>0.05). Among the 80 patients with stroke, 19 (23.8%) had limb apraxia and 21 (26.3%) had oral apraxia. Left hemispheric lesions and aphasia were significantly more frequently observed in the limb/oral apraxia group than in the non-apraxia group (p<0.001). Conclusion The LOAT is a newly developed comprehensive test for limb and oral apraxia for Korean patients with stroke. It has high internal consistency, reliability, and validity and is a useful apraxia test for patients with stroke.
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Affiliation(s)
- Sung-Bom Pyun
- Department of Physical Medicine and Rehabilitation, Korea University College of Medicine, Seoul, Korea.,Brain Convergence Research Center, Korea University College of Medicine, Seoul, Korea
| | - Yu Mi Hwang
- Brain Convergence Research Center, Korea University College of Medicine, Seoul, Korea
| | - Soo Yung Jo
- Department of Physical Medicine and Rehabilitation, Korea University College of Medicine, Seoul, Korea
| | - Ji-Wan Ha
- Department of Speech Pathology, Daegu University, Gyeongsan, Korea
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24
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Deficient body structural description contributes to apraxic end-position errors in imitation. Neuropsychologia 2019; 133:107150. [DOI: 10.1016/j.neuropsychologia.2019.107150] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Revised: 06/24/2019] [Accepted: 07/26/2019] [Indexed: 11/21/2022]
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25
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Matt E, Fischmeister FPS, Foki T, Beisteiner R. Dopaminergic modulation of the praxis network in Parkinson's disease. Neuroimage Clin 2019; 24:101988. [PMID: 31479896 PMCID: PMC6726913 DOI: 10.1016/j.nicl.2019.101988] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 08/07/2019] [Accepted: 08/16/2019] [Indexed: 02/02/2023]
Abstract
Apraxia is a deficit in central motor planning impairing praxis functions such as gesture production or tool use that affects a substantial number of patients with advanced Parkinson's disease. We investigated the functional connectivity of the praxis network in patients in early stages of Parkinson's disease having an increased risk for apraxia and evaluated the influence of dopaminergic therapy on praxis abilities and related networks. 13 patients with mild to moderate Parkinson's disease (ON and OFF dopaminergic therapy) and 13 healthy controls completed a praxis sensitive functional MRI task and apraxia assessments. Functional connectivity analyses included a graph theoretical approach analyzing the global efficiency within the praxis network followed by a seed-to-voxel functional connectivity analysis. Patients in the OFF but not in the ON state showed significantly lower praxis scores than controls. Patients in both states displayed higher global efficiency within the praxis network than controls revealing the bilateral supramarginal gyri as hubs. Seed-to-voxel functional connectivity analyses showed aberrations of right-hemispheric praxis areas in the OFF but not in the ON state. Patients in the ON state exhibited a significantly higher functional connectivity between the supramarginal gyrus and the primary motor cortex, basal ganglia, and frontal areas than in the OFF state. Dopaminergic therapy seems to normalize praxis abilities and related praxis networks in early stages of Parkinson's disease potentially by facilitating the propagation of long-term representations of object-related actions to motor execution areas.
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Affiliation(s)
- Eva Matt
- Department of Neurology, High Field Magnetic Resonance Centre, Medical University of Vienna, Spitalgasse 23, 1090 Vienna, Austria.
| | | | - Thomas Foki
- Department of Neurology, University Clinic Tulln, Alter Ziegelweg 10, 3430 Tulln, Austria.
| | - Roland Beisteiner
- Department of Neurology, High Field Magnetic Resonance Centre, Medical University of Vienna, Spitalgasse 23, 1090 Vienna, Austria.
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26
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Achilles EIS, Ballweg CS, Niessen E, Kusch M, Ant JM, Fink GR, Weiss PH. Neural correlates of differential finger gesture imitation deficits in left hemisphere stroke. Neuroimage Clin 2019; 23:101915. [PMID: 31491825 PMCID: PMC6627029 DOI: 10.1016/j.nicl.2019.101915] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 06/15/2019] [Accepted: 06/29/2019] [Indexed: 11/16/2022]
Abstract
Behavioural studies in apraxic patients revealed dissociations between the processing of meaningful (MF) and meaningless (ML) gestures. Consequently, the existence of two differential neural mechanisms for the imitation of either gesture type has been postulated. While the indirect (semantic) route exclusively enables the imitation of MF gestures, the direct route can be used for the imitation of any gesture type, irrespective of meaning, and thus especially for ML gestures. Concerning neural correlates, it is debated which of the visuo-motor streams (i.e., the ventral steam, the ventro-dorsal stream, or the dorso-dorsal stream) supports the postulated indirect and direct imitation routes. To probe the hypotheses that regions of the dorso-dorsal stream are involved differentially in the imitation of ML gestures and that regions of the ventro-dorsal stream are involved differentially in the imitation of MF gestures, we analysed behavioural (imitation of MF and ML finger gestures) and lesion data of 293 patients with a left hemisphere (LH) stroke. Confirming previous work, the current sample of LH stroke patients imitated MF finger gestures better than ML finger gestures. The analysis using voxel-based lesion symptom mapping (VLSM) revealed that LH damage to dorso-dorsal stream areas was associated with an impaired imitation of ML finger gestures, whereas damage to ventro-dorsal regions was associated with a deficient imitation of MF finger gestures. Accordingly, the analyses of the imitation of visually uniform and thus highly comparable MF and ML finger gestures support the dual-route model for gesture imitation at the behavioural and lesion level in a substantial patient sample. Furthermore, the data show that the direct route for ML finger gesture imitation depends on the dorso-dorsal visuo-motor stream while the indirect route for MF finger gesture imitation is related to regions of the ventro-dorsal visuo-motor stream.
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Affiliation(s)
- Elisabeth I S Achilles
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Neurology, Germany; Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-3), Research Centre Jülich, Germany, Wilhelm-Johnen-Straße, 52428 Jülich, Germany.
| | - Charlotta S Ballweg
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Neurology, Germany
| | - Eva Niessen
- Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-3), Research Centre Jülich, Germany, Wilhelm-Johnen-Straße, 52428 Jülich, Germany
| | - Mona Kusch
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Neurology, Germany
| | - Jana M Ant
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Neurology, Germany
| | - Gereon R Fink
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Neurology, Germany; Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-3), Research Centre Jülich, Germany, Wilhelm-Johnen-Straße, 52428 Jülich, Germany
| | - Peter H Weiss
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Neurology, Germany; Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-3), Research Centre Jülich, Germany, Wilhelm-Johnen-Straße, 52428 Jülich, Germany
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27
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Buchmann I, Finkel L, Dangel M, Erz D, Maren Harscher K, Kaupp-Merkle M, Liepert J, Rockstroh B, Randerath J. A combined therapy for limb apraxia and related anosognosia. Neuropsychol Rehabil 2019; 30:2016-2034. [DOI: 10.1080/09602011.2019.1628075] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Ilka Buchmann
- Department of Psychology, University of Konstanz, Konstanz, Germany
- Lurija Institute for Rehabilitation Sciences and Health Research at the University of Konstanz, Konstanz, Germany
| | - Lisa Finkel
- Department of Psychology, University of Konstanz, Konstanz, Germany
- Lurija Institute for Rehabilitation Sciences and Health Research at the University of Konstanz, Konstanz, Germany
| | - Mareike Dangel
- Department of Psychology, University of Konstanz, Konstanz, Germany
| | - Dorothee Erz
- Department of Psychology, University of Konstanz, Konstanz, Germany
- Department of Psychology, Johannes Gutenberg University Mainz, Mainz, Germany
| | | | | | - Joachim Liepert
- Lurija Institute for Rehabilitation Sciences and Health Research at the University of Konstanz, Konstanz, Germany
- Kliniken Schmieder, Allensbach, Germany
| | - Brigitte Rockstroh
- Department of Psychology, University of Konstanz, Konstanz, Germany
- Lurija Institute for Rehabilitation Sciences and Health Research at the University of Konstanz, Konstanz, Germany
| | - Jennifer Randerath
- Department of Psychology, University of Konstanz, Konstanz, Germany
- Lurija Institute for Rehabilitation Sciences and Health Research at the University of Konstanz, Konstanz, Germany
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28
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Ubben SD, Fink GR, Kaesberg S, Kalbe E, Kessler J, Vossel S, Weiss PH. Deficient allo-centric visuospatial processing contributes to apraxic deficits in sub-acute right hemisphere stroke. J Neuropsychol 2019; 14:242-259. [PMID: 31207114 DOI: 10.1111/jnp.12191] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Indexed: 11/30/2022]
Abstract
While visuospatial deficits are well-characterized cognitive sequelae of right hemisphere (RH) stroke, apraxic deficits in RH stroke remain poorly understood. Likewise, very little is known about the association between apraxic and visuospatial deficits in RH stroke or about the putative common or differential pathophysiology underlying these deficits. Therefore, we examined the behavioural and lesion patterns of apraxic deficits (pantomime of object use and bucco-facial imitation) and visuospatial deficits (line bisection and letter cancellation tasks) in 50 sub-acute RH stroke patients. Using principal component analysis (PCA), we characterized the relationship between the two deficits. We hypothesized that any interaction of these neuropsychological measures may be influenced by the demands of ego-centric/space-based and/or allo-centric/object-based processing. Contralesional visuospatial deficits were common in our clinically representative patient sample, affecting more than half of RH stroke patients. Furthermore, about one-third of all patients demonstrated apraxic deficits. PCA revealed that pantomiming and the imitation of bucco-facial gestures loaded clearly on a first component (PCA1), while letter cancellation loaded heavily on a second component (PCA2). For line bisection, overall mean deviation loaded on PCA1, while the difference between the mean deviations in contra- versus ipsilesional space loaded on PCA2. These results suggest that PCA1 represents allo-centric/object-based processing and PCA2 ego-centric/space-based processing. This interpretation was corroborated by the statistical lesion analyses with the component scores. Data suggest that disturbed allo-centric/object-based processing contributes to apraxic pantomime and imitation deficits in (sub-acute) RH stroke.
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Affiliation(s)
- Simon D Ubben
- Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-3), Research Centre Jülich, Jülich, Germany
| | - Gereon R Fink
- Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-3), Research Centre Jülich, Jülich, Germany.,Department of Neurology, University Hospital Cologne, Cologne, Germany
| | | | - Elke Kalbe
- Department of Medical Psychology, University Hospital Cologne, Cologne, Germany
| | - Josef Kessler
- Department of Neurology, University Hospital Cologne, Cologne, Germany
| | - Simone Vossel
- Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-3), Research Centre Jülich, Jülich, Germany.,Department of Psychology, University of Cologne, Cologne, Germany
| | - Peter H Weiss
- Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-3), Research Centre Jülich, Jülich, Germany.,Department of Neurology, University Hospital Cologne, Cologne, Germany
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29
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Buchmann I, Dangel M, Finkel L, Jung R, Makhkamova I, Binder A, Dettmers C, Herrmann L, Liepert J, Möller JC, Richter G, Vogler T, Wolf C, Randerath J. Limb apraxia profiles in different clinical samples. Clin Neuropsychol 2019; 34:217-242. [DOI: 10.1080/13854046.2019.1585575] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- Ilka Buchmann
- University of Konstanz, Konstanz, Germany
- Lurija Institute for Rehabilitation Sciences and Health Research at the University of Konstanz, Konstanz, Germany
| | | | - Lisa Finkel
- University of Konstanz, Konstanz, Germany
- Lurija Institute for Rehabilitation Sciences and Health Research at the University of Konstanz, Konstanz, Germany
| | | | - Inara Makhkamova
- University of Konstanz, Konstanz, Germany
- Graduate School of Systemic Neurosciences, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Andreas Binder
- Center for Neurological Rehabilitation, Rehaklinik Zihlschlacht, Zihlschlacht, Switzerland
| | - Christian Dettmers
- Lurija Institute for Rehabilitation Sciences and Health Research at the University of Konstanz, Konstanz, Germany
- Kliniken Schmieder, Konstanz, Germany
| | - Laura Herrmann
- Klinik für Alterspsychiatrie, Zentrum für Psychiatrie Reichenau, Reichenau, Germany
| | - Joachim Liepert
- Lurija Institute for Rehabilitation Sciences and Health Research at the University of Konstanz, Konstanz, Germany
- Kliniken Schmieder, Allensbach, Germany
| | - Jens Carsten Möller
- Center for Neurological Rehabilitation, Rehaklinik Zihlschlacht, Zihlschlacht, Switzerland
- Department of Neurology, Philipps University, Marburg, Germany
| | - Gabriel Richter
- Klinik für Alterspsychiatrie, Zentrum für Psychiatrie Reichenau, Reichenau, Germany
| | - Tobias Vogler
- Klinik für Alterspsychiatrie, Zentrum für Psychiatrie Reichenau, Reichenau, Germany
| | - Caroline Wolf
- Klinik für Alterspsychiatrie, Zentrum für Psychiatrie Reichenau, Reichenau, Germany
| | - Jennifer Randerath
- University of Konstanz, Konstanz, Germany
- Lurija Institute for Rehabilitation Sciences and Health Research at the University of Konstanz, Konstanz, Germany
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30
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Rossi M, Fornia L, Puglisi G, Leonetti A, Zuccon G, Fava E, Milani D, Casarotti A, Riva M, Pessina F, Cerri G, Bello L. Assessment of the praxis circuit in glioma surgery to reduce the incidence of postoperative and long-term apraxia: a new intraoperative test. J Neurosurg 2019; 130:17-27. [PMID: 29473778 DOI: 10.3171/2017.7.jns17357] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Accepted: 07/06/2017] [Indexed: 11/06/2022]
Abstract
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.
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Affiliation(s)
- Marco Rossi
- 1Unit of Neurosurgical Oncology, Department of Hematology and Hemato-Oncology, and
- 2Unit of Neurosurgical Oncology, Humanitas Research Hospital, Rozzano, Italy
| | - Luca Fornia
- 3Laboratory of Motor Control, Department of Medical Biotechnology and Translational Medicine, Università degli Studi di Milano; and
| | - Guglielmo Puglisi
- 2Unit of Neurosurgical Oncology, Humanitas Research Hospital, Rozzano, Italy
- 3Laboratory of Motor Control, Department of Medical Biotechnology and Translational Medicine, Università degli Studi di Milano; and
| | - Antonella Leonetti
- 2Unit of Neurosurgical Oncology, Humanitas Research Hospital, Rozzano, Italy
- 3Laboratory of Motor Control, Department of Medical Biotechnology and Translational Medicine, Università degli Studi di Milano; and
| | - Gianmarco Zuccon
- 1Unit of Neurosurgical Oncology, Department of Hematology and Hemato-Oncology, and
| | - Enrica Fava
- 2Unit of Neurosurgical Oncology, Humanitas Research Hospital, Rozzano, Italy
| | - Daniela Milani
- 2Unit of Neurosurgical Oncology, Humanitas Research Hospital, Rozzano, Italy
| | - Alessandra Casarotti
- 1Unit of Neurosurgical Oncology, Department of Hematology and Hemato-Oncology, and
- 2Unit of Neurosurgical Oncology, Humanitas Research Hospital, Rozzano, Italy
| | - Marco Riva
- 1Unit of Neurosurgical Oncology, Department of Hematology and Hemato-Oncology, and
- 2Unit of Neurosurgical Oncology, Humanitas Research Hospital, Rozzano, Italy
| | - Federico Pessina
- 2Unit of Neurosurgical Oncology, Humanitas Research Hospital, Rozzano, Italy
| | - Gabriella Cerri
- 3Laboratory of Motor Control, Department of Medical Biotechnology and Translational Medicine, Università degli Studi di Milano; and
| | - Lorenzo Bello
- 1Unit of Neurosurgical Oncology, Department of Hematology and Hemato-Oncology, and
- 2Unit of Neurosurgical Oncology, Humanitas Research Hospital, Rozzano, Italy
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31
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Kusch M, Schmidt C, Göden L, Tscherpel C, Stahl J, Saliger J, Karbe H, Fink G, Weiss P. Recovery from apraxic deficits and its neural correlate. Restor Neurol Neurosci 2018; 36:669-678. [DOI: 10.3233/rnn-180815] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- M. Kusch
- Department of Neurology, University Hospital Cologne, Cologne, Germany
- Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-3), Research Centre Jülich, Jülich, Germany
| | - C.C. Schmidt
- Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-3), Research Centre Jülich, Jülich, Germany
| | - L. Göden
- Department of Neurology, University Hospital Cologne, Cologne, Germany
| | - C. Tscherpel
- Department of Neurology, University Hospital Cologne, Cologne, Germany
- Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-3), Research Centre Jülich, Jülich, Germany
| | - J. Stahl
- Department of Psychology, University of Cologne, Cologne, Germany
| | - J. Saliger
- Neurological Rehabilitation Centre Godeshöhe, Bonn, Germany
| | - H. Karbe
- Neurological Rehabilitation Centre Godeshöhe, Bonn, Germany
| | - G.R. Fink
- Department of Neurology, University Hospital Cologne, Cologne, Germany
- Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-3), Research Centre Jülich, Jülich, Germany
| | - P.H. Weiss
- Department of Neurology, University Hospital Cologne, Cologne, Germany
- Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-3), Research Centre Jülich, Jülich, Germany
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32
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Functional fixedness and body-part-as-object production in pantomime. Acta Psychol (Amst) 2018; 190:174-187. [PMID: 30121526 DOI: 10.1016/j.actpsy.2018.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2017] [Revised: 06/16/2018] [Accepted: 07/31/2018] [Indexed: 11/21/2022] Open
Abstract
In pantomiming the use of tools, it is possible to use a body part as the object (BPO) or imagine the object (IO). The present four studies test how conceptualizing the functions of objects may underlie BPO production in a non-clinical adult population. We showed that familiar vs. unfamiliar tools (Study 1) and visual experience only vs. visual + motor experience with novel tools (Study 2) made no difference in BPO production. In Study 3, participants showed a trend for higher BPO production for tools presented in two-dimensional pictures rather than in reality. In Study 4, participants' functional fixedness was experimentally manipulated: participants were told unfamiliar tools had either five functions or only one function. Participants produced significantly more BPOs in the one-function condition. These results suggest that conceptualizing objects as having a fixed function is a predictor of BPO production.
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33
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Nobusako S, Ishibashi R, Takamura Y, Oda E, Tanigashira Y, Kouno M, Tominaga T, Ishibashi Y, Okuno H, Nobusako K, Zama T, Osumi M, Shimada S, Morioka S. Distortion of Visuo-Motor Temporal Integration in Apraxia: Evidence From Delayed Visual Feedback Detection Tasks and Voxel-Based Lesion-Symptom Mapping. Front Neurol 2018; 9:709. [PMID: 30210434 PMCID: PMC6119712 DOI: 10.3389/fneur.2018.00709] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Accepted: 08/06/2018] [Indexed: 12/30/2022] Open
Abstract
Limb apraxia is a higher brain dysfunction that typically occurs after left hemispheric stroke and its cause cannot be explained by sensory disturbance or motor paralysis. The comparison of motor signals and visual feedback to generate errors, i.e., visuo-motor integration, is important in motor control and motor learning, which may be impaired in apraxia. However, in apraxia after stroke, it is unknown whether there is a specific deficit in visuo-motor temporal integration compared to visuo-tactile and visuo-proprioceptive temporal integration. We examined the precision of visuo-motor temporal integration and sensory-sensory (visuo-tactile and visuo-proprioception) temporal integration in apraxia after stroke by using a delayed visual feedback detection task with three different conditions (tactile, passive movement, and active movement). The delay detection threshold and the probability curve for delay detection obtained in this task were quantitative indicators of the respective temporal integration functions. In addition, we performed subtraction and voxel-based lesion-symptom mapping to identify the brain lesions responsible for apraxia and deficits in visuo-motor temporal integration. The behavioral experiments showed that the delay detection threshold was extended and that the probability curve for delay detection was less steep in apraxic patients compared to controls (pseudo-apraxic patients and unaffected patients), only for the active movement condition, and not for the tactile and passive movement conditions. Furthermore, the severity of apraxia was significantly correlated with the delay detection threshold and the steepness of the probability curve in the active movement condition. These results indicated that multisensory (i.e., visual, tactile, and proprioception) feedback was normally temporally integrated, but motor prediction and visual feedback were not correctly temporally integrated in apraxic patients. That is, apraxic patients had difficulties with visuo-motor temporal integration. Lesion analyses revealed that both apraxia and the distortion of visuo-motor temporal integration were associated with lesions in the fronto-parietal motor network, including the left inferior parietal lobule and left inferior frontal gyrus. We suppose that damage to the left inferior fronto-parietal network could cause deficits in motor prediction for visuo-motor temporal integration, but not for sensory-sensory (visuo-tactile and visuo-proprioception) temporal integration, leading to the distortion of visuo-motor temporal integration in patients with apraxia.
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Affiliation(s)
- Satoshi Nobusako
- Neurorehabilitation Research Center, Kio University, Nara, Japan.,Graduate School of Health Science, Kio University, Nara, Japan
| | | | - Yusaku Takamura
- Graduate School of Health Science, Kio University, Nara, Japan.,Department of Rehabilitation, Murata Hospital, Osaka, Japan
| | - Emika Oda
- Department of Rehabilitation, Murata Hospital, Osaka, Japan
| | | | - Masashi Kouno
- Department of Rehabilitation, Murata Hospital, Osaka, Japan
| | | | - Yurie Ishibashi
- Cognitive-Neurorehabilitation Center, Setsunan General Hospital, Osaka, Japan
| | - Hiroyuki Okuno
- Cognitive-Neurorehabilitation Center, Setsunan General Hospital, Osaka, Japan
| | - Kaori Nobusako
- Cognitive-Neurorehabilitation Center, Setsunan General Hospital, Osaka, Japan
| | - Takuro Zama
- Rhythm-Based Brain Information Processing Unit, RIKEN CBS-TOYOTA Collaboration Center, RIKEN Center for Brain Science, Saitama, Japan
| | - Michihiro Osumi
- Neurorehabilitation Research Center, Kio University, Nara, Japan.,Graduate School of Health Science, Kio University, Nara, Japan
| | - Sotaro Shimada
- Department of Electronics and Bioinformatics, School of Science and Technology, Meiji University, Kanagawa, Japan
| | - Shu Morioka
- Neurorehabilitation Research Center, Kio University, Nara, Japan.,Graduate School of Health Science, Kio University, Nara, Japan
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Abstract
In Parkinson’s disease (PD) the prevalence of apraxia increases with disease severity implying that patients in early stages may already have subclinical deficits. The aim of this exploratory fMRI study was to investigate if subclinical aberrations of the praxis network are already present in patients with early PD. In previous functional imaging literature only data on basal motor functions in PD exists. Thirteen patients with mild parkinsonian symptoms and without clinically diagnosed apraxia and 14 healthy controls entered this study. During fMRI participants performed a pantomime task in which they imitated the use of visually presented objects. Patients were measured ON and OFF dopaminergic therapy to evaluate a potential medication effect on praxis abilities and related brain functions. Although none of the patients was apraxic according to De Renzi ideomotor scores (range 62–72), patients OFF showed significantly lower praxis scores than controls. Patients exhibited significant hyperactivation in left fronto-parietal core areas of the praxis network. Frontal activations were clearly dominant in patients and were correlated with lower individual praxis scores. We conclude that early PD patients already show characteristic signs of praxis network dysfunctions and rely on specific hyperactivations to avoid clinically evident apraxic symptoms. Subclinical apraxic deficits were shown to correlate with an activation shift from left parietal to left frontal areas implying a prospective individual imaging marker for incipient apraxia.
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Esteves S, Ramirez Romero DA, Torralva T, Martínez Cuitiño M, Herndon S, Couto B, Ibañez A, Manes F, Roca M. Posterior cortical atrophy: a single case cognitive and radiological follow-up. Neurocase 2018; 24:16-30. [PMID: 29308699 DOI: 10.1080/13554794.2017.1421667] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Posterior cortical atrophy (PCA) is a rare neurodegenerative syndrome characterized by initial predominant visuoperceptual deficits followed by a progressive decline in other cognitive functions. This syndrome has not been as thoroughly described as other dementias, particularly from a neuropsychological evolution perspective with only a few studies describing the evolution of its cognitive progression. In this investigation we review the literature on this rare condition and we perform a 7-year neuropsychological and neuroradiological follow-up of a 64-year-old man with PCA. The subject's deficits initially appeared in his visuoperceptual skills with later affectation appearing in language and other cognitive functions, this being coherent with the patient's parieto-temporal atrophy evolution.
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Affiliation(s)
- Sol Esteves
- a Neuropsychological Research Laboratory, Institute of Cognitive and Translational Neuroscience (INCyT), INECO Foundation, Favaloro University, CONICET , Buenos Aires , Argentina
| | - Diana Andrea Ramirez Romero
- a Neuropsychological Research Laboratory, Institute of Cognitive and Translational Neuroscience (INCyT), INECO Foundation, Favaloro University, CONICET , Buenos Aires , Argentina
| | - Teresa Torralva
- a Neuropsychological Research Laboratory, Institute of Cognitive and Translational Neuroscience (INCyT), INECO Foundation, Favaloro University, CONICET , Buenos Aires , Argentina
| | - Macarena Martínez Cuitiño
- a Neuropsychological Research Laboratory, Institute of Cognitive and Translational Neuroscience (INCyT), INECO Foundation, Favaloro University, CONICET , Buenos Aires , Argentina
| | - Shannon Herndon
- a Neuropsychological Research Laboratory, Institute of Cognitive and Translational Neuroscience (INCyT), INECO Foundation, Favaloro University, CONICET , Buenos Aires , Argentina.,b Department of Psychiatry, School of Medicine, University of North Carolina Chapel Hill , Chapel Hill , USA
| | - Blas Couto
- c Laboratory of Experimental Psychology and Neuroscience (LPEN), Institute of Cognitive and Translational Neuroscience (INCyT), INECO Foundation, Favaloro University, CONICET , Buenos Aires , Argentina
| | - Agustín Ibañez
- c Laboratory of Experimental Psychology and Neuroscience (LPEN), Institute of Cognitive and Translational Neuroscience (INCyT), INECO Foundation, Favaloro University, CONICET , Buenos Aires , Argentina.,d Centre of Excellence in Cognition and its Disorders, Australian Research Council (ACR) , Sydney , Australia.,e Universidad Autónoma del Caribe, Barranquilla , Colombia.,f Centre for Social and Cognitive Neuroscience (CSCN), School of Psychology, Universidad Adolfo Ibañez , Santiago de Chile , Chile.,g National Scientific and Technical Research Council (CONICET) , Buenos Aires , Argentina
| | - Facundo Manes
- d Centre of Excellence in Cognition and its Disorders, Australian Research Council (ACR) , Sydney , Australia.,g National Scientific and Technical Research Council (CONICET) , Buenos Aires , Argentina
| | - María Roca
- g National Scientific and Technical Research Council (CONICET) , Buenos Aires , Argentina
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Fernandez YM, Frucht SJ. Primary progressive apraxia: an unusual ideomotor syndrome. JOURNAL OF CLINICAL MOVEMENT DISORDERS 2018; 4:17. [PMID: 29375885 PMCID: PMC5771468 DOI: 10.1186/s40734-017-0064-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Accepted: 09/21/2017] [Indexed: 11/10/2022]
Abstract
BACKGROUND Primary progressive apraxia is a rare form of apraxia in the absence of dementia which develops insidiously and is slowly progressive. Most reports of patients with apraxia also describe coexisting aphasias or involve additional apraxias with affected speech, usually in the setting of neurodegenerative diseases such as corticobasal degeneration, Alzheimer's disease or frontotemporal dementia. The aim of this report is to describe and demonstrate by video two cases of isolated primary progressive ideomotor apraxia seen in our clinic. CASE PRESENTATION We describe two patients with 2-5 years of progressive difficulty using their hands, despite having intact cognition and lack of correlating lesions on imaging. CONCLUSION We report two cases of primary progressive apraxia that may be early presentations of taupathic disease in both patients. In both cases, there is isolated profound ideomotor apraxia of the hands, with preserved cognition, language skills, muscle power and tone, and gait. There are no correlating lesions on imaging.
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Affiliation(s)
| | - Steven J Frucht
- Mount Sinai, 5 East 98 street 1st floor, New York, NY 10029 USA
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Bolognini N, Russo C, Edwards DJ. The sensory side of post-stroke motor rehabilitation. Restor Neurol Neurosci 2018; 34:571-86. [PMID: 27080070 DOI: 10.3233/rnn-150606] [Citation(s) in RCA: 74] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Contemporary strategies to promote motor recovery following stroke focus on repetitive voluntary movements. Although successful movement relies on efficient sensorimotor integration, functional outcomes often bias motor therapy toward motor-related impairments such as weakness, spasticity and synergies; sensory therapy and reintegration is implied, but seldom targeted. However, the planning and execution of voluntary movement requires that the brain extracts sensory information regarding body position and predicts future positions, by integrating a variety of sensory inputs with ongoing and planned motor activity. Neurological patients who have lost one or more of their senses may show profoundly affected motor functions, even if muscle strength remains unaffected. Following stroke, motor recovery can be dictated by the degree of sensory disruption. Consequently, a thorough account of sensory function might be both prognostic and prescriptive in neurorehabilitation. This review outlines the key sensory components of human voluntary movement, describes how sensory disruption can influence prognosis and expected outcomes in stroke patients, reports on current sensory-based approaches in post-stroke motor rehabilitation, and makes recommendations for optimizing rehabilitation programs based on sensory stimulation.
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Affiliation(s)
- Nadia Bolognini
- Department of Psychology and Milan Center for Neuroscience, University of Milano-Bicocca, Milano, Italy.,Laboratory of Neuropsychology, IRCCS Istituto Auxologico, Milano, Italy
| | - Cristina Russo
- Department of Psychology and Milan Center for Neuroscience, University of Milano-Bicocca, Milano, Italy
| | - Dylan J Edwards
- Burke-Cornell Medical Research Institute, White Plains, New York, NY, USA
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Achilles EIS, Weiss PH, Fink GR, Binder E, Price CJ, Hope TMH. Using multi-level Bayesian lesion-symptom mapping to probe the body-part-specificity of gesture imitation skills. Neuroimage 2017; 161:94-103. [PMID: 28822751 PMCID: PMC5692920 DOI: 10.1016/j.neuroimage.2017.08.036] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Revised: 08/01/2017] [Accepted: 08/12/2017] [Indexed: 11/21/2022] Open
Abstract
Past attempts to identify the neural substrates of hand and finger imitation skills in the left hemisphere of the brain have yielded inconsistent results. Here, we analyse those associations in a large sample of 257 left hemisphere stroke patients. By introducing novel Bayesian methods, we characterise lesion symptom associations at three levels: the voxel-level, the single-region level (using anatomically defined regions), and the region-pair level. The results are inconsistent across those three levels and we argue that each level of analysis makes assumptions which constrain the results it can produce. Regardless of the inconsistencies across levels, and contrary to past studies which implicated differential neural substrates for hand and finger imitation, we find no consistent voxels or regions, where damage affects one imitation skill and not the other, at any of the three analysis levels. Our novel Bayesian approach indicates that any apparent differences appear to be driven by an increased sensitivity of hand imitation skills to lesions that also impair finger imitation. In our analyses, the results of the highest level of analysis (region-pairs) emphasise a role of the primary somatosensory and motor cortices, and the occipital lobe in imitation. We argue that this emphasis supports an account of both imitation tasks based on direct sensor-motor connections, which throws doubt on past accounts which imply the need for an intermediate (e.g. body-part-coding) system of representation.
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Affiliation(s)
- Elisabeth I S Achilles
- Department of Neurology, University Hospital of Cologne, Cologne, Germany; Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-3), Research Centre Jülich, Germany
| | - Peter H Weiss
- Department of Neurology, University Hospital of Cologne, Cologne, Germany; Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-3), Research Centre Jülich, Germany
| | - Gereon R Fink
- Department of Neurology, University Hospital of Cologne, Cologne, Germany; Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-3), Research Centre Jülich, Germany
| | - Ellen Binder
- Department of Neurology, University Hospital of Cologne, Cologne, Germany; Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-3), Research Centre Jülich, Germany
| | - Cathy J Price
- Wellcome Trust Centre for Neuroimaging, University College London, UK
| | - Thomas M H Hope
- Wellcome Trust Centre for Neuroimaging, University College London, UK.
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Binder E, Dovern A, Hesse MD, Ebke M, Karbe H, Saliger J, Fink GR, Weiss PH. Lesion evidence for a human mirror neuron system. Cortex 2017; 90:125-137. [DOI: 10.1016/j.cortex.2017.02.008] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Revised: 02/10/2017] [Accepted: 02/14/2017] [Indexed: 12/21/2022]
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Worthington A. Treatments and technologies in the rehabilitation of apraxia and action disorganisation syndrome: A review. NeuroRehabilitation 2017; 39:163-74. [PMID: 27314872 PMCID: PMC4942853 DOI: 10.3233/nre-161348] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND: Apraxia and Action Disorganisation Syndrome are characterised by an inability to use tools and carry out ordered sequences of movements in the absence of motor or sensory impairment. To date treatment for these complex but debilitating conditions has received little attention. OBJECTIVES: To provide an overview of apraxia and action disorganisation syndrome and its treatment, providing a state of the art summary for practitioners including likely future therapeutic directions. METHOD: Review of apraxia literature and treatment studies collated from internet searches involving MEDLINE, PubMed, PyscINFO and Google Scholar as well as the author’s own catalogue. RESULTS: Evidence for current restitution and compensatory approaches is critically reviewed, with limited evidence to date in support of either method. Strategy training is the most promising intervention type with no support for sensory and exploratory interventions, practice effects only for direct task-specific training, and modest support for gestural training. CONCLUSIONS: Larger controlled studies are needed but evidence is sufficient to indicate certain approaches over others. Advances in assistive technology have not translated into mainstream therapy but future interventions are likely to require a model-based approach which embraces current technologies in order to provide a more accessible, effective and cost-efficient approach to rehabilitation.
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Affordance processing in segregated parieto-frontal dorsal stream sub-pathways. Neurosci Biobehav Rev 2016; 69:89-112. [DOI: 10.1016/j.neubiorev.2016.07.032] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Revised: 05/29/2016] [Accepted: 07/07/2016] [Indexed: 02/04/2023]
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Kim SJ, Yang YN, Lee JW, Lee JY, Jeong E, Kim BR, Lee J. Reliability and Validity of Korean Version of Apraxia Screen of TULIA (K-AST). Ann Rehabil Med 2016; 40:769-778. [PMID: 27847706 PMCID: PMC5108703 DOI: 10.5535/arm.2016.40.5.769] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Accepted: 02/01/2016] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To evaluate the reliability and validity of Korean version of AST (K-AST) as a bedside screening test of apraxia in patients with stroke for early and reliable detection. METHODS AST was translated into Korean, and the translated version received authorization from the author of AST. The performances of K-AST in 26 patients (21 males, 5 females; mean age 65.42±17.31 years) with stroke (23 ischemic, 3 hemorrhagic) were videotaped. To test the reliability and validity of K-AST, the recorded performances were assessed by two physiatrists and two occupational therapists twice at a 1-week interval. The patient performances at admission in Korean version of Mini-Mental State Examination (K-MMSE), self-care and transfer categories of Functional Independence Measure (FIM), and motor praxis area of Loewenstein Occupational Therapy Cognitive Assessment, the second edition (LOTCA-II) were also evaluated. Scores of motor praxis area of LOTCA-II was used to assess the validity of K-AST. RESULTS Inter-rater reliabilities were 0.983 (p<0.001) at the first assessment and 0.982 (p<0.001) at the second assessment. For intra-rater (test-retest) reliabilities, the values of four raters were 0.978 (p<0.001), 0.957 (p<0.001), 0.987 (p<0.001), and 0.977 (p<0.001). K-AST showed significant correlation (r=0.758, p<0.001) with motor praxis area of LOTCA-II test. K-AST also showed positive correlations with the total FIM score (r=0.694, p<0.001), the selfcare category of FIM (r=0.705, p<0.001) and the transfer category of FIM (r=653, p<0.001). CONCLUSION K-AST is a reliable and valid test for bedside screening of apraxia.
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Affiliation(s)
- Soo Jin Kim
- Department of Rehabilitation Medicine, Konkuk University School of Medicine and Konkuk University Medical Center, Seoul, Korea
| | - You-Na Yang
- Department of Rehabilitation Medicine, Konkuk University School of Medicine and Konkuk University Medical Center, Seoul, Korea
| | - Jong Won Lee
- Department of Rehabilitation Medicine, Konkuk University School of Medicine and Konkuk University Medical Center, Seoul, Korea
| | - Jin-Youn Lee
- Department of Rehabilitation Medicine, Konkuk University School of Medicine and Konkuk University Medical Center, Seoul, Korea
| | - Eunhwa Jeong
- Department of Rehabilitation Medicine, Konkuk University School of Medicine and Konkuk University Medical Center, Seoul, Korea
| | - Bo-Ram Kim
- Department of Rehabilitation Medicine, Konkuk University School of Medicine and Konkuk University Medical Center, Seoul, Korea
| | - Jongmin Lee
- Department of Rehabilitation Medicine, Konkuk University School of Medicine and Konkuk University Medical Center, Seoul, Korea
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EP 121. Motor sequence learning in patients with limb apraxia – The effects of long-term training. Clin Neurophysiol 2016. [DOI: 10.1016/j.clinph.2016.05.163] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Winstein CJ, Stein J, Arena R, Bates B, Cherney LR, Cramer SC, Deruyter F, Eng JJ, Fisher B, Harvey RL, Lang CE, MacKay-Lyons M, Ottenbacher KJ, Pugh S, Reeves MJ, Richards LG, Stiers W, Zorowitz RD. Guidelines for Adult Stroke Rehabilitation and Recovery: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke 2016; 47:e98-e169. [PMID: 27145936 DOI: 10.1161/str.0000000000000098] [Citation(s) in RCA: 1571] [Impact Index Per Article: 196.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE The aim of this guideline is to provide a synopsis of best clinical practices in the rehabilitative care of adults recovering from stroke. METHODS Writing group members were nominated by the committee chair on the basis of their previous work in relevant topic areas and were approved by the American Heart Association (AHA) Stroke Council's Scientific Statement Oversight Committee and the AHA's Manuscript Oversight Committee. The panel reviewed relevant articles on adults using computerized searches of the medical literature through 2014. The evidence is organized within the context of the AHA framework and is classified according to the joint AHA/American College of Cardiology and supplementary AHA methods of classifying the level of certainty and the class and level of evidence. The document underwent extensive AHA internal and external peer review, Stroke Council Leadership review, and Scientific Statements Oversight Committee review before consideration and approval by the AHA Science Advisory and Coordinating Committee. RESULTS Stroke rehabilitation requires a sustained and coordinated effort from a large team, including the patient and his or her goals, family and friends, other caregivers (eg, personal care attendants), physicians, nurses, physical and occupational therapists, speech-language pathologists, recreation therapists, psychologists, nutritionists, social workers, and others. Communication and coordination among these team members are paramount in maximizing the effectiveness and efficiency of rehabilitation and underlie this entire guideline. Without communication and coordination, isolated efforts to rehabilitate the stroke survivor are unlikely to achieve their full potential. CONCLUSIONS As systems of care evolve in response to healthcare reform efforts, postacute care and rehabilitation are often considered a costly area of care to be trimmed but without recognition of their clinical impact and ability to reduce the risk of downstream medical morbidity resulting from immobility, depression, loss of autonomy, and reduced functional independence. The provision of comprehensive rehabilitation programs with adequate resources, dose, and duration is an essential aspect of stroke care and should be a priority in these redesign efforts. (Stroke.2016;47:e98-e169. DOI: 10.1161/STR.0000000000000098.).
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Achilles E, Fink G, Fischer M, Dovern A, Held A, Timpert D, Schroeter C, Schuetz K, Kloetzsch C, Weiss P. Effect of meaning on apraxic finger imitation deficits. Neuropsychologia 2016; 82:74-83. [DOI: 10.1016/j.neuropsychologia.2015.12.022] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Revised: 11/24/2015] [Accepted: 12/20/2015] [Indexed: 10/22/2022]
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Pérez-Mármol JM, García-Ríos MC, Barrero-Hernandez FJ, Molina-Torres G, Brown T, Aguilar-Ferrándiz ME. Functional rehabilitation of upper limb apraxia in poststroke patients: study protocol for a randomized controlled trial. Trials 2015; 16:508. [PMID: 26542104 PMCID: PMC4636071 DOI: 10.1186/s13063-015-1034-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2014] [Accepted: 10/27/2015] [Indexed: 11/21/2022] Open
Abstract
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.
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Affiliation(s)
| | | | | | | | - Ted Brown
- Department of Occupational Therapy, School of Primary Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia.
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Johnen A, Frommeyer J, Modes F, Wiendl H, Duning T, Lohmann H. Dementia Apraxia Test (DATE): A Brief Tool to Differentiate Behavioral Variant Frontotemporal Dementia from Alzheimer’s Dementia Based on Apraxia Profiles. J Alzheimers Dis 2015; 49:593-605. [DOI: 10.3233/jad-150447] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Timpert DC, Weiss PH, Vossel S, Dovern A, Fink GR. Apraxia and spatial inattention dissociate in left hemisphere stroke. Cortex 2015; 71:349-58. [DOI: 10.1016/j.cortex.2015.07.023] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Revised: 06/09/2015] [Accepted: 07/17/2015] [Indexed: 11/28/2022]
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49
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Martin M, Beume L, Kümmerer D, Schmidt CSM, Bormann T, Dressing A, Ludwig VM, Umarova RM, Mader I, Rijntjes M, Kaller CP, Weiller C. Differential Roles of Ventral and Dorsal Streams for Conceptual and Production-Related Components of Tool Use in Acute Stroke Patients. Cereb Cortex 2015; 26:3754-71. [DOI: 10.1093/cercor/bhv179] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Johnen A, Tokaj A, Kirschner A, Wiendl H, Lueg G, Duning T, Lohmann H. Apraxia profile differentiates behavioural variant frontotemporal from Alzheimer's dementia in mild disease stages. J Neurol Neurosurg Psychiatry 2015; 86:809-15. [PMID: 25248366 DOI: 10.1136/jnnp-2014-308773] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Accepted: 08/27/2014] [Indexed: 11/03/2022]
Abstract
OBJECTIVE Despite refined criteria for behavioural variant frontotemporal dementia (bvFTD), its differentiation from Alzheimer's dementia (AD) remains difficult at early clinical presentation. Apraxia is not considered as a supportive feature for the diagnosis of bvFTD, but for AD. However, only few studies have quantified praxis disturbances in mild disease stages and their specificity for AD compared with bvFTD remains indistinct. We explore apraxia in bvFTD and investigate the differential validity of apraxia screening tests to distinguish between AD, bvFTD and healthy controls (HC). METHODS We compared composite apraxia scores assessed with standardised neuropsychological screening tests as well as performance in praxis subdomains in patients who fulfil current clinical criteria for AD (N=20), bvFTD (N=20), and in HC (N=20). RESULTS Composite scores of apraxia screening tests provided high diagnostic accuracy for detecting mild stages of both neurodegenerative disorders compared with HC (sensitivity: 75-95%; specificity: 70-90%). Both patient groups showed pronounced impairments in limb praxis, especially in imitation of hand and finger postures (bvFTD: 71.7%; AD: 55.5%; HC: 86.7%) and pantomime of object use (bvFTD: 88.6%; AD: 81.4%; HC: 97.5%). Beyond that, patients with bvFTD displayed a unique profile of deficits for imitating face postures (bvFTD: 69%; AD: 88%; HC: 95.5%). CONCLUSIONS Praxis disturbances are important but under-represented diagnostic features in mild stages of AD and bvFTD. Apraxia screening tests are easily applicable diagnostic tools, which may support clinical diagnoses of both neurodegenerative diseases. The analysis of individual apraxia profiles can effectively facilitate differential diagnosis of AD and bvFTD.
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Affiliation(s)
- Andreas Johnen
- Department of Neurology, University Hospital Münster, Münster, Germany
| | - Amelie Tokaj
- Department of Neurology, University Hospital Münster, Münster, Germany
| | - Anne Kirschner
- Department of Neurology, University Hospital Münster, Münster, Germany
| | - Heinz Wiendl
- Department of Neurology, University Hospital Münster, Münster, Germany
| | - Gero Lueg
- Department of Neurology, University Hospital Münster, Münster, Germany
| | - Thomas Duning
- Department of Neurology, University Hospital Münster, Münster, Germany
| | - Hubertus Lohmann
- Department of Neurology, University Hospital Münster, Münster, Germany
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