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Rounis E, Binkofski F. Limb Apraxias: The Influence of Higher Order Perceptual and Semantic Deficits in Motor Recovery After Stroke. Stroke 2023; 54:30-43. [PMID: 36542070 DOI: 10.1161/strokeaha.122.037948] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Stroke is a leading cause of disability worldwide. Limb apraxia is a group of higher order motor disorders associated with greater disability and dependence after stroke. Original neuropsychology studies distinguished separate brain pathways involved in perception and action, known as the dual stream hypothesis. This framework has allowed a better understanding of the deficits identified in Limb Apraxia. In this review, we propose a hierarchical organization of this disorder, in which a distinction can be made between several visuomotor pathways that lead to purposeful actions. Based on this, executive apraxias (such as limb kinetic apraxia) cause deficits in executing fine motor hand skills, and intermediate apraxias (such as optic ataxia and tactile apraxia) cause deficits in reaching to grasp and manipulating objects in space. These disorders usually affect the contralesional limb. A further set of disorders collectively known as limb apraxias include deficits in gesture imitation, pantomime, gesture recognition, and object use. These deficits are due to deficits in integrating perceptual and semantic information to generate complex movements. Limb apraxias are usually caused by left-hemisphere lesions in right-handed stroke patients, affecting both limbs. The anterior- to posterior-axis of brain areas are disrupted depending on the increasing involvement of perceptual and semantic processes with each condition. Lower-level executive apraxias are linked to lesions in the frontal lobe and the basal ganglia, while intermediate apraxias are linked to lesions in dorso-dorsal subdivisions of the dorsal fronto-parietal networks. Limb apraxias can be caused by lesions in both dorsal and ventral subdivisions including the ventro-dorsal stream and a third visuomotor pathway, involved in body schema and social cognition. Rehabilitation of these disorders with behavioral therapies has aimed to either restore perceptuo-semantic deficits or compensate to overcome these deficits. Further studies are required to better stratify patients, using modern neurophysiology and neuroimaging techniques, to provide targeted and personalized therapies for these disorders in the future.
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Affiliation(s)
- Elisabeth Rounis
- Chelsea and Westminster NHS Foundation Trust, West Middlesex University Hospital, Isleworth, United Kingdom (E.R.).,MRC Cognition and Brain Sciences Unit, University of Cambridge, United Kingdom (E.R.).,Department of Brain Sciences, Faculty of Medicine, Imperial College London, United Kingdom (E.R.)
| | - Ferdinand Binkofski
- Division for Clinical Cognitive Sciences, Department of Neurology, University Hospital RWTH Aachen, Germany (F.B.).,Institute for Neuroscience and Medicine (INM-4), Research Center Juelich GmbH, Germany (F.B.).,Juelich Aachen Research Alliance - JARA, Germany (F.B.)
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Willms S, Abel M, Karni A, Gal C, Doyon J, King BR, Classen J, Rumpf JJ, Buccino G, Pellicano A, Klann J, Binkofski F. Motor sequence learning in patients with ideomotor apraxia: Effects of long-term training. Neuropsychologia 2021; 159:107921. [PMID: 34181927 DOI: 10.1016/j.neuropsychologia.2021.107921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 06/10/2021] [Accepted: 06/18/2021] [Indexed: 10/21/2022]
Abstract
Recent studies show that limb apraxia is a quite frequent, yet often underdiagnosed, higher motor impairment following stroke. Because it adversely affects every-day life and personal independence, successful rehabilitation of apraxia is essential for personal well-being. Nevertheless, evidence of long-term efficacy of training schemes and generalization to untrained actions is still scarce. One possible reason for the tendency of this neurological disorder to persist may be a deficit in planning, conceptualisation and storage of complex motor acts. This pilot study aims at investigating explicit motor learning in apractic stroke patients. In particular, we addressed the ability of apractic patients to learn and to retain new explicit sequential finger movements across 10 training sessions over a 3-week interval. Nine stroke patients with ideomotor apraxia in its chronic stage participated in a multi-session training regimen and were included in data analyses. Patients performed an explicit finger sequence learning task (MSLT - motor sequence learning task), which is a well-established paradigm to investigate motor learning and memory processes. Patients improved task performance in terms of speed and accuracy across sessions. Specifically, they showed a noticeable reduction in the mean time needed to perform a correct sequence and the number of erroneous sequences. We found also a trend for improved performance at the Goldenberg apraxia test protocol: "imitation of meaningless hand and finger gestures" relative to when assessed before the MSLT training. Patients with ideomotor apraxia demonstrated the ability to acquire and maintain a novel sequence of movements; and, this training was associated with hints towards improvement of apraxia symptoms.
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Affiliation(s)
- Sarah Willms
- Division for Clinical and Cognitive Sciences, Department of Neurology, Medical Faculty, RWTH Aachen University, Germany
| | - Miriam Abel
- Division for Clinical and Cognitive Sciences, Department of Neurology, Medical Faculty, RWTH Aachen University, Germany
| | - Avi Karni
- Department of Neurobiology, University of Haifa, Israel
| | - Carmit Gal
- Department of Neurobiology, University of Haifa, Israel
| | - Julien Doyon
- McConnell Brain Imaging Centre, McGill University, Montreal, Canada
| | - Bradley R King
- Department of Health and Kinesiology, University of Utah, USA; Department of Movement Sciences, KU Leuven, Belgium
| | | | | | - Giovanni Buccino
- Division of Neuroscience, IRCCS San Raffaele and Vita Salute San Raffaele University, Milano, Italy
| | - Antonello Pellicano
- Division for Clinical and Cognitive Sciences, Department of Neurology, Medical Faculty, RWTH Aachen University, Germany
| | - Juliane Klann
- Division for Clinical and Cognitive Sciences, Department of Neurology, Medical Faculty, RWTH Aachen University, Germany; SRH University of Applied Health Sciences, Campus Heidelberg, Germany
| | - Ferdinand Binkofski
- Division for Clinical and Cognitive Sciences, Department of Neurology, Medical Faculty, RWTH Aachen University, Germany; Institute for Medicine and Neuroscience (INM-4), Research Center Jülich GmbH, Germany.
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