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De Luca R, Gangemi A, Maggio MG, Bonanno M, Calderone A, Mazzurco Masi VM, Rifici C, Cappadona I, Pagano M, Cardile D, Giuffrida GM, Ielo A, Quartarone A, Calabrò RS, Corallo F. Effects of Virtual Rehabilitation Training on Post-Stroke Executive and Praxis Skills and Depression Symptoms: A Quasi-Randomised Clinical Trial. Diagnostics (Basel) 2024; 14:1892. [PMID: 39272676 PMCID: PMC11394403 DOI: 10.3390/diagnostics14171892] [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: 08/02/2024] [Revised: 08/22/2024] [Accepted: 08/26/2024] [Indexed: 09/15/2024] Open
Abstract
INTRODUCTION Apraxia is a neurological disorder that is common after a stroke and impairs the planning and execution of movements. In the rehabilitation field, virtual reality (VR) presents new opportunities and offers advantages to both rehabilitation teams and individuals with neurological conditions. Indeed, VR can stimulate and improve cognitive reserve and abilities, including executive function, and enhance the patient's emotional status. AIM The objective of this research is to determine the effectiveness of VR in improving praxis skills and behavioural functioning in individuals with severe stroke. METHODS A total of 20 stroke patients were enrolled from February 2022 to March 2023 and divided by the order of their recruitment into two groups: the experimental group (EG: n = 10) received training to improve their praxis skills using VR whereas the control one (CG: n = 10) received the same amount of standard training. All patients underwent an evaluation using a psychometric battery that consisted of the Hamilton Rating Scale for Depression (HRS-D), Mini-Mental State Examination (MMSE), Frontal Assessment Battery (FAB), Spinnler and Tognoni test, and De Renzi and Faglioni test. Valuations were performed before rehabilitation (T0) and after its completion (T1). RESULTS Both groups demonstrated significant improvements post-intervention. The EG showed a greater enhancement in their MMSE scores (p = 0.002), and reductions in both ideomotor and constructive apraxia (p = 0.002 for both), compared to the CG. The VR-based training also resulted in significant improvements in their depression symptoms (HRSD scores improved, p = 0.012 in EG vs. p = 0.021 in CG). CONCLUSIONS This pilot study suggests that VR could help reduce cognitive, constructive apraxia and ideomotor apraxia symptoms caused by stroke injury.
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Affiliation(s)
- Rosaria De Luca
- IRCCS Centro Neurolesi Bonino-Pulejo, S.S. 113 Via Palermo, C. da Casazza, 98124 Messina, Italy
| | - Antonio Gangemi
- IRCCS Centro Neurolesi Bonino-Pulejo, S.S. 113 Via Palermo, C. da Casazza, 98124 Messina, Italy
| | - Maria Grazia Maggio
- IRCCS Centro Neurolesi Bonino-Pulejo, S.S. 113 Via Palermo, C. da Casazza, 98124 Messina, Italy
| | - Mirjam Bonanno
- IRCCS Centro Neurolesi Bonino-Pulejo, S.S. 113 Via Palermo, C. da Casazza, 98124 Messina, Italy
| | - Andrea Calderone
- IRCCS Centro Neurolesi Bonino-Pulejo, S.S. 113 Via Palermo, C. da Casazza, 98124 Messina, Italy
| | | | - Carmela Rifici
- IRCCS Centro Neurolesi Bonino-Pulejo, S.S. 113 Via Palermo, C. da Casazza, 98124 Messina, Italy
| | - Irene Cappadona
- IRCCS Centro Neurolesi Bonino-Pulejo, S.S. 113 Via Palermo, C. da Casazza, 98124 Messina, Italy
| | - Maria Pagano
- IRCCS Centro Neurolesi Bonino-Pulejo, S.S. 113 Via Palermo, C. da Casazza, 98124 Messina, Italy
| | - Davide Cardile
- IRCCS Centro Neurolesi Bonino-Pulejo, S.S. 113 Via Palermo, C. da Casazza, 98124 Messina, Italy
| | - Giulia Maria Giuffrida
- IRCCS Centro Neurolesi Bonino-Pulejo, S.S. 113 Via Palermo, C. da Casazza, 98124 Messina, Italy
| | - Augusto Ielo
- IRCCS Centro Neurolesi Bonino-Pulejo, S.S. 113 Via Palermo, C. da Casazza, 98124 Messina, Italy
| | - Angelo Quartarone
- IRCCS Centro Neurolesi Bonino-Pulejo, S.S. 113 Via Palermo, C. da Casazza, 98124 Messina, Italy
| | - Rocco Salvatore Calabrò
- IRCCS Centro Neurolesi Bonino-Pulejo, S.S. 113 Via Palermo, C. da Casazza, 98124 Messina, Italy
| | - Francesco Corallo
- IRCCS Centro Neurolesi Bonino-Pulejo, S.S. 113 Via Palermo, C. da Casazza, 98124 Messina, Italy
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Unruh KE, Bartolotti JV, McKinney WS, Schmitt LM, Sweeney JA, Mosconi MW. Functional connectivity of cortical-cerebellar networks in relation to sensorimotor behavior and clinical features in autism spectrum disorder. Cereb Cortex 2023; 33:8990-9002. [PMID: 37246152 PMCID: PMC10350826 DOI: 10.1093/cercor/bhad177] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 04/21/2023] [Accepted: 04/22/2023] [Indexed: 05/30/2023] Open
Abstract
Sensorimotor issues are present in the majority of individuals with autism spectrum disorder (ASD) and are associated with core symptoms. The neural systems associated with these impairments remain unclear. Using a visually guided precision gripping task during functional magnetic resonance imaging, we characterized task-based connectivity and activation of cortical, subcortical, and cerebellar visuomotor networks. Participants with ASD (n = 19; ages 10-33) and age- and sex-matched neurotypical controls (n = 18) completed a visuomotor task at low and high force levels. Relative to controls, individuals with ASD showed reduced functional connectivity of right primary motor-anterior cingulate cortex and left anterior intraparietal lobule (aIPL)-right Crus I at high force only. At low force, increased caudate, and cerebellar activation each were associated with sensorimotor behavior in controls, but not in ASD. Reduced left aIPL-right Crus I connectivity was associated with more severe clinically rated ASD symptoms. These findings suggest that sensorimotor problems in ASD, particularly at high force levels, involve deficits in the integration of multimodal sensory feedback and reduced reliance on error-monitoring processes. Adding to literature positing that cerebellar dysfunction contributes to multiple developmental issues in ASD, our data implicate parietal-cerebellar connectivity as a key neural marker underlying both core and comorbid features of ASD.
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Affiliation(s)
- Kathryn E Unruh
- Life Span Institute, University of Kansas, Lawrence, KS, United States
- Kansas Center for Autism Research and Training (K-CART), University of Kansas, Lawrence, KS, United States
| | - James V Bartolotti
- Hoglund Biomedical Imaging Center, University of Kansas Medical Center, Kansas City, KS, United States
| | - Walker S McKinney
- Kansas Center for Autism Research and Training (K-CART), University of Kansas, Lawrence, KS, United States
- Clinical Child Psychology Program, University of Kansas, Lawrence, KS, United States
| | - Lauren M Schmitt
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, United States
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - John A Sweeney
- Department of Psychiatry, University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - Matthew W Mosconi
- Life Span Institute, University of Kansas, Lawrence, KS, United States
- Kansas Center for Autism Research and Training (K-CART), University of Kansas, Lawrence, KS, United States
- Clinical Child Psychology Program, University of Kansas, Lawrence, KS, United States
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Ji EK, Kwon JS, Kwon JS. Effects of limb apraxia intervention in patients with stroke: A meta-analysis of randomized controlled trials. J Stroke Cerebrovasc Dis 2023; 32:106921. [PMID: 36512886 DOI: 10.1016/j.jstrokecerebrovasdis.2022.106921] [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: 09/19/2022] [Revised: 11/14/2022] [Accepted: 11/29/2022] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE Limb apraxia, a complication of stroke, causes difficulties in performing activities of daily living (ADL). To date, there are no studies on the effectiveness of limb apraxia interventions. We conducted a meta-analysis to assess the effectiveness of limb apraxia interventions in reducing its severity and improving ADL. METHODS We conducted a search of randomized controlled trials (RCTs) related to limb apraxia till December 2021 using the databases of PubMed, Embase, CINAHL, and the Cochrane Library. We measured the outcome variables in the subgroups of total apraxia (TA), ideational apraxia (IA), ideomotor apraxia (IMA), and ADL. The Physiotherapy Evidence Database (PEDro) scale was used to assess the quality. RESULTS Five RCTs were selected, and of the 310 participants, 155 were in the experimental and 155 in the control group. A random-effects model was used for the effect size distribution. The limb apraxia intervention methods included gesture and strategy training (three and two studies, respectively). The effect sizes of the outcome variables in the subgroups were small for the TA and IA, with 0.475 (95% confidence interval [CI]: -0.151-1.102; p = 0.137) and 0.289 (95% CI: -0.144-0.722; p = 0.191), respectively. IMA had a medium effect size of 0.731 (95% CI: -0.062-1.525; p = 0.071), not statistically significant, whereas ADL effect size was small and statistically significant, 0.416 (95% CI: 0.159-0.673; p = 0.002). CONCLUSIONS Gesture and strategy training had statistically significant effects on ADL as limb apraxia interventions. Therefore, the effectiveness of the apraxia interventions needs to be further evaluated through continuous RCTs.
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Affiliation(s)
- Eun Kyu Ji
- Department of Occupational Therapy, St. Vincent's Hospital, The Catholic University, 93, Jungbu-daero, Paldal-gu, Suwon-si, Gyeonggi-do, Republic of Korea
| | - Jae Sung Kwon
- Department of Occupational Therapy, College of Health & Medical Sciences, Cheongju University, 298, Daesung-ro, Cheongwon-gu, Cheongju-si, Chungcheongbuk-do, Republic of Korea, 28497.
| | - Jae Sung Kwon
- Department of Occupational Therapy, College of Health & Medical Sciences, Cheongju University, 298, Daesung-ro, Cheongwon-gu, Cheongju-si, Chungcheongbuk-do, Republic of Korea, 28497.
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Maggio MG, Stagnitti MC, Rizzo E, Andaloro A, Manuli A, Bruschetta A, Naro A, Calabrò RS. Limb apraxia in individuals with multiple sclerosis: Is there a role of semi-immersive virtual reality in treating the Cinderella of neuropsychology? Mult Scler Relat Disord 2023; 69:104405. [PMID: 36417812 DOI: 10.1016/j.msard.2022.104405] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 11/02/2022] [Accepted: 11/07/2022] [Indexed: 11/11/2022]
Abstract
BACKGROUND Limb apraxia is an acquired cognitive-motor disorder characterized by spatial and temporal disorganization of limb movements, negatively affecting the quality of life of patients, including those with multiple sclerosis (MS). Although recent studies have shown the potential role of VR in increasing cognitive and motor functions, only a few studies have been carried out on the rehabilitation of upper limb apraxia. Hence, our study aims to evaluate the potential efficacy of VR training to improve upper limb ideomotor apraxia in patients with MS. METHODS One hundred and six patients, affected by secondary progressive MS, who attended our Robotic and Behavioral Neurorehabilitation Service from March 2019 to February 2020, were enrolled in this study and randomly divided into two groups: the control group (CG: 53 patients) performed traditional therapy whereas the experimental group (EG:53 patients) received training using semi-immersive VR. All patients underwent the same amount of cognitive training, 3 times a week for 8 weeks. They were submitted to a specific neuropsychological assessment before (T0) and after the rehabilitation treatment (T1). RESULTS The VR training led to a significant improvement in global cognitive functions, with regard to constructive and ideomotor apraxia. On the contrary, the CG achieved significant improvements only in ideomotor apraxia. Moreover, only in the EG, we observed an improvement in the mood at the end of training. CONCLUSION The present study demonstrates that VR rehabilitation can be an effective tool for the treatment of apraxia, which is a neuropsychological problem often underestimated in MS patients. Further studies with long-term follow-up periods are needed to confirm the effect of this promising approach.
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Affiliation(s)
- Maria Grazia Maggio
- University of Catania, Department of Biomedical and Biotechnological Science, Via S. Sofia, 64, 95125 Catania (CT), Italy
| | - Maria Chiara Stagnitti
- Studio di Psicoterapia Relazionale e Riabilitazione Cognitiva, viale Europa, 107, 98121, Messina (ME), Italy
| | - Erika Rizzo
- I.O.M.I. "Franco Scalabrino", Via Consolare Pompea, 360, 98165 Ganzirri, Messina (ME), Italy
| | - Adriana Andaloro
- Studio di Riabilitazione Nutrizionale e Cognitiva, Via Sant'Agostino, 14, 98122, Messina (ME), Italy
| | - Alfredo Manuli
- Azienda Ospedaliera Universitaria di Messina "G. Martino", Via Consolare Valeria, 98125, Messina (ME), Italy
| | - Antongiulio Bruschetta
- Azienda Ospedaliera Universitaria di Messina "G. Martino", Via Consolare Valeria, 98125, Messina (ME), Italy
| | - Antonino Naro
- Azienda Ospedaliera Universitaria di Messina "G. Martino", Via Consolare Valeria, 98125, Messina (ME), Italy
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Moinuddin A, Faridi K, Sethi Y, Goel A. A Systematic Review on Strategy Training: A Novel Standardized Occupational Therapy Program for Apraxia Patients to Perform Activities of Daily Living. Cureus 2022; 14:e23547. [PMID: 35494920 PMCID: PMC9045785 DOI: 10.7759/cureus.23547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/26/2022] [Indexed: 11/05/2022] Open
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Heilman KM. Upper Limb Apraxia. Continuum (Minneap Minn) 2021; 27:1602-1623. [PMID: 34881728 DOI: 10.1212/con.0000000000001014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE OF REVIEW Limb apraxia is one of the most common and most disabling disorders caused by brain damage. However, apraxia is one of the least recognized disorders associated with cerebral disease. This article discusses the signs and symptoms of, means of testing for, the pathophysiology of, and possible management of upper limb apraxia. RECENT FINDINGS Upper limb apraxia has four major forms: ideomotor, limb-kinetic, conceptual, and ideational. Although recent findings are included in this article, a full understanding of these disorders, including the means of testing, their possible pathophysiology, and the diseases that may cause these disorders, requires that some older literature is also discussed. SUMMARY This article guides clinicians in testing for and diagnosing the different forms of upper limb apraxia, identifying the underlying diseases that may cause apraxia, managing the different forms of the disorder, and possible forms of rehabilitation.
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Rohrbach N, Krewer C, Löhnert L, Thierfelder A, Randerath J, Jahn K, Hermsdörfer J. Improvement of Apraxia With Augmented Reality: Influencing Pantomime of Tool Use via Holographic Cues. Front Neurol 2021; 12:711900. [PMID: 34512524 PMCID: PMC8427527 DOI: 10.3389/fneur.2021.711900] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 08/02/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Defective pantomime of tool use is a hall mark of limb apraxia. Contextual information has been demonstrated to improve tool use performance. Further, knowledge about the potential impact of technological aids such as augmented reality for patients with limb apraxia is still scarce. Objective: Since augmented reality offers a new way to provide contextual information, we applied it to pantomime of tool use. We hypothesize that the disturbed movement execution can be mitigated by holographic stimulation. If visual stimuli facilitate the access to the appropriate motor program in patients with apraxia, their performance should improve with increased saliency, i.e., should be better when supported by dynamic and holographic cues vs. static and screen-based cues. Methods: Twenty one stroke patients and 23 healthy control subjects were randomized to mime the use of five objects, presented in two Environments (Screen vs. Head Mounted Display, HMD) and two Modes (Static vs. Dynamic) resulting in four conditions (ScreenStat, ScreenDyn, HMDStat, HMDDyn), followed by a real tool demonstration. Pantomiming was analyzed by a scoring system using video recordings. Additionally, the sense of presence was assessed using a questionnaire. Results: Healthy control participants performed close to ceiling and significantly better than patients. Patients achieved significantly higher scores with holographic or dynamic cues. Remarkably, when their performance was supported by animated holographic cues (e.g., striking hammer), it did not differ significantly from real tool demonstration. As the sense of presence increases with animated holograms, so does the pantomiming. Conclusion: Patients' performance improved with visual stimuli of increasing saliency. Future assistive technology could be implemented upon this knowledge and thus, positively impact the rehabilitation process and a patient's autonomy.
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Affiliation(s)
- Nina Rohrbach
- Technical University Munich, Chair of Human Movement Science, Munich, Germany
| | - Carmen Krewer
- Technical University Munich, Chair of Human Movement Science, Munich, Germany
- Schön Klinik Bad Aibling, Bad Aibling, Germany
| | - Lisa Löhnert
- Technical University Munich, Chair of Human Movement Science, Munich, Germany
| | - Annika Thierfelder
- Technical University Munich, Chair of Human Movement Science, Munich, Germany
| | - Jennifer Randerath
- Lurija Institute for Rehabilitation Sciences and Health Research at the University of Konstanz, Konstanz, Germany
| | - Klaus Jahn
- Schön Klinik Bad Aibling, Bad Aibling, Germany
- Ludwig-Maximilians University of Munich, University Hospital Grosshadern, Munich, Germany
| | - Joachim Hermsdörfer
- Technical University Munich, Chair of Human Movement Science, Munich, Germany
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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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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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Rounis E, Halai A, Pizzamiglio G, Lambon Ralph MA. Characterising factors underlying praxis deficits in chronic left hemisphere stroke patients. Cortex 2021; 142:154-168. [PMID: 34271260 DOI: 10.1016/j.cortex.2021.04.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 03/02/2021] [Accepted: 04/29/2021] [Indexed: 11/17/2022]
Abstract
Limb apraxia, a disorder of skilled action not consequent on primary motor or sensory deficits, has traditionally been defined according to errors patients make on neuropsychological tasks. Previous models of the disorder have failed to provide a unified account of patients' deficits, due to heterogeneity in the patients and tasks used. In this study we hypothesised that we may be able to map apraxic deficits onto principal components, some of which may be specific, whilst others may align with other cognitive disorders. We implemented principal component analysis (PCA) to elucidate core factors of the disorder in a preliminary cohort of 41 unselected left hemisphere chronic stroke patients who were tested on a comprehensive and validated apraxia screen. Three principal components were identified: posture selection, semantic control and multi-demand sequencing. These were submitted to a lesion symptom mapping (VBCM) analysis in a subset of 24 patients, controlled for lesion volume, age and time post-stroke. The first component revealed no significant structural correlates. The second component was related to regions in inferior frontal gyrus, primary motor area, and adjacent parietal opercular (including inferior parietal and supramarginal gyrus) areas. The third component was associated with lesions within the white matter underlying the left sensorimotor cortex, likely involving the 2nd branch of the left superior longitudinal fasciculus as well as the posterior orbitofrontal cortex (pOFC). These results highlight a significant role of common cognitive functions in apraxia, which include action selection, and sequencing, whilst more specific deficits may relate to semantic control. Moreover, they suggest that previously described 'ideomotor' and 'ideational' deficits may have a common neural basis within semantic control. Further research using this technique would help elucidate the cognitive processes underlying limb apraxia, its neural correlates and their relationship with other cognitive disorders.
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Affiliation(s)
- Elisabeth Rounis
- Chelsea and Westminster NHS Foundation Trust, West Middlesex University Hospital, Isleworth, UK; Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK.
| | - Ajay Halai
- MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK
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Alashram AR, Annino G, Aldajah S, Raju M, Padua E. Rehabilitation of limb apraxia in patients following stroke: a systematic review. APPLIED NEUROPSYCHOLOGY-ADULT 2021; 29:1658-1668. [PMID: 33851895 DOI: 10.1080/23279095.2021.1900188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Apraxia is widely used to describe one of the more disabling deficits following left strokes. The role of rehabilitation in treating apraxic stroke patients remains unclear. This systematic review was conducted to study the impacts of various rehabilitation interventions on the limb apraxia post-stroke. PubMed, SCOPUS, PEDro, CINAHL, MEDLINE, REHABDATA, and Web of Science were searched for the experimental studies that investigated the effects of the rehabilitation interventions on apraxia in patients with stroke. The methodological quality was rated using the Physiotherapy Evidence Database scale (PEDro). Six studies met our inclusion criteria in this systematic review. Four were randomized controlled trials, pilot (n = 1), and case study (n = 1). The scores on the PEDro scale ranged from two to eight, with a median of seven. The results showed some evidence for the effects of strategy training and gesture training interventions on the cognitive functions, motor activities, and activities of daily livings outcomes poststroke. The preliminary findings showed that the effects of the strategy training and the gesture training on apraxia in patients with stroke are promising. Further randomized controlled trials with long-term follow-ups are strongly needed.
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Affiliation(s)
- Anas Radi Alashram
- Department of Medicine Systems, Faculty of Medicine and Surgery, University of Rome Tor Vergata, Roma, Italy.,Department of Physiotherapy, Isra University, Amman, Jordan
| | - Giuseppe Annino
- Department of Medicine Systems, Faculty of Medicine and Surgery, University of Rome Tor Vergata, Roma, Italy
| | | | - Manikandan Raju
- Department of Neuroscience, University of Rome La Sapienza, Roma, Italy
| | - Elvira Padua
- Department of Human Sciences and Promotion of the Quality of Life, Telematic University San Raffaele Rome Srl, Roma, Italy
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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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Mailend ML, Maas E. To Lump or to Split? Possible Subtypes of Apraxia of Speech. APHASIOLOGY 2020; 35:592-613. [PMID: 33981126 PMCID: PMC8112072 DOI: 10.1080/02687038.2020.1836319] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 09/17/2020] [Indexed: 05/09/2023]
Abstract
BACKGROUND The speculation that apraxia of speech (AOS) is not a unitary diagnosis, but consists of different subtypes instead, has been around for decades. However, attempts to empirically substantiate such a notion remain few and far between. AIMS The primary objective of this article is to consider the different bases for identifying subtypes of AOS, review existing evidence regarding subtypes under each classification basis, and provide discussion and implications for future research. MAIN CONTRIBUTION AOS subtypes have been proposed on the basis of clinical symptomatology, theoretical constructs, and an analogy to limb apraxia. Different possible subtypes of AOS are reviewed, along with their empirical support and limitations. Empirical evidence, particularly in the context of a progressive disease, supports the idea that AOS diagnosis may capture different underlying impairments of speech motor planning. Future research to advance our understanding of AOS should carefully consider the basis for subtype classification, and include large sample sizes to differentiate individual variability from possible subtypes. CONCLUSIONS Several proposed AOS subtypes have found some support in the literature. Further research is needed to determine the validity, coherence and utility of possible AOS subtypes for theoretical and clinical purposes.
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Ha SY, Sung YH. Effects of Fresnel prism glasses on balance and gait in stroke patients with hemiplegia: A randomized controlled trial pilot study. Technol Health Care 2020; 28:625-633. [PMID: 32280072 DOI: 10.3233/thc-191973] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Fresnel prism shifts the field of view and converts object position in space, but its effect on stroke patients without unilateral neglect has not been examined. OBJECTIVE We aimed to investigate the effect of Fresnel prism glasses on balance and gait in stroke patients with hemiplegia. METHODS This study included 17 stroke patients with hemiplegia without unilateral neglect. Balance and gait training were applied in the control group (n= 9), and Fresnel prism glasses were applied with balance and gait training in the experimental group (n= 8). In all groups, interventions were done for 30 min/day for 5 times/week for 4 weeks. Motor-free visual perception test for visual perception (MVPT), Berg Balance Scale (BBS), and functional reach test (FRT) for dynamic balance ability, and gait were performed. Measurements were done before and after interventions. RESULTS MVPT showed no significant difference between the groups (p> 0.05). A significant increase in BBS and FRT results was found before and after interventions in the experimental group (p< 0.05). Gait variables showed significant difference in the experimental group (p< 0.05). CONCLUSION Fresnel prism glasses may effectively improve dynamic balance and gait functions by shifting body weight to the affected side of stroke patients with hemiplegia without vision loss.
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Affiliation(s)
- Sun-Young Ha
- Department of Physical Therapy, Graduate School, Kyungnam University, Korea
| | - Yun-Hee Sung
- Department of Physical Therapy, Graduate School, Kyungnam University, Korea.,Department of Physical Therapy, College of Health Sciences, Kyungnam University, Korea
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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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Pazzaglia M, Galli G. Action Observation for Neurorehabilitation in Apraxia. Front Neurol 2019; 10:309. [PMID: 31001194 PMCID: PMC6456663 DOI: 10.3389/fneur.2019.00309] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 03/11/2019] [Indexed: 12/21/2022] Open
Abstract
Neurorehabilitation and brain stimulation studies of post-stroke patients suggest that action-observation effects can lead to rapid improvements in the recovery of motor functions and long-term motor cortical reorganization. Apraxia is a clinically important disorder characterized by marked impairment in representing and performing skillful movements [gestures], which limits many daily activities and impedes independent functioning. Recent clinical research has revealed errors of visuo-motor integration in patients with apraxia. This paper presents a rehabilitative perspective focusing on the possibility of action observation as a therapeutic treatment for patients with apraxia. This perspective also outlines impacts on neurorehabilitation and brain repair following the reinforcement of the perceptual-motor coupling. To date, interventions based primarily on action observation in apraxia have not been undertaken.
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Affiliation(s)
- Mariella Pazzaglia
- Department of Psychology, University of Rome "La Sapienza", Rome, Italy.,IRCCS Fondazione Santa Lucia, Rome, Italy
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18
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Liouta E, Stranjalis G, Kalyvas AV, Koutsarnakis C, Pantinaki S, Liakos F, Komaitis S, Stavrinou LC. Parietal association deficits in patients harboring parietal lobe gliomas: a prospective study. J Neurosurg 2019; 130:773-779. [PMID: 29726775 DOI: 10.3171/2017.12.jns171799] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Accepted: 12/11/2017] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Although the parietal lobe is a common site for glioma formation, current literature is scarce, consists of retrospective studies, and lacks consistency with regard to the incidence, nature, and severity of parietal association deficits (PADs). The aim of this study was to assess the characteristics and incidence of PADs in patients suffering from parietal lobe gliomas through a prospective study and a battery of comprehensive neuropsychological tests. METHODS Between 2012 and 2016 the authors recruited 38 patients with glioma confined in the parietal lobe. Patients were examined for primary and secondary association deficits with a dedicated battery of neuropsychological tests. The PADs were grouped into 5 categories: visuospatial attention, gnosis, praxis, upper-limb coordination, and language. For descriptive analysis tumors were divided into high- and low-grade gliomas and also according to patient age and tumor size. RESULTS Parietal association deficits were elicited in 80% of patients, thus being more common than primary deficits (50%). Apraxia was the most common PAD (47.4%), followed by anomic aphasia and subcomponents of Gerstmann's syndrome (34.2% each). Other deficits such as hemineglect, stereoagnosia, extinction, and visuomotor ataxia were also detected, albeit at lower rates. There was a statistically nonsignificant difference between PADs and sex (72.2% males, 85% females) and age (77.8% at ≤ 60 years, 80% at age > 60 years), but a statistically significant difference between the > 4 cm and the ≤ 4 cm diameter group (p = 0.02, 94.7% vs 63.2%, respectively). There was a tendency (p = 0.094) for low-grade gliomas to present with fewer PADs (50%) than high-grade gliomas (85.7%). Tumor laterality showed a strong correlation with hemineglect (p = 0.004, predilection for right hemisphere), anomia (p = 0.001), and Gerstmann's symptoms (p = 0.01); the last 2 deficits showed a left (dominant) hemispheric preponderance. CONCLUSIONS This is the first study to prospectively evaluate the incidence and nature of PADs in patients with parietal gliomas. It could be that the current literature may have underestimated the true incidence of deficits. Dedicated neuropsychological examination detects a high frequency of PADs, the most common being apraxia, followed by anomia and subcomponents of Gerstmann's syndrome. Nevertheless, a direct correlation between the clinical deficit and its anatomical substrate is only possible to a limited extent, highlighting the need for intraoperative cortical and subcortical functional mapping.
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Affiliation(s)
- Evangelia Liouta
- 1Department of Neurosurgery, University of Athens, Evangelismos Hospital; and
- 2Hellenic Center for Neurosurgical Research "Prof. Petros Kokkalis," Athens, Greece
| | - George Stranjalis
- 1Department of Neurosurgery, University of Athens, Evangelismos Hospital; and
- 2Hellenic Center for Neurosurgical Research "Prof. Petros Kokkalis," Athens, Greece
| | - Aristotelis V Kalyvas
- 1Department of Neurosurgery, University of Athens, Evangelismos Hospital; and
- 2Hellenic Center for Neurosurgical Research "Prof. Petros Kokkalis," Athens, Greece
| | - Christos Koutsarnakis
- 1Department of Neurosurgery, University of Athens, Evangelismos Hospital; and
- 2Hellenic Center for Neurosurgical Research "Prof. Petros Kokkalis," Athens, Greece
| | - Stavroula Pantinaki
- 2Hellenic Center for Neurosurgical Research "Prof. Petros Kokkalis," Athens, Greece
| | - Faidon Liakos
- 1Department of Neurosurgery, University of Athens, Evangelismos Hospital; and
- 2Hellenic Center for Neurosurgical Research "Prof. Petros Kokkalis," Athens, Greece
| | - Spyros Komaitis
- 1Department of Neurosurgery, University of Athens, Evangelismos Hospital; and
- 2Hellenic Center for Neurosurgical Research "Prof. Petros Kokkalis," Athens, Greece
| | - Lampis C Stavrinou
- 2Hellenic Center for Neurosurgical Research "Prof. Petros Kokkalis," Athens, Greece
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Candidi M, Sacheli LM, Era V, Canzano L, Tieri G, Aglioti SM. Come together: human-avatar on-line interactions boost joint-action performance in apraxic patients. Soc Cogn Affect Neurosci 2018; 12:1793-1802. [PMID: 29140533 PMCID: PMC5714226 DOI: 10.1093/scan/nsx114] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Accepted: 10/01/2017] [Indexed: 01/24/2023] Open
Abstract
Limb apraxia (LA) is a high-order motor disorder linked to left-hemisphere damage. It is characterized by defective execution of purposeful actions upon delayed imitation, or verbal command when the actions are performed in isolated, non-naturalistic, conditions. Whether interpersonal interactions provide social affordances that activate neural resources different from those requested by individual action execution, which may improve LA performance, is unknown. To fill this gap, we measured interaction performance, behavioral and kinematic indexes of left-brain damaged patients with/without LA in a social reach-to-grasp task involving two different degrees of spatio-temporal interactivity with an avatar. We found that LA patients' impairment in coordinating with the virtual partner was abolished in highly interactive conditions (where patients selected their actions on-line based on the behavior of the virtual partner) with respect to low interactive conditions (where actions were selected beforehand based on abstract instructions). Voxel-based-Lesion-Symptom-Mapping indicated that impairments in low-interactive conditions were underpinned by lesions of premotor, motor and insular areas, and of the basal ganglia. Our approach expands current understanding of the behavioral and neural correlates of interactive motor performance by highlighting the important role of social affordances, and provides novel, potentially important, views on rehabilitation of higher-order motor cognition disorders.
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Affiliation(s)
- Matteo Candidi
- Department of Psychology, Sapienza University, 00185 Rome, Italy.,IRCCS Fondazione Santa Lucia, 00100 Rome, Italy
| | - Lucia M Sacheli
- Department of Psychology, Sapienza University, 00185 Rome, Italy.,IRCCS Fondazione Santa Lucia, 00100 Rome, Italy.,Department of Psychology and Milan Center for Neuroscience (NeuroMi), University of Milano-Bicocca, 20126 Milan, Italy
| | - Vanessa Era
- Department of Psychology, Sapienza University, 00185 Rome, Italy.,IRCCS Fondazione Santa Lucia, 00100 Rome, Italy
| | - Loredana Canzano
- Department of Psychology, Sapienza University, 00185 Rome, Italy.,IRCCS Fondazione Santa Lucia, 00100 Rome, Italy
| | - Gaetano Tieri
- IRCCS Fondazione Santa Lucia, 00100 Rome, Italy.,"Unitelme Sapienza", 00161 Rome, Italy
| | - Salvatore M Aglioti
- Department of Psychology, Sapienza University, 00185 Rome, Italy.,IRCCS Fondazione Santa Lucia, 00100 Rome, Italy
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Pillai AS, McAuliffe D, Lakshmanan BM, Mostofsky SH, Crone NE, Ewen JB. Altered task-related modulation of long-range connectivity in children with autism. Autism Res 2018; 11:245-257. [PMID: 28898569 PMCID: PMC5825245 DOI: 10.1002/aur.1858] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Revised: 07/19/2017] [Accepted: 08/14/2017] [Indexed: 11/07/2022]
Abstract
Functional connectivity differences between children with autism spectrum disorder (ASD) and typically developing children have been described in multiple datasets. However, few studies examine the task-related changes in connectivity in disorder-relevant behavioral paradigms. In this paper, we examined the task-related changes in functional connectivity using EEG and a movement-based paradigm that has behavioral relevance to ASD. Resting-state studies motivated our hypothesis that children with ASD would show a decreased magnitude of functional connectivity during the performance of a motor-control task. Contrary to our initial hypothesis, however, we observed that task-related modulation of functional connectivity in children with ASD was in the direction opposite to that of TDs. The task-related connectivity changes were correlated with clinical symptom scores. Our results suggest that children with ASD may have differences in cortical segregation/integration during the performance of a task, and that part of the differences in connectivity modulation may serve as a compensatory mechanism. Autism Res 2018, 11: 245-257. © 2017 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY Decreased connectivity between brain regions is thought to cause the symptoms of autism. Because most of our knowledge comes from data in which children are at rest, we do not know how connectivity changes directly lead to autistic behaviors, such as impaired gestures. When typically developing children produced complex movements, connectivity decreased between brain regions. In children with autism, connectivity increased. It may be that behavior-related changes in brain connectivity are more important than absolute differences in connectivity in autism.
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Affiliation(s)
- Ajay S Pillai
- Department of Neurology and Developmental Medicine, Kennedy Krieger Institute, Baltimore, MD
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Danielle McAuliffe
- Department of Neurology and Developmental Medicine, Kennedy Krieger Institute, Baltimore, MD
| | - Balaji M Lakshmanan
- Department of Neurology and Developmental Medicine, Kennedy Krieger Institute, Baltimore, MD
| | - Stewart H Mostofsky
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD
- Center for Neurodevelopmental and Imaging Research, Kennedy Krieger Institute, Baltimore, MD
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Nathan E Crone
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Joshua B Ewen
- Department of Neurology and Developmental Medicine, Kennedy Krieger Institute, Baltimore, MD
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Psychological and Brain Sciences, Johns Hopkins University, Baltimore, MD
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21
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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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Abstract
Limb apraxia is a heterogeneous disorder of skilled action and tool use that has long perplexed clinicians and researchers. It occurs after damage to various loci in a densely interconnected network of regions in the left temporal, parietal, and frontal lobes. Historically, a highly classificatory approach to the study of apraxia documented numerous patterns of performance related to two major apraxia subtypes: ideational and ideomotor apraxia. More recently, there have been advances in our understanding of the functional neuroanatomy and connectivity of the left-hemisphere "tool use network," and the patterns of performance that emerge from lesions to different loci within this network. This chapter focuses on the left inferior parietal lobe, and its role in tool and body representation, action prediction, and action selection, and how these functions relate to the deficits seen in patients with apraxia subsequent to parietal lesions. Finally, suggestions are offered for several future directions that will benefit the study of apraxia, including increased attention to research on rehabilitation of this disabling disorder.
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Affiliation(s)
- Laurel J Buxbaum
- Moss Rehabilitation Research Institute, Elkins Park, PA, United States.
| | - Jennifer Randerath
- Motor Cognition Group, Clinical Neuropsychology and Lurija Institute for Rehabilitation and Health Sciences, University of Konstanz, Konstanz; and Schmieder Foundation for Sciences and Research, Allensbach, Germany
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23
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The Neuropsychology of Movement and Movement Disorders: Neuroanatomical and Cognitive Considerations. J Int Neuropsychol Soc 2017; 23:768-777. [PMID: 29198273 DOI: 10.1017/s1355617717000698] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
This paper highlights major developments over the past two to three decades in the neuropsychology of movement and its disorders. We focus on studies in healthy individuals and patients, which have identified cognitive contributions to movement control and animal work that has delineated the neural circuitry that makes these interactions possible. We cover advances in three major areas: (1) the neuroanatomical aspects of the "motor" system with an emphasis on multiple parallel circuits that include cortical, corticostriate, and corticocerebellar connections; (2) behavioral paradigms that have enabled an appreciation of the cognitive influences on the preparation and execution of movement; and (3) hemispheric differences (exemplified by limb praxis, motor sequencing, and motor learning). Finally, we discuss the clinical implications of this work, and make suggestions for future research in this area. (JINS, 2017, 23, 768-777).
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Buchmann I, Randerath J. Selection and application of familiar and novel tools in patients with left and right hemispheric stroke: Psychometrics and normative data. Cortex 2017; 94:49-62. [DOI: 10.1016/j.cortex.2017.06.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2017] [Revised: 05/27/2017] [Accepted: 06/01/2017] [Indexed: 10/19/2022]
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Etcharry-Bouyx F, Le Gall D, Jarry C, Osiurak F. Gestural apraxia. Rev Neurol (Paris) 2017; 173:430-439. [DOI: 10.1016/j.neurol.2017.07.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Revised: 06/30/2017] [Accepted: 07/04/2017] [Indexed: 10/19/2022]
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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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Abstract
OBJECTIVES The cardinal motor deficits seen in ideomotor limb apraxia are thought to arise from damage to internal representations for actions developed through learning and experience. However, whether apraxic patients learn to develop new representations with training is not well understood. We studied the capacity of apraxic patients for motor adaptation, a process associated with the development of a new internal representation of the relationship between movements and their sensory effects. METHODS Thirteen healthy adults and 23 patients with left hemisphere stroke (12 apraxic, 11 nonapraxic) adapted to a 30-degree visuomotor rotation. RESULTS While healthy and nonapraxic participants successfully adapted, apraxics did not. Rather, they showed a rapid decrease in error early but no further improvement thereafter, suggesting a deficit in the slow, but not the fast component of a dual-process model of adaptation. The magnitude of this late learning deficit was predicted by the degree of apraxia, and was correlated with the volume of damage in parietal cortex. Apraxics also demonstrated an initial after-effect similar to the other groups likely reflecting the early learning, but this after-effect was not sustained and performance returned to baseline levels more rapidly, consistent with a disrupted slow learning process. CONCLUSIONS These findings suggest that the early phase of learning may be intact in apraxia, but this leads to the development of a fragile representation that is rapidly forgotten. The association between this deficit and left parietal damage points to a key role for this region in learning to form stable internal representations. (JINS, 2017, 23, 139-149).
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Affiliation(s)
- Pratik K. Mutha
- Department of Biological Engineering and Center for Cognitive Science, Indian Institute of Technology Gandhinagar, Palaj, Gandhinagar, Gujarat, India
| | - Lee H. Stapp
- New Mexico VA Healthcare System, Albuquerque, New Mexico
| | - Robert L. Sainburg
- Department of Kinesiology, Pennsylvania State University, University Park, Pennsylvania
- Department of Neurology, Pennsylvania State University, Hershey, Pennsylvania
| | - Kathleen Y. Haaland
- Departments of Psychiatry & Behavioral Sciences and Neurology, University of New Mexico, Albuquerque, New Mexico
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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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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: 1596] [Impact Index Per Article: 199.5] [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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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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Smits LL, Flapper M, Sistermans N, Pijnenburg YAL, Scheltens P, van der Flier WM. Apraxia in mild cognitive impairment and Alzheimer's disease: validity and reliability of the Van Heugten test for apraxia. Dement Geriatr Cogn Disord 2015; 38:55-64. [PMID: 24603451 DOI: 10.1159/000358168] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/12/2013] [Indexed: 11/19/2022] Open
Abstract
AIM To assess the reliability and validity of the Van Heugten test for apraxia (VHA), developed for and used in stroke patients, in a memory clinic population. Furthermore, we assess the presence and severity of apraxia in mild cognitive impairment (MCI) and Alzheimer's disease (AD) and investigate which AD patients are likely to develop apraxia. METHODS We included 90 controls (age: 60 ± 9 years, MMSE: 28 ± 2), 90 MCI patients (age: 65 ± 7 years, MMSE: 26 ± 2) and 158 AD patients (age: 66 ± 8 years, MMSE: 20 ± 5). Apraxia was evaluated by the VHA assessing ideational and ideomotor praxis. We retested 20 patients to assess reliability. RESULTS Intrarater reliability was 0.88 and interrater reliability was 0.73. AD patients performed worse on the VHA (median: 88; range: 51-90) than controls (median: 90; range: 88-90) and MCI patients (median: 89; range: 84-90) (both p < 0.001). Apraxia was prevalent in 35% of AD patients, in 10% of MCI and it was not observed in controls (0%; p < 0.001). In AD, dementia severity was the main risk for apraxia; 15% of mildly versus 52% of moderately demented patients had apraxia (OR = 6.7, 95% CI 2.9-15.6). The second risk factor was APOE genotype. APOE ε4 noncarriers (47%) were at increased risk compared to carriers (30%) (OR = 2.1, 95% CI 1-4.7). CONCLUSION Apraxia can be reliably measured with the VHA and is present in a proportion of patients with MCI and AD. The presence of apraxia in AD is related to dementia severity and APOE ε4.
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Affiliation(s)
- Lieke L Smits
- Department of Neurology, Alzheimer Center, Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
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Civelek GM, Atalay A, Turhan N. Association of ideomotor apraxia with lesion site, etiology, neglect, and functional independence in patients with first ever stroke. Top Stroke Rehabil 2015; 22:94-101. [PMID: 25936541 DOI: 10.1179/1074935714z.0000000027] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
BACKGROUND Ideomotor apraxia (IMA) is characterized by the inability to correctly imitate hand gestures and voluntarily pantomime tool use. The relationship between IMA and characteristics of stroke has not been totally elucidated. OBJECTIVE This study aimed to find out associations between presence of IMA and stroke etiology, site of the lesions, neglect, and temporal and functional parameters of stroke in patients with first ever stroke. METHODS Thirty-nine patients with first ever stroke were included. Patients with severe cognitive deficits were excluded. Assessment tools included Ideomotor Apraxia Test, Functional Independence Measure (FIM), Brunnstrom recovery stages, Mini Mental Test (MMT), and star cancellation test. Etiology (hemorrhagic or ischemic) and site of stroke was assessed through brain imaging methods. Location and size of ischemic lesion was determined by using the Oxfordshire Community Stroke Project system. RESULTS IMA was identified in 35.9% of the patients. Patients with IMA had significantly lower FIM scores both on admission and discharge (P = 0.001, P = 0.001). Presence of IMA was significantly associated with the presence of neglect (P = 0.004), total anterior circulation ischemia (TACI) (P < 0.001), and lower MMT scores (P < 0.001). Lesion site, patient age, time since onset, and stroke etiology had no impact on the presence of IMA. CONCLUSION IMA was in concordance with poor cognitive and functional state and was not limited to left hemisphere lesions. The study revealed strong associations between IMA, neglect, and TACI. Every patient with stroke should be evaluated for the presence of IMA on admission to rehabilitation unit.
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Oliveira J, Brito R. Insights into the neural mechanisms underlying hand praxis: implications for the neurocognitive rehabilitation of apraxia. Front Psychol 2014; 5:1380. [PMID: 25538646 PMCID: PMC4260482 DOI: 10.3389/fpsyg.2014.01380] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2014] [Accepted: 11/11/2014] [Indexed: 11/13/2022] Open
Affiliation(s)
- Jorge Oliveira
- COPELABS, Universidade Lusófona de Humanidades e Tecnologias Lisbon, Portugal
| | - Rodrigo Brito
- COPELABS, Universidade Lusófona de Humanidades e Tecnologias Lisbon, Portugal
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Bolognini N, Convento S, Banco E, Mattioli F, Tesio L, Vallar G. Improving ideomotor limb apraxia by electrical stimulation of the left posterior parietal cortex. Brain 2014; 138:428-39. [DOI: 10.1093/brain/awu343] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Abstract
Given the increasing rates of stroke and our aging population, it is critical that we continue to foster innovation in stroke rehabilitation. Although there is evidence supporting cognitive rehabilitation in stroke, the set of cognitive domains effectively addressed to date represents only a small subset of the problems experienced by stroke survivors. Further, a gap remains between investigational treatments and our evolving theories of brain function. These limitations present opportunities for improving the functional impact of stroke rehabilitation. The authors use a case example to encourage the reader to consider the evidence base for cognitive rehabilitation in stroke, focusing on four domains critical to daily life function: (1) speech and language, (2) functional memory, (3) executive function and skilled learned purposive movements, and (4) spatial-motor systems. Ultimately, they attempt to draw neuroscience and practice closer together by using translational reasoning to suggest possible new avenues for treating these disorders.
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Affiliation(s)
- Cheryl L Shigaki
- Department of Health Psychology, University of Missouri, Columbia, Missouri
| | - Scott H Frey
- Department of Psychological Sciences and Brain Imaging Center, University of Missouri, Columbia, Missouri
| | - A M Barrett
- Stroke Rehabilitation Research, Kessler Foundation, West Orange, New Jersey
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Lindsten-McQueen K, Weiner NW, Wang HY, Josman N, Connor LT. Systematic Review of Apraxia Treatments to Improve Occupational Performance Outcomes. OTJR-OCCUPATION PARTICIPATION AND HEALTH 2014; 34:183-92. [DOI: 10.3928/15394492-20141006-02] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2013] [Accepted: 08/04/2014] [Indexed: 11/20/2022]
Abstract
The objective was to assess effectiveness of apraxia treatments using a systematic review. In contrast to previous reviews, each study was rated as to its applicability to occupational therapy practice and its focus on occupational performance using the FAME rating system (defined by four categories: Feasibility, Appropriateness, Meaningfulness, Effectiveness). This systematic review included eight studies: four randomized controlled trials (level 1 evidence) and four pre-post designs (level 3 evidence). Three treatment approaches were reported: errorless learning with training of details; gesture training; and strategy training. FAME scores ranged from A to C. All studies reported significant treatment effects, but only one demonstrated an impact on observed occupational performance that transferred from clinic to home.
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Hughes CML, Baber C, Bienkiewicz M, Worthington A, Hazell A, Hermsdörfer J. The application of SHERPA (Systematic Human Error Reduction and Prediction Approach) in the development of compensatory cognitive rehabilitation strategies for stroke patients with left and right brain damage. ERGONOMICS 2014; 58:75-95. [PMID: 25222822 DOI: 10.1080/00140139.2014.957735] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Approximately 33% of stroke patients have difficulty performing activities of daily living, often committing errors during the planning and execution of such activities. The objective of this study was to evaluate the ability of the human error identification (HEI) technique SHERPA (Systematic Human Error Reduction and Prediction Approach) to predict errors during the performance of daily activities in stroke patients with left and right hemisphere lesions. Using SHERPA we successfully predicted 36 of the 38 observed errors, with analysis indicating that the proportion of predicted and observed errors was similar for all sub-tasks and severity levels. HEI results were used to develop compensatory cognitive strategies that clinicians could employ to reduce or prevent errors from occurring. This study provides evidence for the reliability and validity of SHERPA in the design of cognitive rehabilitation strategies in stroke populations.
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Affiliation(s)
- Charmayne M L Hughes
- a Department of Sport and Health Science , Institute of Movement Science, Technical University of Munich , Munich , Germany
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Pastorino M, Fioravanti A, Arredondo MT, Cogollor JM, Rojo J, Ferre M, Bienkiewicz M, Hermsdörfer J, Fringi E, Wing AM. Preliminary evaluation of a personal healthcare system prototype for cognitive eRehabilitation in a living assistance domain. SENSORS (BASEL, SWITZERLAND) 2014; 14:10213-33. [PMID: 24922452 PMCID: PMC4118340 DOI: 10.3390/s140610213] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Revised: 05/29/2014] [Accepted: 05/31/2014] [Indexed: 11/17/2022]
Abstract
The integration of rehabilitation systems in an ambient assisted living environment can provide a powerful and versatile tool for long-term stroke rehabilitation goals. This paper introduces a novel concept of a personalized cognitive rehabilitation system in a naturalistic setting. The proposed platform was developed within the CogWatch project, with the intent of fostering independence in activities of daily living in patients with apraxia and action disorganization syndrome. Technical usability was evaluated in a series of pilot experiments, which illustrate how this approach may help to retrain patients in activities of daily living. The first system prototype has been tested with 36 participants divided into three groups, providing an exploratory evaluation of the usability of this solution and its acceptability. The technical solutions used within the CogWatch project are targeted to meet both the end users' needs from the interaction and usability point of views and the clinical requirements associated with the use of such systems. The challenges behind the development of ambient assisted living systems for cognitive rehabilitation are discussed.
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Affiliation(s)
- Matteo Pastorino
- Life Supporting Technologies, Universidad Politecnica de Madrid, Avenida Complutense 30, Madrid 28040, Spain.
| | - Alessio Fioravanti
- Life Supporting Technologies, Universidad Politecnica de Madrid, Avenida Complutense 30, Madrid 28040, Spain.
| | - Maria Teresa Arredondo
- Life Supporting Technologies, Universidad Politecnica de Madrid, Avenida Complutense 30, Madrid 28040, Spain.
| | - José M Cogollor
- Centre for Automation and Robotics UPM-CSIC, Universidad Politecnica de Madrid, Calle de José Gutiérrez Abascal 2, Madrid 28006, Spain.
| | - Javier Rojo
- Centre for Automation and Robotics UPM-CSIC, Universidad Politecnica de Madrid, Calle de José Gutiérrez Abascal 2, Madrid 28006, Spain.
| | - Manuel Ferre
- Centre for Automation and Robotics UPM-CSIC, Universidad Politecnica de Madrid, Calle de José Gutiérrez Abascal 2, Madrid 28006, Spain.
| | - Marta Bienkiewicz
- Institute of Movement Science, Department of Sport and Health Science, Technische Universität München, Munich 80992, Germany.
| | - Joachim Hermsdörfer
- Institute of Movement Science, Department of Sport and Health Science, Technische Universität München, Munich 80992, Germany.
| | - Evangelia Fringi
- School of Psychology, the University of Birmingham, Edgbaston, Birmingham B15 2TT, UK.
| | - Alan M Wing
- School of Psychology, the University of Birmingham, Edgbaston, Birmingham B15 2TT, UK.
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Bieńkiewicz MMN, Brandi ML, Goldenberg G, Hughes CML, Hermsdörfer J. The tool in the brain: apraxia in ADL. Behavioral and neurological correlates of apraxia in daily living. Front Psychol 2014; 5:353. [PMID: 24795685 PMCID: PMC4005934 DOI: 10.3389/fpsyg.2014.00353] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2014] [Accepted: 04/04/2014] [Indexed: 01/08/2023] Open
Abstract
Humans differ from other animals in the way they can skilfully and precisely operate or invent tools to facilitate their everyday life. Tools have dominated our home, travel and work environment, becoming an integral step for our motor skills development. What happens when the part of the brain responsible for tool use is damaged in our adult life due to a cerebrovascular accident? How does daily life change when we lose the previously mastered ability to make use of the objects around us? How do patients suffering from compromised tool use cope with food preparation, personal hygiene, grooming, housework, or use of home appliances? In this literature review we present a state of the art for single and multiple tool use research, with a focus on the impact that apraxia (impaired ability to perform tool-based actions) and action disorganization syndrome (ADS; impaired ability to carry out multi-step actions) have on activities of daily living (ADL). Firstly, we summarize the behavioral studies investigating the impact of apraxia and other comorbidity syndromes, such as neglect or visual extinction, on ADL. We discuss the hallmarks of the compromised tool use in terms of the sequencing of action steps, conceptual errors committed, spatial motor control, and temporal organization of the movement. In addition, we present an up-to-date overview of the neuroimaging and lesion analyses studies that provide an insight into neural correlates of tool use in the human brain and functional changes in the neural organization following a stroke, in the context of ADL. Finally we discuss the current practice in neurorehabilitation of ADL in apraxia and ADS aiming at increasing patients' independence.
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Affiliation(s)
| | - Marie-Luise Brandi
- Lehrstuhl für Bewegungswissenschaft, Technische Universität MünchenMünchen, Germany
- Graduate School of Systemic Neurosciences, Ludwig-Maximilians-Universität MünchenMünchen, Germany
| | - Georg Goldenberg
- Klinik für Neuropsychologie, Städtisches Klinikum MünchenMünchen, Germany
| | | | - Joachim Hermsdörfer
- Lehrstuhl für Bewegungswissenschaft, Technische Universität MünchenMünchen, Germany
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Abstract
SUMMARY Apraxia is a cognitive-motor disorder affecting gestural communication and tool use, and is seen in various neurodegenerative disorders. Apraxia is a major feature of the corticobasal syndrome associated with nonlevodopa-responsive, typically asymmetric parkinsonism. Mild apraxia may also be seen in Parkinson’s disease, at least in later stages of the disease. Furthermore, patients with Alzheimer’s disease or posterior cortical atrophy are prone to develop apraxia during their disease course. However, apraxia may be difficult to dissect from other motor (e.g., dystonia and bradykinesia in corticobasal syndrome) or cognitive (e.g., dysexecutive or semantic memory deficits in Alzheimer’s disease) dysfunction. Therefore, the ecological significance of apraxia in neurodegenerative disorders may not always be obvious. Although treatment protocols for apraxia have been developed in stroke, there is little information on the management of apraxia in neurodegenerative disorders. Owing to their progressive nature, benefits from therapeutic interventions are certainly limited, although some capacity of motor learning may be preserved, at least in earlier disease stages. In advanced cases, management of apraxia should focus on compensatory measures, for instance, on adapting the patient’s environment to their needs, particularly when related to safety and comfort.
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Affiliation(s)
- Stephan Bohlhalter
- Neurology & Neurorehabilitation Center, Department of Internal Medicine, Luzerner Kantonsspital & Department of Clinical Research, University of Bern, 6000 Luzern 16, Switzerland
| | - Francois Osiurak
- Laboratoire d’Etude des Mécanismes Cognitifs (EA 3082), Université Lyon 2, Lyon, France
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Barrett AM, Goedert KM, Basso JC. Prism adaptation for spatial neglect after stroke: translational practice gaps. Nat Rev Neurol 2012; 8:567-77. [PMID: 22926312 DOI: 10.1038/nrneurol.2012.170] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Spatial neglect increases hospital morbidity and costs in around 50% of the 795,000 people per year in the USA who survive stroke, and an urgent need exists to reduce the care burden of this condition. However, effective acute treatment for neglect has been elusive. In this article, we review 48 studies of a treatment of intense neuroscience interest: prism adaptation training. Due to its effects on spatial motor 'aiming', prism adaptation training may act to reduce neglect-related disability. However, research failed, first, to suggest methods to identify the 50-75% of patients who respond to treatment; second, to measure short-term and long-term outcomes in both mechanism-specific and functionally valid ways; third, to confirm treatment utility during the critical first 8 weeks poststroke; and last, to base treatment protocols on systematic dose-response data. Thus, considerable investment in prism adaptation research has not yet touched the fundamentals needed for clinical implementation. We suggest improved standards and better spatial motor models for further research, so as to clarify when, how and for whom prism adaptation should be applied.
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Affiliation(s)
- A M Barrett
- Stroke Rehabilitation Research Laboratory, Kessler Foundation Research Center, 1199 Pleasant Valley Way, West Orange, NJ 07052, USA.
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Kamm CP, Heldner MR, Vanbellingen T, Mattle HP, Müri R, Bohlhalter S. Limb Apraxia in Multiple Sclerosis: Prevalence and Impact on Manual Dexterity and Activities of Daily Living. Arch Phys Med Rehabil 2012; 93:1081-5. [DOI: 10.1016/j.apmr.2012.01.008] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2011] [Revised: 01/10/2012] [Accepted: 01/16/2012] [Indexed: 11/24/2022]
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Cantagallo A, Maini M, Rumiati RI. The cognitive rehabilitation of limb apraxia in patients with stroke. Neuropsychol Rehabil 2012; 22:473-88. [DOI: 10.1080/09602011.2012.658317] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Arntzen C, Elstad I. The bodily experience of apraxia in everyday activities: a phenomenological study. Disabil Rehabil 2012; 35:63-72. [DOI: 10.3109/09638288.2012.687032] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Dovern A, Fink GR, Weiss PH. Diagnosis and treatment of upper limb apraxia. J Neurol 2012; 259:1269-83. [PMID: 22215235 PMCID: PMC3390701 DOI: 10.1007/s00415-011-6336-y] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2011] [Accepted: 11/22/2011] [Indexed: 10/30/2022]
Abstract
Upper limb apraxia, a disorder of higher motor cognition, is a common consequence of left-hemispheric stroke. Contrary to common assumption, apraxic deficits not only manifest themselves during clinical testing but also have delirious effects on the patients' everyday life and rehabilitation. Thus, a reliable diagnosis and efficient treatment of upper limb apraxia is important to improve the patients' prognosis after stroke. Nevertheless, to date, upper limb apraxia is still an underdiagnosed and ill-treated entity. Based on a systematic literature search, this review summarizes the current tools of diagnosis and treatment strategies for upper limb apraxia. It furthermore provides clinicians with graded recommendations. In particular, a short screening test for apraxia, and a more comprehensive diagnostic apraxia test for clinical use are recommended. Although currently only a few randomized controlled studies investigate the efficacy of different apraxia treatments, the gesture training suggested by Smania and colleagues can be recommended for the therapy of apraxia, the effects of which were shown to extend to activities of daily living and to persist for at least 2 months after completion of the training. This review aims at directing the reader's attention to the ecological relevance of apraxia. Moreover, it provides clinicians with appropriate tools for the reliable diagnosis and effective treatment of apraxia. Nevertheless, this review also highlights the need for further research into how to improve diagnosis of apraxia based on neuropsychological models and to develop new therapeutic strategies.
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Affiliation(s)
- A Dovern
- Institute of Neuroscience and Medicine, Research Centre Jülich, Leo-Brandt-Straße 5, Jülich, Germany.
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48
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Pomeroy V, Aglioti SM, Mark VW, McFarland D, Stinear C, Wolf SL, Corbetta M, Fitzpatrick SM. Neurological principles and rehabilitation of action disorders: rehabilitation interventions. Neurorehabil Neural Repair 2011; 25:33S-43S. [PMID: 21613536 DOI: 10.1177/1545968311410942] [Citation(s) in RCA: 90] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This third chapter discusses the evidence for the rehabilitation of the most common movement disorders of the upper extremity. The authors also present a framework, building on the computation, anatomy, and physiology (CAP) model, for incorporating some of the principles discussed in the 2 previous chapters by Frey et al and Sathian et al in the practice of rehabilitation and for discussing potentially helpful interventions based on emergent neuroscience principles.
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Abstract
Apraxia caused by left hemispheric stroke typically impairs skilled sequential movements. After stroke, apraxic patients need to reacquire motor skills by motor learning. The current study assessed for the first time incidental motor sequence learning in apraxic patients. Forty-eight human subjects (henceforth called "patients") with left hemispheric stroke affecting the middle cerebral artery territory (18 with apraxia and 30 without apraxia) and 17 age-matched healthy controls were tested on a visuomanual serial reaction time task. Subjects performed four blocks consisting of repetitions of a complex six element sequence containing ambiguous pairwise transitions before a new and unfamiliar sequence was introduced in block 5. Reaction time (RT) disadvantages in this fifth block indicated incidental sequence-specific motor learning. The intentional retrieval of the learned motor knowledge was assessed subsequently with a free recall task. Voxel-based lesion-symptom mapping (VLSM) was performed to investigate for the first time the lesion correlates of deficits in learning and retrieving sequential motor knowledge. Despite generally prolonged RTs, apraxic patients showed sequence-specific motor learning as could be observed in nonapraxic patients and healthy controls. However, apraxic patients showed reduced intentional retrieval of the learned sequence. VLSM revealed that impaired intentional retrieval of motor sequence knowledge resulted from dorsal premotor cortex lesions. Apraxic patients showed a dissociation of preserved incidental motor (sequence) learning and deficient intentional retrieval of this incidentally learned motor knowledge. The data suggest that novel approaches for treating apraxia should focus on incidental motor learning, but that automatic rather than intentional retrieval strategies should be enforced.
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From pantomime to actual use: How affordances can facilitate actual tool-use. Neuropsychologia 2011; 49:2410-6. [DOI: 10.1016/j.neuropsychologia.2011.04.017] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2010] [Revised: 04/13/2011] [Accepted: 04/14/2011] [Indexed: 11/21/2022]
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