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