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Abstract
RATIONALE We report the possible therapeutic efficacy of immersive virtual reality (VR) rehabilitation for the treatment of ideomotor apraxia in a patient with stroke. PATIENT CONCERNS A 56-year-old man with sudden weakness of his left side caused by right frontal, parietal, and corpus callosal infarction was transferred to rehabilitation medicine center for intensive rehabilitation. Although his left-sided weakness had almost subsided 10 days after the onset of symptoms, he presented difficulty using his left hand and required assistance in most activities of daily living. DIAGNOSES Ideomotor apraxia in a patient with right hemispheric infarction. INTERVENTIONS VR content was displayed to the study participants using a head-mounted display that involved catching of moving fish in the sea by grasping. Before and after of rehabilitative intervention including VR, functional measurements incorporating the Test of Upper Limb Apraxia (TULIA) were conducted. To directly compare therapeutic potencies under different conditions, success rates of consecutive grasping gesture performance were observed in VR, conventional occupational therapy setting, and augmented reality intervention. OUTCOMES The patient demonstrated remarkable amelioration of apraxic symptoms while performing the task in the VR environment. At 1 and 3 months after the training, he showed significant improvement in most functions, and the TULIA score increased to 176 from 121 at the initiation of therapy. The number of successful grasps during 30 trials of each grasp trial was 28 in VR, 8 in the occupational therapy setting, and 20 in augmented reality. LESSONS This case report suggests the possible therapeutic efficacy of immersive VR training as a rehabilitative measure for ideomotor apraxia.
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Affiliation(s)
- Wookyung Park
- Department of Rehabilitation Medicine, CHA Bundang Medical Center, CHA University School of Medicine, Gyeonggi-do, Korea
| | - Jongwook Kim
- Department of Rehabilitation Medicine, CHA Bundang Medical Center, CHA University School of Medicine, Gyeonggi-do, Korea
| | - MinYoung Kim
- Department of Rehabilitation Medicine, CHA Bundang Medical Center, CHA University School of Medicine, Gyeonggi-do, Korea
- Rehabilitation and Regeneration Research Center, CHA University School of Medicine, Gyeonggi-do, Korea
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Morihara K, Kakinuma K, Kobayashi E, Kawakami N, Narita W, Kanno S, Tanaka F, Suzuki K. Improvement in callosal disconnection syndrome with recovery of callosal connectivity. Neurocase 2021; 27:323-331. [PMID: 34365896 DOI: 10.1080/13554794.2021.1959935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Recent advancements in radiological techniques have enabled the observation of the topographic distribution of the human corpus callosum. However, its functional connectivity remains to be elucidated. The symptoms of callosal disconnection syndrome (CDS) can potentially reveal the functional connections between the cerebral hemispheres. Herein, we report a patient with CDS, whose callosal lesion was restricted to the posterior midbody, isthmus, and an anterior part of the dorsal splenium. A 53-year-old right-handed woman demonstrated CDS following cerebral infarction associated with subarachnoid hemorrhage. She exhibited CDS including ideomotor apraxia, and tactile anomia with the left hand, cross-replication of hand postures, cross-localization of the fingers, and constructional impairment with the right hand. Six months after onset, the left-handed ideomotor apraxia on imitation improved, but that to command did not, which indicated the difference in the nature of the transcallosal connections between ideomotor apraxia on imitation and ideomotor apraxia to command. Longitudinal CDS observation and corpus callosum tractography will prove useful in expanding our understanding of the nature of the organization of interhemispheric information transference.
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Affiliation(s)
- Keisuke Morihara
- Department of Behavioral Neurology and Cognitive Neuroscience, Tohoku University School of Medicine, Sendai, Japan.,Department of Neurology and Stroke Medicine, Yokohama City University, Yokohama, Japan
| | - Kazuo Kakinuma
- Department of Behavioral Neurology and Cognitive Neuroscience, Tohoku University School of Medicine, Sendai, Japan
| | - Erena Kobayashi
- Department of Behavioral Neurology and Cognitive Neuroscience, Tohoku University School of Medicine, Sendai, Japan.,Department of Neurology and Stroke Medicine, Yokohama City University, Yokohama, Japan
| | - Nobuko Kawakami
- Department of Behavioral Neurology and Cognitive Neuroscience, Tohoku University School of Medicine, Sendai, Japan
| | - Wataru Narita
- Department of Behavioral Neurology and Cognitive Neuroscience, Tohoku University School of Medicine, Sendai, Japan
| | - Shigenori Kanno
- Department of Behavioral Neurology and Cognitive Neuroscience, Tohoku University School of Medicine, Sendai, Japan
| | - Fumiaki Tanaka
- Department of Neurology and Stroke Medicine, Yokohama City University, Yokohama, Japan
| | - Kyoko Suzuki
- Department of Behavioral Neurology and Cognitive Neuroscience, Tohoku University School of Medicine, Sendai, Japan
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Mantovani-Nagaoka J, Ortiz KZ. The influence of age, gender and education on the performance of healthy individuals on a battery for assessing limb apraxia. Dement Neuropsychol 2016; 10:232-236. [PMID: 29213460 PMCID: PMC5642420 DOI: 10.1590/s1980-5764-2016dn1003010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Introduction: Apraxia is defined as a disorder of learned skilled movements, in the absence of
elementary motor or sensory deficits and general cognitive impairment, such as
inattention to commands, object-recognition deficits or poor oral comprehension.
Limb apraxia has long been a challenge for clinical assessment and understanding
and covers a wide spectrum of disorders, all involving motor cognition and the
inability to perform previously learned actions. Demographic variables such as
gender, age, and education can influence the performance of individuals on
different neuropsychological tests. Objective: The present study aimed to evaluate the performance of healthy subjects on a limb
apraxia battery and to determine the influence of gender, age, and education on
the praxis skills assessed. Methods: Forty-four subjects underwent a limb apraxia battery, which was composed of
numerous subtests for assessing both the semantic aspects of gestural production
as well as motor performance itself. The tasks encompassed lexical-semantic
aspects related to gestural production and motor activity in response to verbal
commands and imitation. Results: We observed no gender effects on any of the subtests. Only the subtest involving
visual recognition of transitive gestures showed a correlation between performance
and age. However, we observed that education level influenced subject performance
for all sub tests involving motor actions, and for most of these, moderate
correlations were observed between education level and performance of the praxis
tasks. Conclusion: We conclude that the education level of participants can have an important
influence on the outcome of limb apraxia tests.
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Affiliation(s)
- Joana Mantovani-Nagaoka
- Speech Therapist, Master in Sciences, Department of Human Communication Sciences, Universidade Federal de São Paulo, SP, Brazil
| | - Karin Zazo Ortiz
- Specialist, Master, and PhD in Human Communication Disorders. Postdoctoral fellow in Neuroscience. Associate Professor, Department of Human Communication Sciences, Universidade Federal de São Paulo, SP, Brazil
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Abstract
Loss of ability of the left upper limb (LUL) to correctly produce spatial and temporal components of skilled purposeful movements was reported 34 years ago in a woman with a callosal infarction. To learn about recovery, we recently reexamined this woman. This woman was tested for ideomotor apraxia by asking her to pantomime to command and to seeing pictures of tools. Whereas she performed normally with her right upper limb, her LUL remained severely apraxic, making many spatial (postural and movement) errors. Initially, she did not reveal loss of finger-hand deftness (limb-kinetic apraxia), and when tested again with the coin rotation task, her left hand performance was normal. Without vision, she could name objects placed in her left hand but not name numbers written in this hand. Since this woman had a callosal lesion, failure to recover cannot be accounted for by left hemisphere inhibition of her right hemisphere. Although failure for her LUL to improve may have been related to not using her LUL for skilled actions, her right hemisphere was able to observe transitive actions, and this failure of her LUL to produce skilled purposeful movements suggests her right hemisphere may have not had the capacity to learn these movement representations. Without vision, her ability to recognize objects with her left hand, but not numbers written on her left palm, suggests graphesthesia may require that her left hand did not have access to movement representations important for programming these numbers when writing.
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Affiliation(s)
- Adam D Falchook
- a Department of Neurology and Center for Neuropsychological Studies , University of Florida College of Medicine , Gainesville , FL , USA.,b Malcom Randall Veteran Affairs Medical Center , Gainesville , FL , USA
| | - Robert T Watson
- c Brain Rehabilitation Research Center and Geriatric Research Education and Clinical Center, Department of Clinical Sciences , Florida State University College of Medicine , Tallahassee , FL , USA
| | - Kenneth M Heilman
- a Department of Neurology and Center for Neuropsychological Studies , University of Florida College of Medicine , Gainesville , FL , USA.,b Malcom Randall Veteran Affairs Medical Center , Gainesville , FL , USA
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Abstract
Limb apraxia, a disorder of higher order motor control, has long been a challenge for clinical assessment and understanding (Leiguarda and Marsden, 2000). The deficits originally described in limb apraxia (Liepmann, 1920) have been classified by the nature of the errors made by the patients leading to, namely, ideational and ideomotor apraxia. The dual stream hypothesis (Goodale and Milner, 1992) has been used to explain these categories: ideational apraxia is thought to relate to a deficit in the concept of a movement (coded in the ventral stream). Patients have difficulty using objects, sequencing actions to interact with them or pantomiming their use. Ideomotor apraxia, on the other hand, is thought to arise from problems in the accurate implementation of movements within the dorsal stream. One of the limitations on understanding apraxia is the failure by the clinical literature to draw on knowledge of the factors determining actions in the environment. Here we emphasize the role of affordance. There is much recent work indicating that our responses to stimuli are strongly influenced by the actions that the objects "afford", based on their physical properties and the intentions of the actor (e.g., Tucker and Ellis, 1998). The concept of affordance, originally suggested by Gibson (1979) has been incorporated in a recent model of interactive behavior that draws from findings in non-human primates, namely the "affordance competition hypothesis" (Cisek, 2007). This postulates that interactive behavior arises by a process of competition between possible actions elicited by the environment. In this paper we argue that "affordance competition" may play a role in apraxia. We review evidence that at least some aspects of apraxia may reflect an abnormal sensitivity to competition when multiple affordances are present (Riddoch et al., 1998) and/or a poor ability to exert cognitive control over this competition when it occurs. This framework suggests a new way of conceptualizing deficits in apraxia which invites further investigations in the field.
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Affiliation(s)
- Elisabeth Rounis
- Department of Experimental Psychology, University of Oxford Oxford, UK ; Nuffield Department of Clinical Neurosciences, University of Oxford Oxford, UK
| | - Glyn Humphreys
- Department of Experimental Psychology, University of Oxford Oxford, UK
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Migliaccio R, Agosta F, Toba MN, Samri D, Corlier F, de Souza LC, Chupin M, Sharman M, Gorno-Tempini ML, Dubois B, Filippi M, Bartolomeo P. Brain networks in posterior cortical atrophy: a single case tractography study and literature review. Cortex 2012; 48:1298-309. [PMID: 22099855 PMCID: PMC4813795 DOI: 10.1016/j.cortex.2011.10.002] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2011] [Revised: 04/01/2011] [Accepted: 10/05/2011] [Indexed: 02/07/2023]
Abstract
Posterior cortical atrophy (PCA) is rare neurodegenerative dementia, clinically characterized by a progressive decline in higher-visual object and space processing. After a brief review of the literature on the neuroimaging in PCA, here we present a study of the brain structural connectivity in a patient with PCA and progressive isolated visual and visuo-motor signs. Clinical and cognitive data were acquired in a 58-years-old patient (woman, right-handed, disease duration 18 months). Brain structural and diffusion tensor (DT) magnetic resonance imaging (MRI) were obtained. A voxel-based morphometry (VBM) study was performed to explore the pattern of gray matter (GM) atrophy, and a fully automatic segmentation was assessed to obtain the hippocampal volumes. DT MRI-based tractography was used to assess the integrity of long-range white matter (WM) pathways in the patient and in six sex- and age-matched healthy subjects. This PCA patient had a clinical syndrome characterized by left visual neglect, optic ataxia, and left limb apraxia, as well as mild visuo-spatial episodic memory impairment. VBM study showed bilateral posterior GM atrophy with right predominance; DT MRI tractography demonstrated WM damage to the right hemisphere only, including the superior and inferior longitudinal fasciculi and the inferior fronto-occipital fasciculus, as compared to age-matched controls. The homologous left-hemisphere tracts were spared. No difference was found between left and right hippocampal volumes. These data suggest that selective visuo-spatial deficits typical of PCA might not result from cortical damage alone, but by a right-lateralized network-level dysfunction including WM damage along the major visual pathways.
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Affiliation(s)
- Raffaella Migliaccio
- Inserm-UPMC UMRS 975, CR-ICM, Centre de Recherche de l’Institut du Cerveau et de la Moelle épinière, Hôpital de la Pitié-Salpêtrière, Paris, France
- Department of Psychology, Catholic University, Milan, Italy
| | - Federica Agosta
- Neuroimaging Research Unit, INSPE, Division of Neuroscience, Scientific Institute and University Ospedale San Raffaele, Milan, Italy
| | - Monica N. Toba
- Inserm-UPMC UMRS 975, CR-ICM, Centre de Recherche de l’Institut du Cerveau et de la Moelle épinière, Hôpital de la Pitié-Salpêtrière, Paris, France
| | - Dalila Samri
- Inserm-UPMC UMRS 975, CR-ICM, Centre de Recherche de l’Institut du Cerveau et de la Moelle épinière, Hôpital de la Pitié-Salpêtrière, Paris, France
| | - Fabian Corlier
- Inserm-UPMC UMRS 975, CR-ICM, Centre de Recherche de l’Institut du Cerveau et de la Moelle épinière, Hôpital de la Pitié-Salpêtrière, Paris, France
| | - Leonardo C. de Souza
- Inserm-UPMC UMRS 975, CR-ICM, Centre de Recherche de l’Institut du Cerveau et de la Moelle épinière, Hôpital de la Pitié-Salpêtrière, Paris, France
| | - Marie Chupin
- Inserm-UPMC UMRS 975, CR-ICM, Centre de Recherche de l’Institut du Cerveau et de la Moelle épinière, Hôpital de la Pitié-Salpêtrière, Paris, France
- CNRS, UMR-S7225, Paris, France
| | - Michael Sharman
- Inserm-UPMC UMRS 975, CR-ICM, Centre de Recherche de l’Institut du Cerveau et de la Moelle épinière, Hôpital de la Pitié-Salpêtrière, Paris, France
- CENIR, Centre de Neuroimagerie de Recherche, Paris, France
| | | | - Bruno Dubois
- Inserm-UPMC UMRS 975, CR-ICM, Centre de Recherche de l’Institut du Cerveau et de la Moelle épinière, Hôpital de la Pitié-Salpêtrière, Paris, France
| | - Massimo Filippi
- Neuroimaging Research Unit, INSPE, Division of Neuroscience, Scientific Institute and University Ospedale San Raffaele, Milan, Italy
| | - Paolo Bartolomeo
- Inserm-UPMC UMRS 975, CR-ICM, Centre de Recherche de l’Institut du Cerveau et de la Moelle épinière, Hôpital de la Pitié-Salpêtrière, Paris, France
- Department of Psychology, Catholic University, Milan, Italy
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Abstract
Apraxia traditionally refers to impaired ability to carry out skilled movements in the absence of fundamental sensorimotor, language, or general cognitive impairment sufficient to preclude them. The child neurology literature includes a much broader and varied usage of the term developmental dyspraxia. It has been used to describe a wide range of motor symptoms, including clumsiness and general coordination difficulties, in various developmental disorders (including autistic spectrum disorders, developmental language disorders, and perinatal stroke). We argue for the need to restrict use of the term developmental dyspraxia to describe impaired performance of skilled gestures, recognizing that, unlike acquired adult-onset apraxia, coexisting sensory and motor problems can also be present.
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Affiliation(s)
- Kyle J. Steinman
- Division of Child Neurology, Department of Neurology, University of California – San Francisco, San Francisco, CA
| | - Stewart H. Mostofsky
- Kennedy Krieger Institute, Baltimore, MD, Departments of Neurology and Psychiatry, Johns Hopkins School of Medicine, Baltimore, MD
| | - Martha B. Denckla
- Kennedy Krieger Institute, Baltimore, MD, Departments of Neurology and Psychiatry, Johns Hopkins School of Medicine, Baltimore, MD
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Abstract
INTRODUCTION Apraxia of face movement in Alzheimer's disease (AD) has been rarely investigated. This study aimed at investigating the frequency of lower (mouth, tongue and throat) and upper (eyes and eyebrows) face apraxia, in AD and its relationship with limb apraxia and severity of dementia. METHODS Fifty seven patients with AD were tested with a new standardised test of face apraxia including upper and lower face movements, which uses an item-difficulty weighted scoring procedure, the IMA test, a test of ideomotor apraxia and the M.O.D.A., a means to assess dementia severity. RESULTS Thirteen (23%) and 19 (33%) participants were below cut-off respectively on the upper and lower face apraxia test. Both sections of the Face Apraxia Test correlated significantly with the Ideomotor Apraxia Test. However, double dissociations between different types of apraxia were observed. Both the upper and lower face apraxia tests correlated significantly with the measure of dementia severity. CONCLUSIONS The finding show that a proportion of AD patients fails face apraxia tests. Their face apraxia is interlinked with ideomotor limb apraxia, although dissociations are possible. Severity of dementia deterioration accounts for a good proportion of the variability of AD patients' performance on face apraxia tests.
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Affiliation(s)
- Jay Guido Capone
- Third Neurology WardSan Paolo HospitalDepartment of MedicineSurgery and DentistryUniversity of MilanMilanItaly
| | - Sergio Della Sala
- Neuropsychology Research GroupDepartment of PsychologyUniversity of AberdeenUK
- *Sergio Della Sala:
| | - Hans Spinnler
- Third Neurology WardSan Paolo HospitalDepartment of MedicineSurgery and DentistryUniversity of MilanMilanItaly
| | - Annalena Venneri
- Neuropsychology Research GroupDepartment of PsychologyUniversity of AberdeenUK
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