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APRAXIA: Neuropsychological- Information Processing Models Kenneth M. Heilman M.D. The James E. Rooks Jr. Distinguished Professor of Neurology, University of Florida, College of Medicine
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Page 1: APRAXIA: Neuropsychological- Information Processing Models Kenneth M. Heilman M.D. The James E. Rooks Jr. Distinguished Professor of Neurology, University.

APRAXIA: Neuropsychological-Information Processing Models

Kenneth M. Heilman M.D.The James E. Rooks Jr. Distinguished

Professor of Neurology, University of Florida, College of Medicine

Page 2: APRAXIA: Neuropsychological- Information Processing Models Kenneth M. Heilman M.D. The James E. Rooks Jr. Distinguished Professor of Neurology, University.

Definition

• Exclusionary: The loss of the ability to perform purposeful skilled movements when this deficit can not be explained by motor deficits (e.g., weakness), sensory defects, movements disorders (tremor, ataxia, chorea, athetosis, ballismus, myoclonus etc) or certain cognitive disorders (e.g., poor comprehension).

• Inclusionary: There are 5 major types of apraxia and each are defined by the task demands and types of errors.

Page 3: APRAXIA: Neuropsychological- Information Processing Models Kenneth M. Heilman M.D. The James E. Rooks Jr. Distinguished Professor of Neurology, University.

Types of Limb Apraxia

• 1. Limb-kinetic

• 2. Ideomotor

• 3. Dissociation and Conduction

• 4. Ideational

• 5. Conceptual

Page 4: APRAXIA: Neuropsychological- Information Processing Models Kenneth M. Heilman M.D. The James E. Rooks Jr. Distinguished Professor of Neurology, University.

LIMB-KINETIC APRAXIA

• Testing: 1) pegboard; 2) pincher grasp to pick up small coins; 3) coin rotation.

• Error Type: Loss of finger deftness or dexterity. Loss of the ability to perform independent, but coordinated precise finger movements.

• Pathophysiology: Injury to corticospinal system and/or convexity premotor cortex. Left hemisphere dominance.

Page 5: APRAXIA: Neuropsychological- Information Processing Models Kenneth M. Heilman M.D. The James E. Rooks Jr. Distinguished Professor of Neurology, University.

IDEOMOTOR APRAXIA

• Testing: 1. Performance of transitive movement to command (e.g., show me how you would slice bread with a knife.

2. Imitation of transitive movements.

3. Use of actual tools and implements

4. Discrimination between correct and incorrect postures and movements.

Page 6: APRAXIA: Neuropsychological- Information Processing Models Kenneth M. Heilman M.D. The James E. Rooks Jr. Distinguished Professor of Neurology, University.

IDEOMOTOR APRAXIA…CON’T

• Error Types– 1. Postural Errors: a) Incorrect posture; b) Body-part as tool.– 2. Movement Errors: a) Movement of incorrect join or joints; b)

Poor joint coordination.– 3. Orientation Error: Not properly directing action toward target.– 4. Timing-Speed Errors:

Page 7: APRAXIA: Neuropsychological- Information Processing Models Kenneth M. Heilman M.D. The James E. Rooks Jr. Distinguished Professor of Neurology, University.

PATHOPHYSIOLOGY

1. Callosal Lesions A) Geschwind and Kaplan, right arm normal, left impaired to command only…possible language disconnection (see Fig.)

B) Watson and Heilman, right arm normal, left arm impaired to

command, imitation, and use of actual objects…disconnection of movement representations.

2. Left Hemisphere Lesions A) Asymbolia – apraxia and aphasia can be dissociated

B) Geschwind Intrahemispheric disconnection-cannot explain

impaired imitation and actual object use (see Fig).

C) Heilman-Rothi- lateralized movement representations in left parietal lobe (see Fig).

Page 8: APRAXIA: Neuropsychological- Information Processing Models Kenneth M. Heilman M.D. The James E. Rooks Jr. Distinguished Professor of Neurology, University.

CALLOSAL APRAXIA-VERBAL DISCONNECTION

Lexical-Sematics

MC

PMC

SSC

VCVAA

LT RT

Page 9: APRAXIA: Neuropsychological- Information Processing Models Kenneth M. Heilman M.D. The James E. Rooks Jr. Distinguished Professor of Neurology, University.

Geschwind’s Model of Ideomotor Apraxia

Auditory cortex

Wernicke’s area

LeftPremotor

Cortex

LeftMotorCortex

RightPremotor

Cortex

RightMotorCortex

Page 10: APRAXIA: Neuropsychological- Information Processing Models Kenneth M. Heilman M.D. The James E. Rooks Jr. Distinguished Professor of Neurology, University.

Heilman-Rothi Model

Lexicon

MovementFormula

SMAPremotor

Cortex

ConvexityPremotor

Cortex

MotorCortex

ObjectRecognition

Units

Page 11: APRAXIA: Neuropsychological- Information Processing Models Kenneth M. Heilman M.D. The James E. Rooks Jr. Distinguished Professor of Neurology, University.

IDEOMOTOR APRAXIA

Lexicon

MovementFormula

SMAPremotor

Cortex

ConvexityPremotor

Cortex

LTMOTORCORTEX

ObjectRecognition

Units

RTMOTORCORTEX

Page 12: APRAXIA: Neuropsychological- Information Processing Models Kenneth M. Heilman M.D. The James E. Rooks Jr. Distinguished Professor of Neurology, University.

Conceptual Apraxia

• Definition: A loss of mechanical knowledge, such that a patient cannot select the proper tools to perform a tasks, or does not understand the mechanical advantage offered by tools.

Page 13: APRAXIA: Neuropsychological- Information Processing Models Kenneth M. Heilman M.D. The James E. Rooks Jr. Distinguished Professor of Neurology, University.

Conceptual Apraxia Continued• Testing: • 1) Tool Selection (e.g., Patient is shown incomplete task, such a

partially driven in nail and tools such as a hammer, screwdriver, hand saw, wrench, and can opener. The patient is asked to point to the tool need to complete the task.

• 2) Alternate Tools (e.g., The hammer is taken away and the patient is asked, “What tool would you use now?”

• 3) Developing Tools (e.g., The patient is shown a wooden block with an eye hook on top which is sitting on the bottom of a plexiglass tube. The patient is given a wire and asked to retrieve block. The patient needs to make hook.)

Page 14: APRAXIA: Neuropsychological- Information Processing Models Kenneth M. Heilman M.D. The James E. Rooks Jr. Distinguished Professor of Neurology, University.

Conceptual Apraxia Continued

• Errors: Inability to correctly perform the tests mentioned above.

• Pathophysiology: Loss of action-tool semantics. In the right handed people this knowledge is stored in the left hemisphere and functional imaging suggests that the left parietal lobe might also be important for storing these representations.

Page 15: APRAXIA: Neuropsychological- Information Processing Models Kenneth M. Heilman M.D. The James E. Rooks Jr. Distinguished Professor of Neurology, University.

Conceptual Apraxia

MovementFormula

SMAPremotor

Cortex

ConvexityPremotor

Cortex

MotorCortex

ObjectRecognition

Units

Action-ToolSemantics

Lexical Semantics

Motor Neurons

Page 16: APRAXIA: Neuropsychological- Information Processing Models Kenneth M. Heilman M.D. The James E. Rooks Jr. Distinguished Professor of Neurology, University.

Dissociation Apraxia

• Definition: Inability to perform correct pantomimes to a modality specific stimulus.

• Testing: Pantomime to command, seeing tool or object, feeling tool or object and imitation.

• Error Types: Failure in one modality (e.g.,command), but normal performance in other modalities (e.g., seeing tool.)

• Pathophysiology: Disconnection of intact movement representations from modality specific input (see figure).

Page 17: APRAXIA: Neuropsychological- Information Processing Models Kenneth M. Heilman M.D. The James E. Rooks Jr. Distinguished Professor of Neurology, University.

Dissociation Apraxia

LexicalSemantics

MovementFormula

SMAPremotor

Cortex

ConvexityPremotor

Cortex

MotorCortex

ObjectRecognition

Units

Page 18: APRAXIA: Neuropsychological- Information Processing Models Kenneth M. Heilman M.D. The James E. Rooks Jr. Distinguished Professor of Neurology, University.

Dissociation and Conduction Apraxias:A=Verbal dissociation apraxia; B= Visual dissociation apraxia;;

C=Conduction apraxia ;

MovementFormula

SMAPremotor

Cortex

ConvexityPremotor

Cortex

MotorCortex

ObjectRecognition

Units

Action-ToolSemantics

Lexical Semantics

Verbal command

View toolVisual Ass’nCortex

V5View Pantomime

A

B

C

Page 19: APRAXIA: Neuropsychological- Information Processing Models Kenneth M. Heilman M.D. The James E. Rooks Jr. Distinguished Professor of Neurology, University.

Ideational Apraxia

• Definition: Loss of the ability to order a series of acts to achieve a goal.

• Testing: Present patient with items needed to complete a task such as making a sandwich (bread, lettuce, tomatoes, cheese, mayo, ham, and a knife). The ask patient to make sandwich.

• Errors: Patient makes errors in ordering a series of acts (e.g., cuts bread in half before putting on the ham etc.

• Pathophysiology: Not fully investigated

Page 20: APRAXIA: Neuropsychological- Information Processing Models Kenneth M. Heilman M.D. The James E. Rooks Jr. Distinguished Professor of Neurology, University.

PRAXIS SYSTEMS

CORPUS CALLOSUM

OBJECTUNITS

MO

TO

R C

OR

TE

XM

OT

OR

CO

RT

EX

PREMOTORCOREX

MOVEMENTREPRESENTATIONS

ACTIONSEMANTICS

LEXICAL-SEMANTICS

PREMOTOR CORTEX

Auditory input

Visual input

To spinal cord

To spinal cord

Right Hemisphere

Visual gesture input

Page 21: APRAXIA: Neuropsychological- Information Processing Models Kenneth M. Heilman M.D. The James E. Rooks Jr. Distinguished Professor of Neurology, University.

SUMMARY:a=dissociation apraxia; b=conceptual apraxia;

c=ideomotor apraxia; d=limb-kinetic apraxia; e = conduction apraxia

MovementFormula

SMAPremotor

Cortex

ConvexityPremotor

Cortex

MotorCortex Object

RecognitionUnits

Action-ToolSemantics

Lexical -Semantics

a

a

b

c

c

c

d

dd

V-5

e


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