Summary of Disorders of Voluntary Movement

Laura H. Goldstein

Jin Hwa Kim Cognitive Science Program Seoul National University

Contents

Assessment of Apraxia

- Challenges to Assessment

- Methodology

- Pitfall in Assessment

Types of Apraxic Errors

- Spatial, Temporal, Content Errors & Others

Management & Treatment of Apraxia

- Restitutive approach

- Substitutive approach

- Specified treatment effects

The Assessment of Apraxia

1. Challenges to Assessment

- Absence of a widely used & well-standardized tool

- Focused on limb apraxia

- Not theoretically related to cognitive neuropsychological models of apraxia (Rothi et al., 1997)

2. Methodology

- Transitive (using objects) and intransitive (not using objects) movements

- Verbal instruction, imitation of examiner’s movement and real object handling

The Assessment of Apraxia (Cont’d)

3. Pitfall in Assessment

- When the patient is aphasic.. (to verbal instruction)

- Visual object agnosia

- Non-meaningful (more easily) vs. meaningful (De Renzi et al., 1980)

Types of Apraxic Errors

1. Spatial Errors

- Exaggerated

- Incorrect amplitude

- Incorrect orientation of limb to target object

- Use of body part as object

[Rothi et al., 1997]

Body Part As Object

[Goodglass & Kaplan, 1983; Poeck, 1986]

Symptom

- Hammering with a closed fist

- Moving one’s finger across teeth instead of holding toothbrush

Diagnosis

- Rare in adults

- For brain-damaged patients, highly suggestive of ideomotor apraxia (Poeck, 1986)

- However, it may be a sign of brain damage only if it occurs when real objects are presented for use. (Mozaz et al., 1993)

Types of Apraxic Errors (Cont’d)

2. Temporal Errors

- Sequence

- Timing

- Incorrect of cycles of movements

3. Content Errors

- Presence of non-related movements

- Perseveration of all or part of a previously performed movements

- Performance in the absence of the real or imagined tool

[Rothi et al., 1997]

Types of Apraxic Errors (Cont’d)

4. Others

- No response

- Unrecognizable response

- A very concrete response (?)

[Rothi et al., 1997]

Management & Treatment of Apraxia

1. Restitutive approach

- Being directed at those behaviors most likely to recover

2. Substitutive approach

- Being employed for those behaviors that are most likely to remain impaired beyond the initial recovery phase(e.g. self-verbalization, use of sequence pictures)

[Rothi, 1995]

Management & Treatment of Apraxia

3. Restitutive vs. substitutive

- Not known the time course of apraxia

- Not known the manageable aspects of apraxia

- However, generalization might occur more readily in the acute phase,

- substitutive approach might achieve better results to people with chronic apraxia. (Maher & Ochipa, 1997)

[Rothi, 1995]

Management & Treatment of Apraxia

4. Specified treatment effects

- Erroneous responses were immediately corrected, but was maintained to a higher level for the treated items. (Maher et al., 1991)

- In general, treatment of one error type did not lead to a reduction of other error types,

- and improvement was specific to the gestures undergoing treatment. (Ochipa et al., 1995)

- Select tasks on the basis of their functional significance and train in their everyday environment.