An update on the Conceptual-Production Systems model of apraxia: evidence from stroke

Limb apraxia is a neurological disorder characterized by an inability to pantomime and/or imitate gestures. It is more commonly observed after left hemisphere damage (LHD), but has also been reported after right hemisphere damage (RHD). The Conceptual-Production Systems model (Roy, 1996) suggests that three systems are involved in the control of purposeful movements: the conceptual, the production and the sensory/perceptual system. Depending on which system is damaged different patterns of apraxia are expressed. To determine the apraxia pattern, pantomime, delayed, and concurrent imitation tasks need to be administered, as well as conceptual tasks assessing one's knowledge of actions. Based on the model, eight patterns of apraxia should emerge. The purpose of this study is to determine whether these patterns are in fact observed in stroke patients and examine their frequency. If the performance of most stroke patients falls into one of the patterns, then we would have strong support for the conceptual-production model. Stroke (34 LHD and 39 RHD) patients and 27 age- and education-matched healthy controls participated in the study. Participants were assessed in four task modalities: pantomime, delayed imitation, concurrent imitation and conceptual knowledge (two tasks were used: tool naming by action and action identification). Patients were categorized as impaired on a task if they scored 2 SD below the mean performance of the controls for gesture production tasks, or below a cut-off score on the conceptual tasks. They were then classified into patterns depending on their performance on the four task modalities. Most patients (86%) fell into one of seven patterns originally predicted from the Conceptual-Production Systems model. The two most common patterns were deficits in pantomime and imitation with preserved gesture recognition and conduction apraxia (selective deficit in imitation). Four new patterns emerged, but mostly single cases of these were found. Overall, the study provides strong support for the Conceptual-Production Systems model.     

A Model-Based Approach to Understanding Apraxia in Corticobasal Syndrome

Limb apraxia is a neurological disorder of higher cognitive function characterized by an inability to perform purposeful skilled movements and not attributable to an elementary sensorimotor dysfunction or comprehension difficulty. Corticobasal Syndrome (CBS) is an akinetic rigid syndrome with asymmetric onset and progression with at least one basal ganglia feature (rigidity, limb dystonia or myoclonus) and one cortical feature (limb apraxia, alien hand syndrome or cortical sensory loss). Even though limb apraxia is highly prevalent in CBS (70–80%), very few studies have examined the performance of CBS patients on praxis measures in detail. This review aims to (1) briefly summarize the clinical, neuroanatomical and pathological findings in CBS, (2) briefly outline what limb apraxia is and how it is assessed, (3) to comprehensively review the literature on limb apraxia in CBS to date and (4) to briefly summarize the literature on other forms of apraxia, such as limb-kinetic apraxia and buccofacial apraxia. Overall, the goal of the review is to bring a model-based perspective to the findings available in the literature to date on limb apraxia in CBS.     

Neuropsychological functions of hand movements and gestures change in the presence or absence of speech

In order to address previous controversies whether hand movements and gestures are linked to mental concepts or solely to the process of speaking, in the present study we investigate the neuropsychological functions of the entire spectrum of unimanual and bimanual hand movements and gestures when they either accompany speaking or when they act as the only means to communicate in the absence of speech. The results showed that the hand movement activity regarding all types of hand movements and gestures stayed constant with and without speaking. The analysis of the Structure of hand movements showed that executions shifted from in space hand movements with a phase structure during the condition without speech to more irregular on body hand movements without a phase structure during the co-speech condition. The gestural analysis revealed that pantomime gestures increase under conditions without speech whereas emotional motions and subject-oriented actions primarily occur when speaking. The present results provide evidence that the overall hand movement activity does not differ between co-speech conditions and conditions without speech, but that the hands adopt different neuropsychological functions. We conclude that the hands primarily externalise mental concepts in conditions without speaking but that their use shifts to more self-regulation and to endorsing verbal output with emotional connotations when they accompany speech.     

Patterns of apraxia associated with the production of intransitive limb gestures following left and right hemisphere stroke

The model of apraxia proposed by Roy (1996) states that three patterns of apraxia should be observed across pantomime and imitation conditions. In the present analysis the frequency and severity of each pattern of apraxia were examined in a consecutive sample of left-(LHD) and right-hemisphere-damaged (RHD) patients during the production of intransitive limb gestures. The results indicated that a significant proportion of LHD and RHD patients were selectively impaired in formulating the ideational component of intransitive limb gestures.