Associated Neurological Findings

Since the diagnosis of apraxia is one of exclusion, a thorough neurological examination is indicated to rule out

TABLE 4-2 -- TYPES OF PRODUCTION AND CONT

ENT ERRORS SEEN IN PATIENTS WITH APRAXIA

Error Type

Description

Example

PRODUCTION ERRORS

Spatial

Postural

Use a body part as tool

Pantomiming the use of scissors, patients use fingers as blades

Orientation

Fail to orient forelimbs to an imaginary target

Pantomiming eutting a piece of paper in half with scissors, patents orient scissors laterally or not in consistent plane

Movement

Incorrect joint movement

Pantomiming the use of a screwdriver, patients rotate the arm at the shoulder and fix the elbow

Timing

Increased lateney and incorrect speed

Absence of smooth sinusoidal speeds of movement when cutting with a knife

CONTENT ERRORS

Tool-object action knowledge

Lack of knowledge of the type of actions associated with tools, utensils, or objects

When pantomiming or using a screwdriver, the patent pantomimes a hammering movement or uses a screwdriver as a hammer

Tool-object association knowledge

Lack of knowledge of the association of a specific tool with a specific object

When shown a partially driven nail, the patent may select a screwdriver instead of a hammer from an array of tools

Mechanical knowledge

Lack of knowledge of overall mechanics of the use of tools

When attempting to drive a nail with no hammer available, the patient selects a screwdriver rather than a heavier tool (pliers)

abnormalities of skilled motor movements that result from abnormalities of attention, language, primary visual disturbances, muscle weakness, ataxia, or disorders of primary sensory function (touch, proprioception). If any of these are present, the diagnosis of apraxia may be difficult to substantiate.

Cerebral. Since patients with apraxia commonly have other neurobehavioral dysfunction, a thorough neuropsychological examination is indicated, including an evaluation of directed attention and language function. Patients with left-sided parietal lesions of the supramarginal and angular gyri may have dyscalculia, finger agnosia, left-right disorientation, and agraphia (Gerstmann's syndrome). Additionally, patients may have alexia, aphasia, and constructional apraxia. Neglect for right-sided stimuli may occur but is uncommon. Patients with degenerative causes of apraxia, such as Alzheimer's disease, may also demonstrate memory loss, aphasia, and agnosia. Individuals with corticobasal ganglionic degeneration may demonstrate frontal-subcortical dysfunction as well.

Cranial Nerves. Since patients with apraxia may have associated visual abnormalities due to involvement of the visual radiations in the parietal lobes, a bedside evaluation of the visual fields should be completed. Patients may demonstrate homonymous hemianopias or quadrantanopias. Visual pursuit and optokinetic nystagmus should be checked using a hand-held strip at the bedside because ipsilateral tracking abnormalities may be seen in patients with parietal lobe lesions. Occasionally, patients with apraxia related to more frontal lesions may demonstrate a conjugate gaze deviation.

Motor/Reflexes/Cerebellar/Gait. Patients with frontal lobe lesions associated with apraxia may have contralateral hemiparesis due to involvement of the motor cortex. Crural weakness without involvement of the arm and face suggests involvement of the medial frontal lobe; when acute, this suggests infarction in the territory of the anterior cerebral artery. These patients may also show evidence of callosal disconnection (see later discussion). Brachial-facial weakness suggests involvement of the distribution of the middle cerebral artery. Evaluation of tone and evaluation for the presence of abnormalities of movement is also important. Patients with apraxia as part of corticobasal ganglionic degeneration may have rigidity, bradykinesia, and tremor or myoclonus.

Sensory. Cortical sensory loss including impaired two-point discrimination, agraphesthesia, and astereognosis indicates involvement of the parietal cortex and can occur in patients with apraxia due to vascular causes as well as in those with corticobasal ganglionic degeneration.

Autonomic Nervous System. Disturbances of the autonomic nervous system generally do not occur in patients with apraxia.

Neurovascular. The patient's neck should be auscultated for the presence of vascular bruits because the presence of significant bilateral bruits is a risk factor for stroke that can cause apraxia in association with other neurological findings.

PreviousNext

Unraveling Alzheimers Disease

Unraveling Alzheimers Disease

I leave absolutely nothing out! Everything that I learned about Alzheimer’s I share with you. This is the most comprehensive report on Alzheimer’s you will ever read. No stone is left unturned in this comprehensive report.

Get My Free Ebook


Post a comment