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Semin Neurol 2000; 20(4): 471-478
DOI: 10.1055/s-2000-13180
Copyright © 2000 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA. Tel.: +1(212) 584-4662

Limb Apraxia

Cynthia Ochipa1 , Leslie J. Gonzalez Rothi2
  • 1Audiology and Speech Pathology Service, James A. Haley Veterans' Hospital, Tampa, Florida
  • 2Rehab R & D Brain Rehabilitation Research Center and Neurology Service, Malcolm Randall Veterans Affairs Medical Center, Department of Neurology, University of Florida, Gainesville, Florida
Further Information

Publication History

Publication Date:
03 March 2004 (online)

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ABSTRACT

Limb apraxia is an impairment in the ability to perform skilled, purposive limb movements as the result of neurological dysfunction. In right-handed individuals, limb apraxia is associated with left hemisphere lesions. This article reviews the subtypes and neuroanatomic correlates of limb apraxia, including limb kinetic apraxia, ideomotor apraxia, ideational apraxia, and conceptual apraxia. The functional impact of limb apraxia on the individual is discussed. Strategies for the assessment and management of this disorder are reviewed.

KEYWORD

Apraxia - movement planning - praxis

REFERENCES

  • 1 Heilman K M, Rothi L JG. Apraxia. In: Heilman KM, Valenstein E, eds. Clinical Neuropsychology New York: Oxford University Press 1993: 141-163
    Google Scholar
  • 2 Heilman K M, Rothi L JG, Valenstein E. Two forms of ideomotor apraxia.  Neurology . 1982;  32 342-346
    CrossrefPubMedGoogle Scholar
  • 3 Liepmann H. The left hemisphere and action (translation from Muench Med Wochenschr 1905;48-49). Translations from Liepmann's assays on apraxia. Research Bulletin 506. Department of Psychology, University of Western Ontario, 1980
    Google Scholar
  • 4 Liepmann H. Apraxia. In: Brown JW, ed. Agnosia and Apraxia. Selected Papers of Liepmann, Lange and Potzl. Hillsdale, NJ: Lawrence Erlbaum Associates; 1988;3-39 (Original work published 1920)
    Google Scholar
  • 5 Marchetti C, Della Sala S. On crossed apraxia: description of a right-handed apraxic patient with right supplementary motor area damage.  Cortex . 1997;  33 341-354
    PubMedGoogle Scholar
  • 6 Rapcsak S Z, Rothi L JG, Heilman K M. Apraxia in a patient with atypical dominance.  Brain Cogn . 1987;  6 450-463
    PubMedGoogle Scholar
  • 7 Raymer A M, Merians A S, Adair J C. Crossed apraxia: implications for handedness.  Cortex . 1999;  35 183-199
    PubMedGoogle Scholar
  • 8 Hecean H, Albert M L. Human Neuropsychology.  New York: John Wiley & Sons; 1978
    Google Scholar
  • 9 Heilman K M, Rothi L JG. Limb apraxia: a look back. In: Rothi LJG, Heilman KM, eds. Apraxia, The Neuropsychology of Action East Sussex, UK: Psychology Press 1997: 7-18
    Google Scholar
  • 10 Lawrence D G, Kuypers H J M G. The functional organization of the motor systems in the monkey.  Brain . 1968;  91 1-36
    PubMedGoogle Scholar
  • 11 Rothi L JG, Mack L, Verfaellie M, Brown P, Heilman K M. Ideomotor apraxia: error pattern analysis.  Aphasiology . 1988;  2 381-388
    PubMedGoogle Scholar
  • 12 Poizner H, Mack L, Verfaellie M, Rothi L JG, Heilman K M. Three dimensional computer graphic analysis of apraxia.  Brain . 1990;  113 85-101
    PubMedGoogle Scholar
  • 13 Poizner H, Merians A S, Clark M A, Rothi L JG, Heilman K M. Kinematic approaches to the study of apraxic disorders. In: Rothi LJG, Heilman KM, eds. Apraxia: The Neuropsychology of Action East Sussex, UK: Psychology Press 1997: 93-109
    Google Scholar
  • 14 Leipmann H, Maas O. Fall von linksseitiger Agraphie und Apraxie bei rechsseitiger Lahmung.  Z Psychol Neurol . 1907;  10 214-227
    PubMedGoogle Scholar
  • 15 Watson R T, Heilman K M. Callosal apraxia.  Brain . 1983;  106 391-403
    CrossrefPubMedGoogle Scholar
  • 16 Graff-Radford N R, Welsh K, Godersky J. Callosal apraxia.  Neurology . 1987;  37 100-105
    PubMedGoogle Scholar
  • 17 Geschwind N, Kaplan E. A human cerebral disconnection syndrome.  Neurology . 1962;  12 675-685
    PubMedGoogle Scholar
  • 18 Gazzaniga M, Bogen J, Sperry R. Dyspraxia following diversion of the cerebral commissures.  Arch Neurol . 1967;  16 606-612
    PubMedGoogle Scholar
  • 19 Heilman K M, Rothi L JG, Kertesz A. Localization of apraxia-inducing lesions. In: Kertesz A, ed. Localization in Neuropsychology New York: Academic Press 1983: 371-392
    Google Scholar
  • 20 Rothi L JG, Raade A S, Heilman, K M. Localization of lesions in limb and buccofacial apraxia. In: Kertesz A, ed. Localization and Neuroimaging in Neuropsychology San Diego: Academic Press 1994: 407-427
    Google Scholar
  • 21 Rapcsak S Z, Ochipa C, Beeson P M, Rubens A B. Praxis and the right hemisphere.  Brain Cogn . 1993;  23 181-202
    PubMedGoogle Scholar
  • 22 Kareken D A, Unverzagt F, Caldemeyer K, Farlow M R, Hutchins G D. Functional brain imaging in apraxia.  Arch Neurol . 1998;  55 107-113
    CrossrefPubMedGoogle Scholar
  • 23 Heilman K M, Watson R T, Rothi L JG. Limb apraxia.  Curr Neurol . 1989;  9 179-190
    PubMedGoogle Scholar
  • 24 Jurgens U. The efferent and afferent connections of the supplementary motor area.  Brain Res . 1984;  300 63-81
    CrossrefPubMedGoogle Scholar
  • 25 Brinkman C, Porter R. Supplementary motor areas in the monkey: activity of neurons during performance of a learned motor task.  J Neurophysiol . 1979;  42 681-709
    PubMedGoogle Scholar
  • 26 Roland P E, Larsen B, Lassen N A, Skinhoj E. Supplementary motor area and other cortical areas in organization of voluntary movements in man.  J Neurophysiol . 1980;  43 118-136
    PubMedGoogle Scholar
  • 27 Watson R T, Fleet W S, Rothi L JG, Heilman K M. Apraxia and the supplementary motor area.  Arch Neurol . 1986;  43 787-792
    PubMedGoogle Scholar
  • 28 Agostini C, Coletti A, Orlando G, Tredici G. Apraxia in deep cerebral lesions.  J Neurol Neurosurg Psychiatry . 1983;  46 804-898
    PubMedGoogle Scholar
  • 29 Basso A, Della Sala. Ideomotor apraxia arising from a purely deep lesion.  J Neurol Neurosurg Psychiatry . 1986;  49 458
    PubMedGoogle Scholar
  • 30 De Renzi E, Faglioni P, Scarpa M, Crisi G. Limb apraxia in patients with damage confined to the left basal ganglia and thalamus.  J Neurol Neurosurg Psychiatry . 1986;  49 1030-1038
    PubMedGoogle Scholar
  • 31 Nadeau S E, Roeltgen D P, Sevush S, Ballinger W E, Watson R T. Apraxia due to a pathologically documented thalamic infarction.  Neurology . 1994;  44 2133-2137
    PubMedGoogle Scholar
  • 32 Shuren J E, Maher L M, Heilman K M. The role of the pulvinar in ideomotor praxis.  J Neurol Neurosurg Psychiatry . 1994;  57 1282-1283
    PubMedGoogle Scholar
  • 33 Crosson B. Subcortical limb apraxia. In: Rothi LJG, Heilman KM, eds. Apraxia: The Neuropsychology of Action East Sussex, UK: Psychology Press 1997: 207-243
    Google Scholar
  • 34 Bauer R M. Agnosia. In: Heilman KM, Valenstein E, eds. Clinical Neuropsychology New York: Oxford University Press 1993: 215-278
    Google Scholar
  • 35 Rothi L JG, Mack L, Heilman K M. Pantomime agnosia.  J Neurol Neurosurg Psychiatry . 1986;  49 451-454
    PubMedGoogle Scholar
  • 36 De Renzi E, Lucchelli F. Ideational apraxia.  Brain . 1988;  3 1173-1185
    PubMedGoogle Scholar
  • 37 De Renzi E, Pieczuro O, Vignolo L A. Ideational apraxia: a quantitative study.  Neuropsychologia . 1968;  6 41-52
    CrossrefPubMedGoogle Scholar
  • 38 Ochipa C, Rothi L JG, Heilman K M. Ideational apraxia: a deficit in tool selection and use.  Ann Neurol . 1989;  25 190-193
    CrossrefPubMedGoogle Scholar
  • 39 Poeck K. Ideational apraxia.  J Neurol . 1983;  230 1-5
    PubMedGoogle Scholar
  • 40 Roy E A, Square P A. Common considerations in the study of limb, verbal and oral apraxia. In: Roy EA, ed. Neuropsychological Studies of Apraxia and Related Disorders Amsterdam: Elsevier Science Publishers 1985: 111-162
    Google Scholar
  • 41 Ochipa C, Rothi L JG, Heilman K M. Conceptual apraxia in Alzheimer's disease.  Brain . 1992;  115 1061-1071
    CrossrefPubMedGoogle Scholar
  • 42 Foster N L, Chase T N, Patronas N J, Gillespie M M, Fedio P. Cerebral mapping of apraxia in Alzheimer's disease by positron emission tomography.  Ann Neurol . 1986;  19 139-143
    CrossrefPubMedGoogle Scholar
  • 43 Rapcsak S Z, Croswell S C, Rubens A B. Apraxia in Alzheimer's disease.  Neurology . 1989;  39 664-669
    PubMedGoogle Scholar
  • 44 Benson D F, Davis J, Snyder B D. Posterior cortical atrophy.  Arch Neurol . 1988;  45 789-793
    CrossrefPubMedGoogle Scholar
  • 45 Dick J PR, Snowden J, Northe B, Goulding P J, Neary D. Slowly progressive apraxia.  Behav Neurol . 1989;  2 101-114
    PubMedGoogle Scholar
  • 46 Rapcsak S Z, Ochipa C, Poizner H, Anderson D. Progressive ideomotor apraxia: evidence for a selective impairment of the action production system.  Brain Cogn . 1995;  27 231-236
    PubMedGoogle Scholar
  • 47 Ross G W, Benson D F, Verity A M, Victoroff J I. Posterior cortical atrophy: neuropathological correlations.  Neurology . 1990;  40 200
    PubMedGoogle Scholar
  • 48 Wenning G K, Litvan I, Jankovic J. Natural history and survival of 14 patients with corticobasal degeneration confirmed at postmortem examination.  J Neurol Neurosurg Psychiatry . 1998;  64 184-189
    CrossrefPubMedGoogle Scholar
  • 49 Jacobs D H, Adair J C, Macauley B. Apraxia in corticobasal degeneration.  Brain Cogn . 1999;  40 336-354
    PubMedGoogle Scholar
  • 50 Leiguarda R C, Pramstaller P P, Merello M. Apraxia in Parkinson's disease, progressive supranuclear palsy, multiple system atrophy and neuroleptic-induced parkinsonism.  Brain . 1997;  120 75-90
    CrossrefPubMedGoogle Scholar
  • 51 De Renzi E, Motti F, Nichelli P. Imitating gestures: a quantitative approach to ideomotor apraxia.  Arch Neurol . 1980;  37 6-10
    CrossrefPubMedGoogle Scholar
  • 52 Poeck K. The clinical examination for motor apraxia.  Neuropsychologia . 1986;  24 129-134
    CrossrefPubMedGoogle Scholar
  • 53 Kertesz A, Ferro J M, Shewan C M. Apraxia and aphasia: the functional-anatomical basis for their dissociation.  Neurology . 1984;  34 40-47
    PubMedGoogle Scholar
  • 54 Maher L M, Raymer A M, Foundas A. Patterns of recovery in ideomotor apraxia. Paper presented at the annual meeting of the International Neuropsychological Society, Cincinnati, OH, 1994
    Google Scholar
  • 55 Rothi L JG, Mack L, Heilman K M. Unawareness of apraxic errors.  Neurology . 1990;  40 202
    PubMedGoogle Scholar
  • 56 McDonald S, Tate R C, Rigby J. Error types in ideomotor apraxia: a qualitative analysis.  Brain Cogn . 1994;  25 250-270
    PubMedGoogle Scholar
  • 57 Foundas A L, Macauley B, Raymer A M, Maher L M, Heilman K M. Ecological implications of limb apraxia: evidence from mealtime behavior.  JINS . 1995;  1 62-66
    PubMedGoogle Scholar
  • 58 Schwartz M F, Buxbaum L J. Naturalistic action. In: Rothi LJG, Heilman KM, eds. Apraxia: The Neuropsychology of Action East Sussex, UK: Psychology Press 1997: 269-289
    Google Scholar
  • 59 Sundet K, Finset A, Reinvang I. Neuropsychological predictors in stroke rehabilitation.  J Clin Exp Neuropsychol . 1988;  10 363-379
    CrossrefPubMedGoogle Scholar
  • 60 Wyller T B, Sveen U, Sodring K M, Pettersen A M, Bautz-Holter E. Subjective well-being one year after stroke.  Clin Rehab . 1997;  11 139-145
    PubMedGoogle Scholar
  • 61 Kirshner H S, Webb W G. Selective involvement of the auditory-verbal modality in acquired communication disorder: benefit from sign language therapy.  Brain Lang . 1981;  13 161-170
    CrossrefPubMedGoogle Scholar
  • 62 Skelly M, Schinsky L, Smith R, Fust R. American Indian sign (Amer-Ind) as a facilitator of verbalization for the oral-verbal apraxic.  J of Speech Hear Disord . 1974;  39 445-456
    PubMedGoogle Scholar
  • 63 Feyereisen P, Barter D, Goossens M, Clerebaut N. Gestures and speech in referential communication by aphasic subjects: channel use and efficiency.  Aphasiology . 1988;  2 21-32
    PubMedGoogle Scholar
  • 64 Rothi L JG, Heilman K M. Acquisition and retention of gestures by apraxic patients.  Brain Cogn . 1984;  3 426-437
    PubMedGoogle Scholar
  • 65 Rothi L JG, Raymer A M, Heilman K M. Limb praxis assessment. In: Rothi LJG, Heilman KM, eds. Apraxia: The Neuropsychology of Action East Sussex, UK: Psychology Press 1997: 61-73
    Google Scholar
  • 66 Rothi L JG, Ochipa C, Heilman K M. A cognitive neuropsychological model of limb praxis and apraxia. In: Rothi LJG, Heilman KM, eds. Apraxia: The Neuropsychology of Action East Sussex, UK: Psychology Press 1997: 29-49
    Google Scholar
  • 67 De Renzi E. Methods of limb apraxia examination and their bearing on the interpretation of the disorder. In: Roy EA, ed. Neuropsychological Studies of Apraxia and Related Disorders Amsterdam: Elsevier Science Publishers 1985: 45-64
    Google Scholar
  • 68 Raymer A M, Maher L M, Foundas A L, Heilman K M, Rothi L JG. The significance of body part as tool errors in limb apraxia.  Brain Cogn . 1997;  34 287-292
    PubMedGoogle Scholar
  • 69 Rothi L JG, Raymer A M, Ochipa C. Florida Apraxia Battery, experimental edition (unpublished), 1992 . 
    Google Scholar
  • 70 De Renzi E, Faglioni P, Sorgato P. Modality-specific and supramodal mechanisms of apraxia.  Brain . 1982;  105 310-312
    PubMedGoogle Scholar
  • 71 Ochipa C, Rothi L JG, Heilman K M. Conduction apraxia.  J Neurol Neurosurg Psychiatry . 1994;  57 1241-1244
    CrossrefPubMedGoogle Scholar
  • 72 Maher L M, Rothi L JG, Greenwald M L. Treatment of gesture impairment: a single case.  ASHA . 1991;  33 195
    PubMedGoogle Scholar
  • 73 Ochipa C, Maher L M, Rothi L JG. Treatment of ideomotor apraxia.  JINS . 1995;  2 149
    PubMedGoogle Scholar
  • 74 Pilgrim E, Humphreys G W. Rehabilitation of a case of ideomotor apraxia. In: Riddoch MJ, Humphreys GW, eds. Cognitive Neuropsychology and Cognitive Rehabilitation Hove, UK: Lawrence Erlbaum Associates; 1994
    Google Scholar
  • 75 Coelho C A. Acquisition and generalization of simple manual sign grammars by aphasic subjects.  J Commun Disord . 1990;  23 383-400
    CrossrefPubMedGoogle Scholar
  • 76 Maher L M, Ochipa C. Management and treatment of limb apraxia. In: Rothi LJG, Heilman KM, eds. Apraxia: The Neuropsychology of Action East Sussex, UK: Psychology Press 1997: 75-911
    Google Scholar
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