Summary of disorders of voluntary movement
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Clinical Neuropsychology: A Practical Guide to Assessment and Management for Clinicians Summary of Chapter 10. Disorders of Voluntary Movement http://as.wiley.com/WileyCDA/WileyTitle/productCd-0470683716.html
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Summary of disorders of voluntary movement
- 1. Summary of Disorders of Voluntary Movement Laura H. Goldstein Jin Hwa Kim Cognitive Science Program Seoul National University
- 2. 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
- 3. 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
- 4. 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)
- 5. 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]
- 6. Body Part As Object 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) [Goodglass & Kaplan, 1983; Poeck, 1986]
- 7. 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]
- 8. Types of Apraxic Errors (Cont’d) 4. Others - No response - Unrecognizable response - A very concrete response (?) [Rothi et al., 1997]
- 9. 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]
- 10. 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]
- 11. 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.