Limb Apraxias: The Influence of Higher Order Perceptual and Semantic Deficits in Motor Recovery After Stroke

Abstract

Stroke is a leading cause of disability worldwide. Limb apraxia is a group of higher order motor disorders associated with greater disability and dependence after stroke. Original neuropsychology studies distinguished separate brain pathways involved in perception and action, known as the dual stream hypothesis. This framework has allowed a better understanding of the deficits identified in Limb Apraxia. In this review, we propose a hierarchical organization of this disorder, in which a distinction can be made between several visuomotor pathways that lead to purposeful actions. Based on this, executive apraxias (such as limb kinetic apraxia) cause deficits in executing fine motor hand skills, and intermediate apraxias (such as optic ataxia and tactile apraxia) cause deficits in reaching to grasp and manipulating objects in space. These disorders usually affect the contralesional limb. A further set of disorders collectively known as limb apraxias include deficits in gesture imitation, pantomime, gesture recognition, and object use. These deficits are due to deficits in integrating perceptual and semantic information to generate complex movements. Limb apraxias are usually caused by left-hemisphere lesions in right-handed stroke patients, affecting both limbs. The anterior- to posterior-axis of brain areas are disrupted depending on the increasing involvement of perceptual and semantic processes with each condition. Lower-level executive apraxias are linked to lesions in the frontal lobe and the basal ganglia, while intermediate apraxias are linked to lesions in dorso-dorsal subdivisions of the dorsal fronto-parietal networks. Limb apraxias can be caused by lesions in both dorsal and ventral subdivisions including the ventro-dorsal stream and a third visuomotor pathway, involved in body schema and social cognition. Rehabilitation of these disorders with behavioral therapies has aimed to either restore perceptuo-semantic deficits or compensate to overcome these deficits. Further studies are required to better stratify patients, using modern neurophysiology and neuroimaging techniques, to provide targeted and personalized therapies for these disorders in the future.

Cognitive Deficits After Stroke

“…Rounis and Binkofski 10 review limb apraxia, which is a group of higher order motor disorders that affect skilled action. Patients with this disorder may be unable to complete simple actions such as getting dressed or preparing a meal.…”

Pragmatic Communication Deficit and Functional Outcome in Patients with Right- and Left-Brain Damage: A Pilot Study

“…Apraxic deficits can be differentiated into subtypes, according to the cognitive and anatomical system involved by the lesion. Rounis and Binkofski [17] have proposed a hierarchical model of apraxia, distinguishing between executive apraxia with deficits in execution of fine-motor hand skills and intermediate apraxia characterized by deficits in reaching and manipulating objects in the space and limb apraxia including pantomime, gesture imitation and comprehension.…”

Interventions to improve the occupational performance of people with post stroke upper limb apraxia – A systematic review and meta-analysis

“…Limb apraxia is operationally defined as a ‘disorder of learned skilled movements that cannot be explained by sensorimotor or comprehension deficits’ (Foundas and Duncan, 2019). Limb apraxia is commonly associated with lesions of the left (dominant) hemisphere, is often coexistent with aphasia and is often present in both limbs (Bounis and Binkifski, 2023). People after stroke with limb apraxia may be unable to gesture or may experience difficulty participating in activities of daily living (ADLs) (Bounis and Binkifski, 2023) due to sequencing errors, spatial temporal movement errors and tool use/content errors (Van Heugten et al, 2000a; Bieńkiewicz et al, 2014).…”