Upper Limb Apraxia

Heilman, Kenneth M.

doi:10.1212/con.0000000000001014

Cited by 6 publications

(3 citation statements)

References 53 publications

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“…Underlying neural networks and pathological mechanisms of movement error can overlap with limb-kinetic apraxia [5][6][7]. Apraxia has been used in different settings and, in the clinical setting of parkinsonism, it is often used as a red flag to suggest a diagnosis of atypical parkinsonian disorders such as corticobasal syndrome, which manifest with prominent praxis dysfunction [52][53][54].…”

Section: Discussionmentioning

confidence: 99%

Exploring the Complex Phenotypes of Impaired Finger Dexterity in Mild-to-moderate Stage Parkinson’s Disease: A Time-Series Analysis

Panyakaew,

Duangjino,

Kerddonfag

et al. 2023

JPD

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Background: Impaired dexterity is an early motor symptom in Parkinson’s disease (PD) that significantly impacts the daily activity of patients; however, what constitutes complex dexterous movements remains controversial. Objective: To explore the characteristics of finger dexterity in mild-to-moderate stage PD. Methods: We quantitatively assessed finger dexterity in 48 mild-to-moderate stage PD patients and 49 age-matched controls using a simple alternating two-finger typing test for 15 seconds. Time-series analyses of various kinematic parameters with machine learning were compared between sides and groups. Results: Both the more and less affected hands of patients with PD had significantly lower typing frequency and slower typing velocity than the non-dominant and the dominant hands of controls (p = 0.04, p = 0.03, p < 0.001, p < 0.001). The slope of the typing velocity decreased with time, indicating a sequence effect in the PD group. A typing duration of 6 seconds was determined sufficient to discriminate PD patients from controls. Typing error, repetition, and repetition rate were significantly higher in the more affected hands of patients with PD than in the non-dominant hand of controls (p = 0.03, p = 0.01, p < 0.001). The error rate was constant, whereas the repetition rate was steep during the initiation of typing. A predictive model of the more affected hand demonstrated an accuracy of 70% in differentiating PD patients from controls. Conclusion: Our study demonstrated complex components of impaired finger dexterity in mild-to-moderate stage PD, namely bradykinesia with sequence effects, error, and repetition at the initiation of movement, suggesting that multiple neural networks may be involved in dexterity deficits in PD.

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Section: Discussionmentioning

confidence: 99%

Exploring the Complex Phenotypes of Impaired Finger Dexterity in Mild-to-moderate Stage Parkinson’s Disease: A Time-Series Analysis

Panyakaew,

Duangjino,

Kerddonfag

et al. 2023

JPD

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“…A detailed description of evaluation of each cognitive domain is provided below with a summary of bedside cognitive tests and pearls and pitfalls of these tests shown in table 1-4 22-35 . Assessment of praxis is discussed separately in the article “Upper Limb Apraxia” by Kenneth L. Heilman, MD, FAAN, 36 in this issue of Continuum .…”

Section: Examinationmentioning

confidence: 99%

Clinical Approach to Cognitive and Neurobehavioral Symptoms

Wicklund¹

2021

CONTINUUM: Lifelong Learning in Neurology

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PURPOSE OF REVIEW This article provides a framework for the approach to patients with cognitive or neurobehavioral concerns. RECENT FINDINGS Recent advances in structural neuroimaging, functional neuroimaging, and disease biomarkers have greatly expanded knowledge of brain-behavior relationships, neural networks and functional connectivity, and pathophysiologic processes leading to cognitive and neurobehavioral disorders. However, any one of these studies is subject to misinterpretation if not applied in the appropriate clinical context. SUMMARY A systematic approach to the history and examination in patients with cognitive and neurobehavioral symptoms is important in marrying clinical assessments with contemporary diagnostic studies and treatments.

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“…Apraxia is the inability to execute learned, skilled movements despite the preservation of power, sensation, coordination, and comprehension for the execution of movements [ 3 – 7 ]. Limb apraxia is an impairment of the performance of skilled, purposive limb movements and is classified into 3 subtypes: ideational apraxia, ideomotor apraxia, and limb-kinetic apraxia (LKA) [ 4 , 5 , 7 – 9 ]. LKA is the execution disorder of movements caused by an injury to the secondary motor area (the supplementary motor area and premotor cortex) with preservation of an intact corticospinal tract (CST) [ 7 – 11 ].…”

Section: Introductionmentioning

confidence: 99%

Role of Diffusion Tensor Tractography in Diagnosis of Limb-Kinetic Apraxia in Stroke Patients: A Mini-Narrative Review

Jang

Byun

2022

Med Sci Monit

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Limb-kinetic apraxia (LKA) is an execution disorder of movements caused by an injury to the secondary motor area (the supplementary motor area and premotor cortex) with preservation of an intact corticospinal tract (CST). A precise diagnosis of LKA is often limited because it is made based on the clinical observation of movement characteristics with confirmation of the CST state, and no specific clinical assessment tools for LKA have been developed. Diffusion tensor tractography (DTT) enables a three-dimensional estimation of the neural tracts related to LKA, such as the CST and corticofugal tract from the secondary motor area. This article reviewed 5 DTT-based studies on LKA-related neural tracts in stroke patients. These studies suggest that DTT could be a useful diagnostic tool for LKA along with previous diagnostic tools, such as brain magnetic resonance imaging and transcranial magnetic stimulation. In particular, DTT for the affected corticofugal tract can provide useful evidence for diagnosing LKA when clinicians cannot observe the movement characteristics because of severe weakness after a severe injury to the affected CST. Furthermore, a reviewed study suggested that LKA might be related to the unaffected neural tracts for motor function when the affected neural tracts were severely injured. This review summarizes the role of DTT in the diagnosis of LKA in stroke patients.

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Upper Limb Apraxia

Cited by 6 publications

References 53 publications

Exploring the Complex Phenotypes of Impaired Finger Dexterity in Mild-to-moderate Stage Parkinson’s Disease: A Time-Series Analysis

Exploring the Complex Phenotypes of Impaired Finger Dexterity in Mild-to-moderate Stage Parkinson’s Disease: A Time-Series Analysis

Clinical Approach to Cognitive and Neurobehavioral Symptoms

Role of Diffusion Tensor Tractography in Diagnosis of Limb-Kinetic Apraxia in Stroke Patients: A Mini-Narrative Review

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