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Ecological implications of ideomotor apraxia

Evidence from physical activities of daily living

From the Department of Cognitive Neurology & Alzheimer’s Disease Center (Dr. Hanna–Pladdy) and Psychiatry & Behavioral Sciences (Dr. Hanna-Pladdy), Northwestern University Medical School, Chicago; Department of Neurology (Dr. Heilman), University of Florida College of Medicine, and Neurology Service (Dr. Heilman), VA Medical Center, Gainesville; Department of Psychiatry & Neurology (Dr. Foundas), Tulane College of Medicine, and Neurology Service (Dr. Foundas), VA Medical Center, New Orleans, LA.

Address correspondence and reprint requests to Dr. Brenda Hanna–Pladdy, Cognitive Neurology & Alzheimer’s Disease Center, Northwestern University Medical School, 320 East Superior Street, Searle 11-504, Chicago, IL 60611; e-mail: pladdybh{at}onebox.com

Objective: To learn if ideomotor apraxia (IMA) adversely influences skilled acts in the environment and interferes with independent functioning after stroke.

Methods: The relationship between IMA severity, based on scores from a verbal gesture-to-command (pantomime) task, and the dependency score, as defined by increased caregiver assistance on the Physical Self-Maintenance Scale (PSMS), was investigated in 10 unilateral left hemisphere–damaged stroke patients and 10 matched control subjects.

Results: There was a significant relationship between apraxia severity and dependency in physical functioning (PSMS). Impairment on the PSMS in the patients with IMA could not be accounted for based on overall cognitive impairment, poststroke depression, content–conceptual errors, elementary motor impairment, lesion size, or stroke–test interval. Analysis of categories composing the PSMS revealed that the patients with apraxia had increased dependency in grooming, bathing, and toileting relative to age-matched control subjects.

Conclusions: These findings emphasize the ecological implications of apraxia and the need for rehabilitation strategies to improve the execution and efficiency of coordinated skilled movements in stroke patients with left hemisphere damage.

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