PubMed · 8140376
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G Assal, F Machado. 1994. [Constructive apraxia].. https://pubmed.ncbi.nlm.nih.gov/8140376/
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Ideomotor apraxia is a symptom of left hemisphere damage. Patients with ideomotor apraxia commit errors when imitating movements with their left, non-paralyzed hand. This has been taken as evidence for a motor dominance of the left hemisphere. It has been hypothesized that the left hemisphere is dominant for internal preprogramming of skilled movements of either hand. We investigated the kinematics of movement trajectories of imitation of meaningless gestures. Group analysis confirmed that hesitant, feedback-controlled movement prevail in patients with apraxia, but analysis of single cases revealed the existence of kinematically normal movements leading to apractic errors. Enhanced reliance on feedback-control appears to be a compensatory strategy rather than the source of apractic errors. In a second study we explored the alternative hypothesis that patients with apraxia lack a general concept of the human body which is necessary to mediate the translation of a target position seen on the model into a target position on the patient's body. Imitation of movements was examined on oneself and on a mannikin. Patients with apraxia who made errors when imitating on themselves committed errors also when imitating on the mannikin. Taken together, both studies support the view that the source of errors in the imitation of gestures is to be sought at a conceptual level. This casts doubts on the alleged dominance of the left hemisphere for motor control.
Developmental apraxia of speech is a disorder of phonological and articulatory output processes. However, it has been suggested that perceptual deficits may contribute to the disorder. Identification and discrimination tasks offer a fine-grained assessment of central auditory and phonetic functions. Seventeen children with developmental apraxia (mean age 8:9, years:months) and 16 control children (mean age 8:0) were administered tests of identification and discrimination of resynthesized and synthesized monosyllabic words differing in place-of-articulation of the initial voiced stop consonants. The resynthetic and synthetic words differed in the intensity of the third formant, a variable potentially enlarging their clinical value. The results of the identification task showed equal slopes for both subject groups, which indicates no phonetic processing deficit in developmental apraxia of speech. The hypothesized effect of the manipulation of the intensity of the third formant of the stimuli was not substantiated. However, the children with apraxia demonstrated poorer discrimination than the control children, which suggests affected auditory processing. Furthermore, analyses of discrimination performance and articulation data per apraxic subject demonstrated a specific relation between the degree to which auditory processing is affected and the frequency of place-of-articulation substitutions in production. This indicates the interdependence of perception and production. The results also suggest that the use of perceptual tasks has significant clinical value.
A case study is presented of a 5-year-old boy who was classified as preschool handicapped and was assessed as having a specific expressive language impairment with verbal apraxia. Chromosomal studies revealed a de novo (new) balanced translocation between first and second chromosomes. Results of the neurological, speech/language, cognitive, and play evaluations revealed a child with a severe expressive speech-language deficit but good nonverbal cognitive and communicative skills. The hypothesis of a relationship between a chromosomal translocation and speech/language disorders is explored.