Apraxia of tool use: more evidence for the technical reasoning hypothesis

Various distinct cognitive processes such as semantic memory, executive planning or technical reasoning have been shown to support tool use. The aim of this study is to investigate the relationship between these processes. To do so, a large apraxia battery was submitted to 16 patients with left brain-damage (LBD) and aphasia and 19 healthy controls. The battery included: classical apraxia tests (Pantomime of Tool Use and Single Tool Use), familiar and novel tool use tests (Tool-Object Pairs and Sequential Mechanical Problem-Solving), semantic memory tests (Recognition of tool utilization gestures and Functional and Categorical Associations) as well as the Tower Of London. The Sequential Mechanical Problem-Solving task is a new task which permits the evaluation of pre-planning in unusual tool use situations. In this task as well as in the Tool-Object Pairs task, participants solved a tool use problem in a Choice and a No-Choice condition to examine the effect of tool selection. Globally, left brain damaged patients were impaired as compared to controls. We found high correlations in left brain damaged patients between performances on classical apraxia tests, familiar and novel tool use tests and Functional and Categorical Associations but no significant association between these performances and Tower Of London or Recognition of tool utilization gestures. Furthermore, the two conditions (Choice and No-Choice) of Tool-Object Pairs and Sequential Mechanical Problem-Solving were associated. In sum, all tasks involving tool use are strongly associated in LBD patients. Moreover, the ability to solve sequential mechanical problems does not depend on executive planning. Also, tool use appears to be associated with knowledge about object function but not with knowledge about tool manipulation. Taken together, these findings indicate that technical reasoning and, to a lesser extent, semantic memory may both play an important role in tool use

Les apraxies : synthèse et nouvelles perspectives

L’étude de l’apraxie a été, et est toujours, sujette à un débat intense, notamment en ce qui concerne l’autonomie du trouble par rapport aux déficits sensorimoteurs élémentaires et aux déficits cognitifs de plus haut niveau. Ces controverses conduisent généralement les cliniciens à s’interroger sur la bonne façon d’évaluer et d’interpréter les phénomènes apraxiques. Dans cet article, nous proposons une lecture des troubles qui s’inspire des développements les plus récents effectués dans le domaine. Après quelques rappels historiques utiles à la compréhension des modèles cognitivistes qui ont émergé au début des années quatre-vingt, nous discuterons l’apport d’études conduites ces quinze dernières années. Les résultats de ces travaux nous invitent à réexaminer les interprétations issues des modèles cognitifs. Par souci de clarté, nous traiterons uniquement des phénomènes apraxiques évalués lors de situations d’imitation de postures non significatives, d’utilisation effective d’outils et de production de pantomimes. Nous espérons que la discussion présentée dans cet article sera utile aux cliniciens mais aussi aux étudiants en neuropsychologie

Different constraints on grip selection in brain-damaged patients: Object use versus object transport

The present study discusses the presence of different constraints on action selection during object use versus object transport. Sixteen left brain-damaged (LBD) patients, 10 right brain-damaged (RBD) and 35 healthy controls were examined on a grip preference test consisting of a grasping-to-transport and a grasping-to-use condition. Assessment included a general praxis testing (pantomime production, object utilization gesture recognition and object use). We also reported the case of a close-head injury patient (DR) with an atypical behavioural pattern. Our results supported the different constraint hypothesis. While several LBD and RBD patients performed inappropriate grips in the grasping-to-transport condition, only two patients (L2 and DR) used inappropriate grips in the grasping-to-use condition. No correlation was found between the two conditions of the grip preference test and measures of the general praxis testing. The discussion focuses on the nature of constraints on grip selection during object use and object transport

Executive functions in clinical and preclinical Alzheimer's disease

Executive functions is an umbrella term describing a wide range of higher order processes that allow the flexible modification of thought and behaviour in response to changing cognitive or environmental contexts. Impairment of executive functions is common in neurodegenerative disorders such as Alzheimer\u27s disease. These deficits negatively affect everyday activities and hamper the ability to cope with other cognitive or behavioural disorders. In this paper, we propose a synthesis of the knowledge on executive impairments in clinical and preclinical Alzheimer\u27s disease, mostly leaning on the current studies made in this domain. We made some propositions for neuropsychological assessment of executive functions in preclinical and clinical phases of Alzheimer\u27s disease. We hope that this overview will provide a useful insight into an area that is still insufficiently explored in the field of the neuropsychology of Alzheimer\u27s disease

Gestural apraxia

Gestural apraxia was first described in 1905 by Hugo Karl Liepmann. While his description is still used, the actual terms are often confusing. The cognitive approach using models proposes thinking of the condition in terms of production and conceptual knowledge. The underlying cognitive processes are still being debated, as are also the optimal ways to assess them. Several neuroimaging studies have revealed the involvement of a left-lateralized frontoparietal network, with preferential activation of the superior parietal lobe, intraparietal sulcus and inferior parietal cortex. The presence of apraxia after a stroke is prevalent, and the incidence is sufficient to propose rehabilitation

Detecting everyday action deficits in Alzheimer’s disease using a non-immersive virtual reality kitchen

Alzheimer’s disease (AD) causes impairments affecting instrumental activities of daily living (IADL). Transdisciplinary research in neuropsychology and virtual reality has fostered the development of ecologically valid virtual tools for the assessment of IADL, using simulations of real life activities. Few studies have examined the benefits of this approach in AD patients. Our aim was to examine the utility of a non-immersive virtual coffee task (NI-VCT) for assessment of IADL in these patients. We focus on the assessment results obtained from a group of 24 AD patients on a task designed to assess their ability to prepare a virtual cup of coffee, using a virtual coffee machine. We compared performance on the virtual task to an identical daily living task involving the actual preparation of a cup of coffee, as well as to global cognitive, executive, and caregiver-reported IADL functioning. Relative to 32 comparable, healthy elderly (HE) controls, AD patients performed worse than HE controls on all tasks. Correlation analyses revealed that NI-VCT measures were related to all other neuropsychological measures. Moreover, regression analyses demonstrated that performance on the NI-VCT predicted actual task performance and caregiver-reported IADL functioning. Our results provide initial support for the utility of our virtual kitchen for assessment of IADL in AD patients. (JINS, 2014, 20, 1–10

The potential of virtual reality-based training to enhance the functional autonomy of Alzheimer's disease patients in cooking activities: A single case study.

Impairments in performing activities of daily living occur early in the course of Alzheimer\u27s disease (AD). There is a great need to develop non-pharmacological therapeutic interventions likely to reduce dependency in everyday activities in AD patients. This study investigated whether it was possible to increase autonomy in these patients in cooking activities using interventions based on errorless learning, vanishing-cue, and virtual reality techniques. We recruited a 79-year-old woman who met NINCDS-ADRDA criteria for probable AD. She was trained in four cooking tasks for four days per task, one hour per day, in virtual and in real conditions. Outcome measures included subjective data concerning the therapeutic intervention and the experience of virtual reality, repeated assessments of training activities, neuropsychological scores, and self-esteem and quality of life measures. The results indicated that our patient could relearn some cooking activities using virtual reality techniques. Transfer to real life was also observed. Improvement of the task performance remained stable over time. This case report supports the value of a non-immersive virtual kitchen to help people with AD to relearn cooking activities

Stratégies d’évaluation des troubles d’utilisation d’objets

A substantial proportion of patients with brain damage and neurodegenerative diseases misuse common tools. However, this neuropsychological syndrome affecting everyday life is relatively unexplored in the field of experimental and clinical neuropsychology. Little is known about long-term evolution and specific evaluation and/or rehabilitation. This is partially due to the lack of an integrative theoretical framework taking into account all cognitive processes underlying gesture orientation, object selection, or action sequencing. Indeed, apraxia of tool use goes far beyond the traditional, obsolete distinction between ideational apraxia and ideomotor apraxia. This is a complex symptomatology requiring a conceptual and clinical differential analysis. After a brief overview of the theoretical principles underpinning our evaluation method, the purpose of this article is to describe the various types of tests that are required to exhaustively assess tool use disorders. We will then focus on tool use assessment: types of objects, basic knowledge related to them, presentation modalities, action planning. A case study is presented to illustrate how our analysis works

Les troubles visuels au cours de la maladie d’Alzheimer

Principale cause de démence chez le sujet âgé, la maladie d’Alzheimer est caractérisée par l’association de troubles mnésiques, d’un syndrome aphaso-apraxo-agnosique et d’un retentissement fonctionnel. Des symptômes visuels peuvent être présents et parfois dominer le tableau, notamment lors de l’atrophie corticale postérieure, décrite comme la « variante visuelle de la maladie d’Alzheimer ». Les patients et leurs proches rapportent ainsi fréquemment des difficultés de lecture, d’écriture, ou de reconnaissance visuelle. Hormis les agnosies visuelles, d’autres anomalies neuro-ophtalmologiques peuvent expliquer cette symptomatologie : atteinte hémianopsique du champ visuel, neuropathies optiques et mouvements oculaires anormaux. L’objectif de cet article est de faire la liste des troubles visuels retrouvés dans la maladie d’Alzheimer

Contribution de la neuropsychologie à la compréhension de la violence : données cliniques et modèles théoriques

La violence a longtemps été étudiée en faisant référence aux théories psychosociales, développementales et psychanalytiques. Il apparaît que l\u27importance de facteurs neurologiques et particulièrement neuropsychologiques a été sous-estimée. Si tous les lésés cérébraux ne montrent pas de signes de violence, ceux qui présentent des lésions circonscrites des aires préfrontales ventromédianes sont néanmoins les plus disposés à avoir ce type de manifestations. Le but de notre travail est de décrire les déficits neuropsychologiques qui sont généralement associés aux comportements violents et qui sont rapportés par la majorité des études récentes. Ces perturbations feront l\u27objet d\u27une discussion par rapport à trois modèles actuels du fonctionnement frontal