Skip to main content
SpringerLink
Log in

A Cognitive Overview of Limb Apraxia

  • Behavior (H Kirshner, Section Editor)
  • Published:
Current Neurology and Neuroscience Reports Aims and scope Submit manuscript

Abstract

Since the first studies on limb apraxia carried out by Hugo Liepmann more than a century ago, research interests focused on the way humans process manual gestures by assessing gesture production after patients suffered neurologic deficits. Recent reviews centered their attention on deficits in gesture imitation or processing object-related gestures, namely pantomimes and transitive gestures, thereby neglecting communicative/intransitive gestures. This review will attempt to reconcile limb apraxia in its entirety. To this end, the existing cognitive models of praxis processing that have been designed to account for the complexity of this disorder will be taken into account, with an attempt to integrate in these models the latest findings in the studies of limb apraxia, in particular on meaningful gestures. Finally, this overview questions the very nature of limb apraxia when other cognitive deficits are observed.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Steinthal H. Abriss der Sprachwissenschaft. 2nd ed. Berlin: Ferd. Dümmlers Verlagsbuchhandlung Harrwitz und Gossmann; 1881.

    Google Scholar 

  2. De Renzi E, Faglioni P. Apraxia In: Denes G, Pizzamiglio L, editors. Handbook of clinical and experimental neuropsychology. Hove: Psychology Press; 1999. p. 421–40.

  3. Vanbellingen T, Kersten B, Van Hemelrijk B, Van de Winckel A, Bertschi M, Müri R, et al. Comprehensive assessment of gesture production: a new test of upper limb apraxia (TULIA). Eur J Neurol. 2010;17:59–66.

    Article  CAS  PubMed  Google Scholar 

  4. Stamenova V, Roy EA, Black SE. Associations and dissociations of transitive and intransitive gestures in left and right hemisphere stroke patients. Brain Cogn. 2010;72:483–90.

    Article  PubMed  Google Scholar 

  5. Goldenberg G, Strauss S. Hemisphere asymmetries for imitation of novel gestures. Neurology. 2002;59:893–7.

    Article  PubMed  Google Scholar 

  6. Goldenberg G, Karnath HO. The neural basis of imitation is body part specific. J Neurosci. 2006;26:6282–7.

    Article  CAS  PubMed  Google Scholar 

  7. Bartolo A, Cubelli R, Della Sala S, Drei S, Marchetti C. Double dissociation between meaningful and meaningless gesture reproduction in apraxia. Cortex. 2001;37:696–9.

    Article  CAS  PubMed  Google Scholar 

  8. Bartolo A, Cubelli R, Della Sala S, Drei S. Pantomimes are special gestures which rely on working memory. Brain Cognit. 2003;53:483–94.

    Article  CAS  Google Scholar 

  9. Bartolo A, Cubelli R, Della Sala S. Cognitive approach to the assessment of limb apraxia. Clin Neuropsychol. 2008;22:27–45.

  10. Tessari A, Canessa N, Ukmar M, Rumiati RI. Neuropsychological evidence for a strategic control of multiple routes in imitation. Brain. 2007;130:1111–26.

    Article  PubMed  Google Scholar 

  11. Tessari A, Toraldo A, Lunardelli A, Zadini A, Rumiati RI. STIMA: a short screening test for ideo-motor apraxia, selective for action meaning and bodily district. Neurol Sci. 2015;36:977–84.

    Article  PubMed  Google Scholar 

  12. De Renzi E, Motti F, Nichelli P. Imitating gestures. A quantitative approach to ideomotor apraxia. Arch Neurol. 1980;37:6–10.

    Article  PubMed  Google Scholar 

  13. De Renzi E, Lucchelli F. Ideational apraxia. Brain. 1988;111:1173–85.

    Article  PubMed  Google Scholar 

  14. Petreska B, Billard A, Hermsdörfer J, Goldenberg G. Revisiting a study of callosal apraxia: the right hemisphere can imitate the orientation but not the position of the hand. Neuropsychologia. 2010;48:2509–16.

    Article  PubMed  Google Scholar 

  15. Rounis E, Humphreys G. Limb apraxia and the “affordance competition hypothesis.” Front Hum Neurosci. 2015;9. This paper reviews transitive gestures and emphasises the role of affordances in object interaction. By using a nonhuman primates’ model, they implemented this model to abnormal behaviour observed in some praxis deficits. Difficulties in object interaction would be accounted for by difficulties in competing when multiple affordances are present or by deficits in the cognitive control required when this competition occur.

  16. Cubelli R, Marchetti C, Boscolo G, Della Sala S. Cognition in action: testing a model of limb apraxia. Brain Cogn. 2000;44:144–65.

  17. Lee CI, Mirman D, Buxbaum LJ. Abnormal dynamics of activation of object use information in apraxia: evidence from eyetracking. Neuropsychologia. 2014;59:13–26.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Hoeren M, Kümmerer D, Bormann T, Beume L, Ludwig VM, Vry MS, et al. Neural bases of imitation and pantomime in acute stroke patients: distinct streams for praxis. Brain. 2014;137(Pt 10):2796–810.

    Article  PubMed  Google Scholar 

  19. Buxbaum LJ, Kyle KM, Menon R. On beyond mirror neurons: internal representations subserving imitation and recognition of skilled object-related actions in humans. Brain Res Cogn Brain Res. 2005;25:226–39.

    Article  PubMed  Google Scholar 

  20. Liepmann H. Apraxie. In: Brugsch H, editor. Ergebnisse der Gesamten Medizin. Wien Berlin: Urban and Schwarzenberg; 1920. p. 516–43.

    Google Scholar 

  21. Cubelli R, Della Sala S. The legacy of automatic/voluntary dissociation in apraxia. Neurocase. 1996;2:449–54.

  22. Ochipa C, Gonzalez Rothi LJ, Heilman KM. Ideational apraxia: a deficit in tool selection and use. Ann Neurol. 1989;25:190–3.

    Article  CAS  PubMed  Google Scholar 

  23. Sundet K, Finset A, Reinvang I. Neuropsychological predictors in stroke rehabilitation. J Clin Exp Neuropsychol. 1988;10:363–79.

    Article  CAS  PubMed  Google Scholar 

  24. Bartolo A, Della Sala S, Cubelli R. The sign of “undue contact” in the object use test. Cortex. 2016;75:235–6. This article refers to the clinical observation of the behavior of left brain damage patients while interacting with objects during laboratory assessment. The unwanted contact with objects not observed in patients with dementia would remind the classical dissociation between voluntary and automatic actions frequently observed in limb apraxia.

    Article  PubMed  Google Scholar 

  25. Gibbs J, Appleton J, Appleton R. Dyspraxia or developmental coordination disorder? Unravelling the enigma. Arch Dis Child. 2007;92:534–9.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Costini O, Roy A, Faure S, Le Gall D. La dyspraxie développementale : actualités et enjeux. Rev Neuropsychol. 2013;5:200–12.

    Article  Google Scholar 

  27. Petreska B, Adriani M, Blanke O, Billard A. Apraxia: a review. In: Von Hofsten C, edr. From action to cognition. Progress in brain research. Amsterdam: Elsevier; 2007 (Vol. 164). p 61–83.

  28. Niessen E, Fink GR, Weiss PH. Apraxia, pantomime and the parietal cortex. Neuroimage Clin. 2014;5:42–52.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  29. Sanger T, Chen D, Delgado M, Gaebler-Spira D, Hallett M, Mink JW. Definition and classification of negative motor signs in childhood. Pediatrics. 2006;118:2159–67.

    Article  PubMed  Google Scholar 

  30. Donkervoort M, Dekker J, van der Ende E, Stehmann-Saris J, Deelman B. Prevalence of apraxia among patients with a first left hemisphere stroke in rehabilitation centres and nursing homes. Clin Rehabil. 2000;14:130–6.

    Article  CAS  PubMed  Google Scholar 

  31. Hodges JR, Spatt J, Patterson K. ''What'' and ''how'': Evidence for the dissociation of object knowledge and mechanical problem-solving skills in the human brain. Proc Natl Acad Sci U S A. 1999;96:9444–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  32. Derouesné C, Lagha-Pierucci S, Thibault S, Baudouin-Madec V, Lacomblez L. Apraxic disturbances in patients with mild to moderate Alzheimer’s disease. Neuropsychologia. 2000;38:1760–9.

    Article  PubMed  Google Scholar 

  33. Stamenova V, Roy EA, Black SE. A model-based approach to understanding apraxia in Corticobasal Syndrome. Neuropsychol Rev. 2009;19:47–63.

    Article  PubMed  Google Scholar 

  34. Stamenova V, Roy EA, Black SE. A model-based approach to limb apraxia in Alzheimer's disease. J Neuropsychol. 2014;8:246–68.

    Article  PubMed  Google Scholar 

  35. Vanbellingen T, Bohlhalter S. Apraxia in neurorehabilitation: classification, assessment and treatment. NeuroRehabilitation. 2011;28:91–8.

    PubMed  Google Scholar 

  36. Cotelli M, Manenti R, Brambilla M, Balconi M. Limb apraxia and verb processing in Alzheimer's disease. J Clin Exp Neuropsychol. 2014;36:843–53.

    Article  PubMed  Google Scholar 

  37. Gonzalez Rothi LJ, Ochipa C, Heilman KM. A cognitive neuropsychological model of limb praxis. Cogn Neuropsychol. 1991;8:443–58.

    Article  Google Scholar 

  38. Roy EA, Square PA. Common considerations in the study of limb, verbal and oral apraxia. In: Roy EA, editor. Neuropsychological Studies of Apraxia and Related Disorders. Amsterdam: North-Holland; 1995. p. 45–64.

    Google Scholar 

  39. Cubelli R, Bartolo A, Nichelli P, Della Sala S. List effect in apraxia assessment. Neurosci Lett. 2006;407:118–20.

  40. Peigneux P, Van der Linden M. Presentation of a cognitive neuropsychological battery for limb apraxia assessment. Rev Neuropsychol. 2000;10:311–62.

    Google Scholar 

  41. Halsband U, Schmitt J, Weyers M, Binkofski F, Grützner G, Freund HJ. Recognition and imitation of pantomimed motor acts after unilateral parietal and premotor lesions: a perspective on apraxia. Neuropsychologia. 2001;39:200–6.

    Article  CAS  PubMed  Google Scholar 

  42. Mäki-Marttunen V, Villarreal M, Leiguarda RC. Lateralization of brain activity during motor planning of proximal and distal gestures. Behav Brain Res. 2014;272:226–37.

    Article  PubMed  Google Scholar 

  43. Roy EA, Square-Storer P, Hogg S, Adams S. Analysis of task demands in apraxia. Int J Neurosci. 1991;56:177–86.

    Article  CAS  PubMed  Google Scholar 

  44. Foundas AL, Macauley BL, Raymer AM, Maher LM, Rothi LJ, Heilman KM. Ideomotor apraxia in Alzheimer disease and left hemispheric stroke: limb transitive and intransitive movements. Cogn Behav Neurol. 1999;12:161–6.

    CAS  Google Scholar 

  45. Haaland KY, Harrington DL, Knight RT. Neural represantations of skilled movement. Brain. 2000;123:2306–13.

    Article  PubMed  Google Scholar 

  46. Mozaz M, Rothi LJ, Anderson JM, Crucian GP, Heilman KM. Postural knowledge of transitive pantomimes and intransitive gestures. J Int Neuropsychol Soc. 2002;8:958–62.

    Article  PubMed  Google Scholar 

  47. Buxbaum LJ, Kyle K, Grossman M, Coslett HB. Left inferior parietal representations for skilled hand-object interactions: evidence from stroke and corticobasal degeneration. Cortex. 2007;43:411–23.

    Article  PubMed  Google Scholar 

  48. Carmo JC, Rumiati RI. Imitation of transitive and intransitive actions in healthy individuals. Brain Cogn. 2009;69:460–4.

    Article  PubMed  Google Scholar 

  49. Dumont C, Ska B, Schiavetto A. Selective impairment of transitive gestures: an unusual case of apraxia. Neurocase. 1999;5:447–58.

    Article  Google Scholar 

  50. Rapcsak SZ, Ochipa C, Beeson PM, Rubens AB. Praxis and the right hemisphere. Brain Cogn. 1993;23:181–202.

    Article  CAS  PubMed  Google Scholar 

  51. Stieglitz Ham H, Bartolo A, Corley M, Swanson S, Rajendran G. Case report: selective deficit in the production of intransitive gestures in an individual with autism. Cortex. 2010;46:407–9.

    Article  Google Scholar 

  52. Happé F, Brownell H, Winner E. Acquired 'theory of mind' impairments following stroke. Cognition. 1999;70:211–40.

    Article  PubMed  Google Scholar 

  53. Heath M, Roy EA, Black SE, Westwood DA. Intransitive limb gestures and apraxia following unilateral stroke. J Clin Exp Neuropsychol. 2001;23:628–42.

    Article  CAS  PubMed  Google Scholar 

  54. Hanna-Pladdy B, Daniels SK, Fieselman MA, Thompson K, Vasterling JJ, Heilman KM, et al. Praxis lateralization: errors in right and left hemisphere stroke. Cortex. 2001;37:219–30.

    Article  CAS  PubMed  Google Scholar 

  55. Flores-Medina Y, Chávez-Oliveros M, Medina LD, Rodríguez-Agudelo Y, Solís-Vivanco R. Brain lateralization of complex movement: neuropsychological evidence from unilateral stroke. Brain Cogn. 2014;84:164–9. The authors compared the performances on pantomimes and intransitive gestures in a group of left and right brain damage patients. Results showed that both groups showed signs of apraxia, but left brain damage patients showed higher number of errors in intransitive gestures than right brain damage patients.

    Article  PubMed  Google Scholar 

  56. Bonivento C, Rothstein P, Humphreys G, Chechlacz M. Neural correlates of transitive and intransitive action imitation: an investigation using voxel-based morphometry. Neuroimage Clin. 2014;19:488–97.

    Article  Google Scholar 

  57. Gallagher HL, Frith CD. Dissociable neural pathways for the perception and recognition of expressive and instrumental gestures. Neuropsychologia. 2004;42:1725–36.

    Article  PubMed  Google Scholar 

  58. Gonzalez Rothi LJ, Raymer AM, Heilman KM. Limb praxis assessment. In: Gonzalez Rothi LJ, Heilman KM, editors. Apraxia: the neuropsychology of action. Brain damage, behaviour and cognition series. Hove: Psychology Press; 1997. p. 29–49.

    Google Scholar 

  59. Bohlhalter S, Hattori N, Wheaton L, Fridman E, Shamim EA, Garraux G, et al. Gesture subtype-dependent left lateralization of praxis planning: an event-related fMRI study. Cereb Cortex. 2008;19:1256–62.

    Article  PubMed  PubMed Central  Google Scholar 

  60. Kroliczak G, Frey SH. A Common network in the left cerebral hemisphere represents planning of tool use pantomimes and familiar intransitive gestures at the hand-independent level. Cereb Cortex. 2009;19:2396–410.

    Article  PubMed  PubMed Central  Google Scholar 

  61. Wamain Y, Pluciennicka E, Kalénine S. Temporal dynamics of action perception: differences on ERP evoked by object-related and nonobject-related actions. Neuropsychologia. 2014;63:249–58.

    Article  PubMed  Google Scholar 

  62. Balconi M, Vanutelli ME, Bartolo A, Cortesi L. Transitive and intransitive gesture execution and observation compared to resting state. The hemodynamic measures (fNIRS). Cogn Process. 2015;16:125–9.

    Article  PubMed  Google Scholar 

  63. Bartolo A, Cubelli R. The cognitive models of limb apraxia and the specific properties of meaningful gestures. Cortex. 2014;57:297–8.

    Article  PubMed  Google Scholar 

  64. Motomura N, Yamadori A. A case of ideational apraxia with impairment of object use and preservation of object Pantomime. Cortex. 1994;30:167–70.

    Article  CAS  PubMed  Google Scholar 

  65. Fukutake T. Apraxia of tool use: an autopsy case of biparietal infarction. Eur Neurol. 2003;49:45–52.

    Article  PubMed  Google Scholar 

  66. Heath M, Almeida QJ, Roy EA, Black SE, Westwood D. Selective dysfunction of tool-use: a failure to integrate somatosensation and action. Neurocase. 2003;9:156–63.

    Article  PubMed  Google Scholar 

  67. Roy EA. Hand preference, manual asymmetries and limb apraxia. In: Elliot D, Roy EA, editors. Manual asymmetries in motor control. Boca Raton: CTC Press; 1996. p. 215–36.

    Google Scholar 

  68. Buxbaum LJ, Saffran EM. Knowledge of object manipulation and object function: dissociations in apraxic and nonapraxic subjects. Brain Lang. 2002;82:179–99.

    Article  PubMed  Google Scholar 

  69. Negri GA, Lunardelli A, Reverberi C, Gigli GL, Rumiati RI. Degraded semantic knowledge and accurate object use. Cortex. 2007;43:376–88.

    Article  PubMed  Google Scholar 

  70. Canzano L, Scandola M, Gobbetto V, Moretto G, D’Imperio D, Moro V. The representation of objects in apraxia: from action execution to error awareness. Front Hum Neurosci. 2016;10:39. In this artice, the authors focus on transitive gestures, in particular they analyzed the possible cognitive and sensorimotor components involved in object use, by concluding that not only object knowledge and sensory-motor representations, but also spatial and body representations and executive functions have a role in object interaction.

    Article  PubMed  PubMed Central  Google Scholar 

  71. Goldenberg G, Hagmann S. Tool use and mechanical problem solving in apraxia. Neuropsychologia. 1998;36:581–9.

    Article  CAS  PubMed  Google Scholar 

  72. Osiurak F, Jarry C, Allain P, Aubin G, Etcharry-Bouyx F, Richard I, et al. Unusual use of objects after unilateral brain damage: the technical reasoning model. Cortex. 2009;45:769–83.

    Article  PubMed  Google Scholar 

  73. Osiurak F, Jarry C, Le Gall D. Grasping the affordances, understanding the reasoning. Toward a dialectical theory of human tool use. Psychol Rev. 2010;117:517–40.

    Article  PubMed  Google Scholar 

  74. Osiurak F, Jarry C, Lesourd M, Baumard J, Le Gall D. Mechanical problem-solving strategies in left-brain damaged patients and apraxia of tool use. Neuropsychologia. 2013;51:1964–72.

    Article  PubMed  Google Scholar 

  75. Jarry C, Osiurak F, Delafuys D, Chauviré V, Etcharry-Bouyx F, Le Gall D. Apraxia of tool use: more evidence for the technical reasoning hypothesis. Cortex. 2013;49:2322–33.

    Article  PubMed  Google Scholar 

  76. Osiurak F. Apraxia of tool use is not a matter of affordances. Front Hum Neurosci. 2013;7:890.

    Article  PubMed  PubMed Central  Google Scholar 

  77. De Renzi E. Methods of limb apraxia examination and their bearing on the interpretation of the disorder. Adv Psychol. 1985;23:45–64.

    Article  Google Scholar 

  78. Roby-Brami A, Hermsdörfer J, Roy AC, Jacobs S. A neuropsychological perspective on the link between language and praxis in modern humans. Phil Trans R Soc B. 2012;367:144–60.

    Article  PubMed  PubMed Central  Google Scholar 

  79. Vingerhoets G, Alderweireldt AS, Vandemaele P, Cai Q, Van der Haegen L, Brysbaer M, et al. Praxis and language are linked: evidence from co-lateralization in individuals with atypical language dominance. Cortex. 2013;49:172–83. In this fMRI study carried out with individuals with atypical language dominance, the authors found evidence of a strong relationship between language and gestures. Results have been interpreted by arguing that such relationship might represent the evolutionary residue of a neural system out of which proto-sign and proto-speech evolved together.

    Article  PubMed  Google Scholar 

  80. Goldenberg G, Randerath J. Shared neural substrates of apraxia and aphasia. Neuropsychologia. 2015;75:40–9.

    Article  PubMed  Google Scholar 

  81. Mengotti P, Corradi-Dell’Acqua C, Negri GAL, Ukmar M, Pesavento V, Rumiati RI. Selective imitation impairments differentially interact with language processing. Brain. 2013;136:2602–18.

    Article  PubMed  Google Scholar 

  82. Dewaele J, Bartolo A, Macchi L, Cautillon M-E. Relation entre dyspraxie gestuelle et dyslexie chez des enfants avec troubles des apprentissages. Psychol Fr. 2015;60:285–300.

    Google Scholar 

  83. Helm-Estabrooks N. A discussion of apraxia, aphasia and gestural language. Am J Physiol. 1984;246:884–7.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Université Lille, CNRS, CHRU Lille, UMR 9193 - SCALab - Sciences Cognitives et Sciences Affectives, F-59000, Lille, France

    Angela Bartolo

  2. Institut Universitaire de France, Paris, France

    Angela Bartolo

  3. Autism and Language Intervention-WA, Nedlands, Western Australia, Australia

    Heidi Stieglitz Ham

  4. Spectrum Fusion, BloomLab, St Catherine’s College, Crawley, Western Australia, Australia

    Heidi Stieglitz Ham

Authors
  1. Angela Bartolo
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Heidi Stieglitz Ham
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Angela Bartolo.

Ethics declarations

Conflict of Interest

Angela Bartolo and Heidi Stieglitz Ham declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

This article is part of the Topical Collection on Behavior

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Bartolo, A., Ham, H.S. A Cognitive Overview of Limb Apraxia. Curr Neurol Neurosci Rep 16, 75 (2016). https://doi.org/10.1007/s11910-016-0675-0

Download citation

  • Published:

  • DOI: https://doi.org/10.1007/s11910-016-0675-0

Keywords

Search

Navigation