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Geschwind accepted Liepmann s proposition that a lesion of a subcortical tract (presumably the arcuate fasciculus) disconnects the parietal from the left frontal cortex, accounting for the ideomotor apraxia of the right limbs, and that the left limb apraxia is due to a callosal disconnection of the left and right premotor association cortices But in a right-handed person there is also the situation of a left limb apraxia from a lesion in the left frontal lobe that includes Broca s area, the left motor cortex, and the deep underlying white matter Clinically there is a motor speech disorder, a right hemiparesis, and this type of apraxia of the nonparalyzed hand, which has been termed sympathetic apraxia If the lesion in the deep white matter separates the language areas from the right motor cortex but not from the left, the patient can write with the right hand but not with the left, or he may write correctly with the right hand and aphasically with the left That such a syndrome is attributable to interruption of a pathway that traverses the genu of the corpus callosum, as depicted by Geschwind, is questionable, insofar as sympathetic apraxia has not been observed in patients with lesions (or surgical sections) con ned to the anterior third of the corpus callosum (see page 395) The disconnection syndromes are discussed further in Chaps 22 and 23 Perhaps surprisingly, there are but a few cases of apraxia of any type with proven prefrontal lesions Of a somewhat different nature is a facial-oral apraxia, which is probably the most common of all apraxias in practice It may occur with lesions that undercut the left supramarginal gyrus or the left motor association cortex and may or may not be associated with the apraxia of the limbs described above Such patients are unable to carry out facial movements to command (lick the lips, blow out a match, etc), although they may do better when asked to imitate the examiner or when holding a lighted match With lesions that are restricted to the facial area of the left motor cortex, the apraxia will be limited to the facial musculature and may be associated with a verbal apraxia or cortical dysarthria (page 418) So-called apraxia of gait is considered in Chap 7 The terms dressing apraxia and constructional apraxia are used to describe certain manifestations of parietal lobe disease These abnormalities are not apraxias in the strict sense of a loss of previously learned behavior but are instead symptoms of contralateral extinction or neglect of the body schema and of extrapersonal space (anosognosia, page 401) Testing for apraxia is carried out in several ways First, one observes the actions of the patient as he engages in such tasks as dressing, washing, shaving, and using eating utensils Second, the patient is asked to carry out familiar symbolic acts wave goodbye, salute the ag, shake a st as though angry, or blow a kiss If he fails, he is asked to imitate such acts made by the examiner Finally, he is asked to show how he would hammer a nail, brush his teeth, take a comb out of his pocket and comb his hair, cross himself, and so forth, or to execute a more complex act, such as lighting and smoking a cigarette or opening a bottle of soda, pouring some into a glass, and drinking it These last actions, involving more complex sequences, are said to be tests of ideational apraxia; the simpler and familiar acts are called tests of ideomotor apraxia To perform these tasks in the absence of the tool or utensil is always more demanding because the patient must mentally formulate a plan of action rather than engage in a habitual motor sequence The patient may fail to carry out a commanded or suggested activity (eg, to take a pen out of his pocket), yet a few minutes later he may perform the same motor sequence automatically One may. vb.net code 128 font truetype tot.net code 128 : SOLUTIONS in .NET Implement code ...
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