Chapter 10. Intentional Motor Disorders and the Apraxias Flashcards
Questions 10-1 through 10-5: For each of the following clinical descriptions, select the appropriate descriptive term for the disorder from the following list: A. Akinesia B. Defective response inhibition C. Ideational apraxia D. Ideomotor apraxia E. Hypometria F. Limb-kinetic apraxia G. Motor impersistence H. Motor perseveration Question 10-1: A patient is asked to hold his arms extended for 20 seconds, but lets then drop after a few seconds. When asked to protrude the tongue, he also fails to keep it protruded for the requisite 20 seconds.
Answer 10-1: G.
Motor impersistence is most commonly tested
by asking the patient to probUde the tongue,
close the eyes. or extend the arms. Repeated
inability to maintain the effort in the absence
of true weakness is motor impersistence.
(p119-120)
Questions 10-1 through 10-5: For each of the following clinical descriptions, select the appropriate descriptive term for the disorder from the following list: A. Akinesia B. Defective response inhibition C. Ideational apraxia D. Ideomotor apraxia E. Hypometria F. Limb-kinetic apraxia G. Motor impersistence H. Motor perseveration Question 10-2: A patient is asked to rotate a coin in her hand but cannot do it despite intact strength and absence of corticospinal tract signs. When the same coin is placed on the table, the patient has difficulty lifting the coin off of the table.
Answer 10-2: F.
Limb-kinetic apraxia is defective ability to
make finely-graded, precise, independent
finger movements. The two tasks mentioned-
lifting a coin and rotating it in the hand - arc
commonly-used procedures for assessing
limb-kinetic apraxia. (p 124)
Questions 10-1 through 10-5: For each of the following clinical descriptions, select the appropriate descriptive term for the disorder from the following list: A. Akinesia B. Defective response inhibition C. Ideational apraxia D. Ideomotor apraxia E. Hypometria F. Limb-kinetic apraxia G. Motor impersistence H. Motor perseveration Question 10-3: A patient is asked to show how to light a cigarette in pantomime, and has difficulty performing the task despite absence of paralysis.
Answer 10-3: D.
Ideomotor apraxia is the most common form
of apraxia encountered in routine practice.
Patients have difficulty performing learned
tasks. Pantomime of lighting a cigarette or
using a hammer are two commonly used tests.
(p115)
Questions 10-1 through 10-5: For each of the following clinical descriptions, select the appropriate descriptive term for the disorder from the following list: A. Akinesia B. Defective response inhibition C. Ideational apraxia D. Ideomotor apraxia E. Hypometria F. Limb-kinetic apraxia G. Motor impersistence H. Motor perseveration Question 104: A patient is asked to move the contralateral arm when the one hand is stimulated. The patient consistently moves the ipsilateral hand.
Answer 10-4: B.
Defective response inhibition has a variety of
manifestations and is tested in a variety of
ways. The task described involves asking the
patient to make a crossed response to an
ipsilateral stimulus. and the patient fails to
make the cross and inhibit the ipsilateral
response. It is important to understand that the
patient understand the task, since failure to
understand the task can also result in the same
response. (p120)
Questions 10-1 through 10-5: For each of the following clinical descriptions, select the appropriate descriptive term for the disorder from the following list: A. Akinesia B. Defective response inhibition C. Ideational apraxia D. Ideomotor apraxia E. Hypometria F. Limb-kinetic apraxia G. Motor impersistence H. Motor perseveration Question 10-5: A patient is asked to copy a cube as part of mental status testing, and repeatedly draws over the same lines.
Answer 10-5: H.
Motor perseveration can have different
manifestations, but one of them is repeatedly
performing the requested task. In fact, the
patient may repeat the initial task even though
the requested task has changed. (p 121)
Question 10-6:
Which of the following statements are true
regarding limb-kinetic apraxia?
I. Limb-kinetic apraxia typically occurs in the limb
contralateral to a hemispheric lesion
2. Injury to the premotor cortex produces limb-kinetic apraxia
3. Limb-kinetic apraxia is loss of deftness of independent
finger movements
4. Dominant hemisphere lesion may evoke limb-kinetic
apraxia in the ipsilateral hand
Select. A = 1.2, 3. B = 1,3. C = 2, 4. D = 4 only. E = All
Answer 10-6: E.
All of these are true. Limb-kinetic apraxia
typically occurs in the limb contralateral to a
hemispheric lesion. When the dominant
hemisphere is affected, the ipsilateral limb
may be affected, however. Although there is
imprecise localization, it appears that
premotor cortex damage is typically seen in
patients with limb-kinetic apraxia. (p124)
Question 10-7:
A patient is examined and found to have no paralysis but is unable to imitate gestures and pantomime using tools with the left hand.
However, when the tool is available, the patient retains the ability to use it correctly. Which of the following is the most Iikely location of lesion?
A. Premotor area
B. Corpus callosum
C. Supplementary motor cortex
D. Motor cortex
E. No structural lesion, a psychogenic manifestation
Answer 10-7: B.
Lesions of the corpus callosum produce a language-motor disconnection. Patients retain
the ability to make the movement
spontaneously. but the command received by
the left hemisphere is not received well by the
right hemisphere. The other lesion locations
can produce apraxia and other motor control
deficits, but not the disconnection
demonstrated by this patient. (P 126)
Questions 10-8:
Which of the following statements is true regarding the differentiation between thc primary motor and supplementary motor areas?
1. Apraxia can result from SMA lesions but not the primary motor cortex.
2. SMA neurons discharge prior to the neurons of the primary motor cortex.
3. The SMA is located immediately lateral to the primary motor cortex.
4. The SMA mediates complex movements whereas the primary motor cortex mediates simple movements. Select: A = 1.2. 3. B = 1.3. C = 2. 4.0 = 4 only. E = All
Answer 10-8: C.
In the initiation of movement, SMA neurons
discharge shortly before discharge of neurons
of the primary motor cortex. The SMA
mediates complex movements, whereas the
primary motor Cortex mediates simple
movements. Apraxia can result from lesions
of either area, not just the SMA. The SMA is
on the medial aspect of the hemisphere, not
lateral. (p 126)
Question 10-9:
A patient with stroke is presented to you by a medical student He has difficulty with performing tasks and the student thinks he has ideomotor apraxia. On your exam, he demonstrates
worse performance with imitation than with command. Which of the conclusions is true?
A. The patient has conduction apraxia rather than ideomotor apraxia
B. The findings confum ideomotor apraxia
C. The patient exhibits oppositional behavior
D. The patient exhibits dissociation apraxia
Answer 10-9: A.
Patients with ideomotor apraxia improve with
imitation whereas patients with conduction
apraxia perform worse with imitation than
with command. Dissociation apraxia is
characterized by the patient not performing
any action to command in the abs.!nce of
paralysis. Cpl:!7-1:!8)
Question 10-10: Examination of a patient with stroke shows That the patient has full use of the limbs, but has difficulty with tool use. The patient is shown how to use a screwdriver, then when grabbing the screwdriver uses it as a hammer. Which of the following types of motor deficit does he have? A. Limb-kinetic apraxia B. Ideomotor apraxia C. Conceptual apraxia D. Conduction apraxia
Answer 10-10: C.
Conceptual apraxia is due to a defect in
understanding the concept involved in complex motor tasks. Patients with ideomotor apraxia make spatial and temporal errors, but
patients with conceptual apraxia have a defect
in the concept of the task. Patients with
ideomotor ataxia might use a body part as the
tool, or make spatial errors in use of the tool,
rather than use the tool wrongly. Limb-kinetic
ataxia is loss of deftness offine finger
movements. Patients with conduction apraxia
have more difficulty with imitation than
response to command (P127)
