Essay on Cerebrum and Patients

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Apraxia

This essay will be discussing Apraxia – a fairly common brain disorder which affects the patient’s ability to perform voluntary actions, these actions can include both speech and movement, depending on what part of the brain has been damaged. There are several different types of apraxia; all affecting the patients ability to understand and communicate with others, through speech or movement. This essay will focus primarily on Ideomotor apraxia and its symptoms, however; touch on other types of apraxia, such as apraxia of speech which can often be brought about in the same way. I shall also be addressing the matter of treatment, and look at how those with apraxia can be helped.

Ideomotor apraxia is perhaps the most widely recognized form of apraxia. The patient cannot perform well known, physical actions when asked to do so; this could be something as simple as waving goodbye or brushing their teeth. Ideomotor apraxia also affects the patients’ sense of special orientation and timing in their movements.
It has been suggested that patients are more impaired in less natural situations, for example performing actions on command rather than when confronted with the situation and the use of the object in everyday life. This could suggest that those who suffer from moderately minor apraxia could continue to live a fairly normal life. The patient will usually not develop apraxia out of nowhere; it can be brought about by any number of conditions, such as a stroke, tumour in the brain, Alzheimer’s disease, Parkinson’s disease, or even injury to the head. The patient will not be able to develop thoughts as well as usual, nor do learned tasks which came naturally beforehand. Sometimes patients do not even recognise these symptoms until tested.
Apraxia is caused by lesions/damage to the parietal and frontal cortex of the brain, as well as white matter between these areas, specifically the left hemisphere. 1

Doctors usually use CT scans or MRI scans to detect the exact location, size and severity of the lesion in the brain – this can pinpoint exactly what aspect of behaviour will be affected, in relation to the location of lesions. For example, results shown in an experiment carried out by Pramstaller and Marsden of the University Department of Clinical Neurology in London showed that the vast majority of those with apraxia showed deep lesions to the left hemisphere, and ideomotor apraxia was associated with seventy two out of the eighty two cases. 2 This is a clear demonstration of the connection between damage to the brain and behaviour; we can see the correlation between the two in these results shown. In testing for apraxia, a physician may also ask the patient to demonstrate various activities; such as blowing out a candle or imitating the doctors movements – this will demonstrate the patients behaviour in relation to the location and severity of lesions in the brain, further pinpointing which aspect of behaviour has been affected.

Actions which were simple and easy become disorganised and fragmented, as the patients problem lies not in carrying out the action as a whole, but initiating the sequence and fitting the routine together. This is thought to be a result of a disconnection between primary and non primary motor areas in the frontal lobe, perhaps due to damage of the basal ganglia – the area of the brain concerned with initiating and regulating motor commands. 3
The primary motor area is responsible for the movement of individual muscles, and non primary areas are first to initiate and organise the sequence. Evidence suggests that non primary neurons fire almost a full second before the movement occurs, showing that a disconnection between the two would affect the link between thinking and doing. 4 For most people it requires little, if any thought to wave goodbye to somebody, for those with ideomotor apraxia; this task may become very difficult indeed.
The effects of the damage to the
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