Apraxia Testing

In order to be classified as being apraxic, the inability to perform skilled purposeful movements should not be caused by sensory loss or by more elemental motor disorders such as weakness, rigidity, tremors, dystonia, chorea, ballismus, athetosis, myoclonus, or seizures. Cognitive, motivational, and attentional disorders may also be associated with an inability to perform skilled acts. Therefore, before diagnosing apraxia, a patient must undergo a detailed neurological examination, including testing of cognitive function. Although the presence of cognitive behavioral disorders does not preclude that the patient may also have apraxia, before diagnosing apraxia the clinician should be certain that these behavioral disorders do not fully account for their patient's inability to perform skilled acts.

Testing praxis involves selectively varying input and task demands. When possible, the same items should be used for all the following subtests. First, patients should be requested to pantomime/gesture. Both transitive (e.g., ''Show me how you would slice bread'') and intransitive gestures (e.g., ''Wave good-bye'') should be tested. Independent of the way in which patients perform to command, patients should be asked to imitate the examiner performing, both with meaningful and meaningless gestures. Independent of the results of the pantomime to command and imitation tests, the patient should also be allowed to see and hold actual tools or objects and to demonstrate how to use them. In addition to having a patient pantomime to verbal command, the examiner may also want to have the patient pantomime in response to seeing pictures of tool or the objects on which tools work. The examiner should learn if the patient can name or recognize transitive and intransitive pantomimes made by the examiner and discriminate between well-performed and poorly performed pantomimes that are performed by the examiner. Lastly, the examiner may want to learn if the patient knows the mechanical advantage that tools afford and if the patient can substitute or even fabricate tools to solve mechanical problems.

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