Tapping, grasping and aiming in ideomotor apraxia.

Very few studies have investigated sensorimotor control in apraxia using tasks that differ in movement complexity. Nevertheless, there is some evidence to suggest that spontaneous behaviour, although relatively preserved, can be rather clumsy or awkward, and that patients with ideomotor apraxia may have subtle kinematic abnormalities in movements made in the laboratory. It remains unclear whether patients with ideomotor apraxia perform normally on movements such as visually guided aiming, that may not depend on higher-order, more cognitive, processes and that are relatively unguided by overlearned contexts. In this study, three different sensorimotor tasks were given to the same sample of patients with quantified apraxic disturbance. Finger tapping, goal-directed grasping and aiming with and without visual feedback were examined in these patients. A clear dissociation was found between grossly impaired gesture imitation and intact motor programming of goal-directed movements with visual feedback. Apraxic patients were, however, impaired on aiming movements without visual feedback, suggesting that apraxia is associated with an increased reliance on integration of online visual information with feedforward/feedback somatosensory and motor signals. Furthermore, patients were impaired on single finger tapping which was a surprisingly good predictor of apraxia severity.