Intransitive limb gestures and apraxia following unilateral stroke.

Apraxia is the loss of the ability to perform learned, skilled movements correctly, and is frequently attributed to left hemisphere damage (Heilman & Rothi, 1985). Recent work (Dumont, Ska, & Schiavetto, 1999) has shown a dissociation between transitive (tool based; e.g., hammering a nail) and intransitive (expressive/ communicative; e.g., waving goodbye) actions; however, few group studies have specifically addressed apraxia for intransitive gestures. The present investigation examined the frequency and severity of praxis errors related to the production of intransitive gestures in left (LHD) or right hemisphere stroke (RHD) patients in the context of Roy's (1996) model of limb praxis. A total of 119 consecutive stroke patients (LHD = 57, RHD = 62) and 20 healthy age-matched controls performed eight intransitive gestures to pantomime and imitation. Performance was quantified via a multi-dimensional error notation system, providing detail about specific elements of performance (e.g., location), and a composite score reflecting overall gestural accuracy. Analyses of pantomime and imitation performance revealed an equal percentage of apraxic patients in each stroke group, and the severity of apraxia in these groups was also equivalent. Further, analyses of the patterns of apraxia specified by Roy (1996) revealed that patients in each stroke group demonstrated selective impairments in pantomime (LHD = 38%, RHD = 42%), or imitation (LHD = 9%, RHD = 5%) conditions, whereas others demonstrated concurrent impairments (LHD = 30%, RHD = 22%) indicating that stroke to either hemisphere can selectively impair each stage in the production of an intransitive action.