Tool use disorders after left brain damage

Neuropsychologia, 2013

Left brain damage (LBD) can impair the ability to use familiar tools (apraxia of tool use) as well as novel tools to solve mechanical problems. Thus far, the emphasis has been placed on quantitative analyses of patients' performance. Nevertheless, the question still to be answered is, what are the strategies employed by those patients when confronted with tool use situations? To answer it, we asked 16 LBD patients and 43 healthy controls to solve mechanical problems by means of several potential tools. To specify the strategies, we recorded the time spent in performing four kinds of action (no manipulation, tool manipulation, box manipulation, and tool-box manipulation) as well as the number of relevant and irrelevant tools grasped. We compared LBD patients' performance with that of controls who encountered difficulties with the task (controls−) or not (controls+). Our results indicated that LBD patients grasped a higher number of irrelevant tools than controls+ and controls−. Concerning time allocation, controls+ and controls− spent significantly more time in performing tool-box manipulation than LBD patients. These results are inconsistent with the possibility that LBD patients could engage in trial-and-error strategies and, rather, suggest that they tend to be perplexed. These findings seem to indicate that the inability to reason about the objects' physical properties might prevent LBD patients from following any problem-solving strategy.

Neuropsychologia, 1998

Moorlaas (1928) proposed that apraxic patients can identify objects and can remember the purpose they have been made for but do not know the way in which they must be used to achieve that purpose. Knowledge about the use of objects and tools can have two sources: It can be based on retrieval of instructions of use from semantic memory or on a direct inference of function from structure. The ability to infer function from structure enables subjects to use unfamiliar tools and to detect alternative uses of familiar tools. It is the basis of mechanical problem solving. The purpose of the present study was to analyze retrieval of instruction of use, mechanical problem solving, and actual tool use in patients with apraxia due to circumscribed lesions of the left hemisphere. For assessing mechanical problem solving we developed a test of selection and application of novel tools. Access to instruction of use was tested by pantomime of tool use. Actual tool use was examined for the same fam...

Experimental Brain Research, 2012

Movement goals and task mechanics differ substantially between actual tool use and corresponding pantomimes. In addition, apraxia seems to be more severe during pantomime than during actual tool use. Comparisons of these two modes of action execution using quantitative methods of movement analyses are rare. In the present study, repetitive scooping movements with a ladle from a bowl into a plate were recorded and movement kinematics was analyzed. Brain-damaged patients using their ipsilesional hand and healthy control subjects were tested in three conditions: pantomime, demonstration with the tool only, and actual use in the normal context. Analysis of the hand trajectories during the transport component revealed clear differences between the tasks, such as slower actual use and moderate deficits in patients with left brain damage (LBD). LBD patients were particularly impaired in the scooping component: LBD patients with apraxia exhibited reduced hand rotation at the bowl and the plate. The deficit was most obvious during pantomime but actual use was also affected, and reduced hand rotation was consistent across conditions as indicated by strong pair-wise correlations between task conditions. In healthy control subjects, correlations between movement parameters were most evident between the pantomime and demonstration conditions but weak in correlation pairs involving actual use. From these findings and published neuroimaging evidence, we conclude that for a specific tool-use action, common motor schemas are activated but are adjusted and modified according to the actual task constraints and demands. An apraxic LBD individual can show a deficit across all three action conditions, but the severity can differ substantially between conditions.

Brain, 2009

Misuse of tools and objects by patients with left brain damage is generally recognized as a manifestation of apraxia, caused by parietal lobe damage. The use of tools and objects can, however, be subdivided in several components. The purpose of our study was to find out which of these are dependent on parietal lobe function. Thirty-eight patients with left brain damage and aphasia were examined using tests to assess the retrieval of functional knowledge from semantic memory (Functional Associations), mechanical problem solving (Novel Tools) and use of everyday tools and objects (Common Tools). Voxel-wise analysis of magnetic resonance images revealed two regions where lesions had a significant impact on the test results. One extended rostrally from the central region and ventrally through the middle frontal cortex to the dorsal margin of the inferior frontal gyrus. The other reached dorsally and caudally from the supramarginal gyrus, through the inferior, to superior parietal lobe. Whereas the frontal lesions had an adverse influence on all experimental tests as well as on the subtests of the Aachen Aphasia test, parietal lesions impaired Novel and Common Tools, but did not have an adverse effect on the Functional Associates. An association between Functional Associations and temporal lesions became apparent when patients with only a selective deficit in the test were considered, but did not show up in the whole group analysis. The parietal influence was as strong for the selection as for the use of either novel or common tools, although choice of appropriate manual configuration and movements was more important for use than for selection. We conclude that the contribution of the parietal lobe to tool use concerns general principles of tool use rather than knowledge about the prototypical use of common tools and objects, and the comprehension of mechanical interactions of the tool with other tools, recipients or material rather than the selection of grip formation and manual movements.

Cerebral Cortex, 2007

Pantomime of tool use is a frequently used test for apraxia. For basic cognitive neuroscience, pantomime of tool use is of interest because it constitutes a link between instrumental and communicative manual actions. We used lesion subtraction analysis to determine the locations specifically associated with defective pantomime of tool use in patients with left-brain damage and aphasia. Subtraction of lesions of patients with normal pantomime from those with defective pantomime yielded a maximum difference in the inferior frontal gyrus and adjacent portions of the insula and precentral gyrus. This result remained essentially the same when possible confounding influences of impaired language comprehension and of lesion size were controlled by selecting patients equated on these measures and when only patients with preserved imitation of gestures were considered. By contrast, parietal lesions did not have a specific impact on pantomime. We speculate that the vulnerability of pantomime to lesions of left inferior frontal cortex is due to the high demands on selection of a very restrained range of features out of the many features that may come to mind when imagining the actual use of the tool.

Journal of Neuropsychology, 2016

Tool use disorders are usually associated with difficulties in retrieving function and manipulation knowledge. Here, we investigate tool use (Real Tool Use, RTU), function (Functional Association, FA) and manipulation knowledge (Gesture Recognition, GR) in 17 left-brain-damaged (LBD) patients and 14 AD patients (Alzheimer disease). LBD group exhibited predicted deficit on RTU but not on FA and GR while AD patients showed deficits on GR and FA with preserved tool use skills. These findings question the role played by function and manipulation knowledge in actual tool use.

Neuropsychologia, 2009

In patients with apraxia the ability to access tool-use-knowledge and to integrate it into a movement plan is frequently disturbed. The present study investigated potential differences between a 'transport'and a 'use'-task as well as the influence of apraxia on the preceding grasping movement, when the tool is presented with its handle pointing away from the participant. 20 controls, 10 patients with right brain damage (RBD-group) and 17 patients with left brain damage (LBD-group) were tested. 10 LBD-patients were classified as moderately to severely apraxic according to erroneous demonstration of tool-use. Participants were asked to grasp the tool and either to demonstrate its typical 'use' or to 'transport' it into a container. Functional grasp, which enables comfortable use, was distinguished from non-functional grasp. The results showed that task-content influences the way to grasp an object. Apart from some LBD-patients, nearly all participants produced 100% functional grasps during the 'use'-task. Additionally inappropriate non-functional grasping has always been followed by apraxic tool-use behaviour. Compared to the 'use'task in the 'transport'-task, functional grasping was significantly reduced in all groups. Our results imply that grasping a tool is specific to a task. Selection of the grasp type seems to be determined by individual weighting of several factors, including knowledge about the function of the object, structural tool characteristics, biomechanical costs of the movement, and previous experience. In general perception and integration of tool-structure plus specific tool-related functional knowledge are necessary for its use and might be processed synchronously. Patients with apraxic tool-use may fail to access any of these information resources. (J. Randerath). spoon for cutting bread. To test tool-use in clinical settings often a single tool is presented. Patients are asked to grasp the tool and demonstrate its typical use. Herein patients with apraxia show typical errors, which include searching for the right movement, producing only partially correct motions -for example hammering with the tapered part of a hammer -, substitutions by other tool-use-movements -for example stirring with a hammer -or even complete omissions .

Annals of Neurology, 1989

Brain Communications, 2021

Pantomime has a long tradition in clinical neuropsychology of apraxia. It has been much more used by researchers and clinicians to assess tool-use disorders than real tool use. Nevertheless, it remains incompletely understood and has given rise to controversies, such as the involvement of the left inferior parietal lobe or the nature of the underlying cognitive processes. The present article offers a comprehensive framework, with the aim of specifying the neural and cognitive bases of pantomime. To do so, we conducted a series of meta-analyses of brain-lesion, neuroimaging, and behavioral studies about pantomime and other related tasks (i.e., real tool use, imitation of meaningless postures, and semantic knowledge). The first key finding is that the area PF (Area PF complex) within the left inferior parietal lobe is crucially involved in both pantomime and real tool use as well as in the kinematics component of pantomime. The second key finding is the absence of a well-defined neura...

Neurocase, 2003

Apraxia is thought to reflect a disruption to high-level perceptual, cognitive and motor systems that form a distributed praxis network. Some authors suggest that apraxic deficits are unique to the neurology clinic; however, mounting evidence suggests that apraxic deficits are observable in natural contexts (e.g. . Naturalistic gesture production involves the integration of conceptual knowledge, gesture ideation, visual and somatosensory cues, and executive processes. Impairments in this context are therefore of interest from a clinical and theoretical standpoint. We present the case of a young female stroke patient (CK) demonstrating a novel limb praxis profile. CK's conceptual, evocation and praxis executive stages were evaluated: performance was contrasted to 30 healthy controls. CK was able to pantomime and imitate transitive gestures, suggesting that her ideational, executive and visual analytic systems were intact. Moreover, CK showed a good conceptual understanding of tools, objects and actions. However, CK demonstrated poor gesture production when actually using the tool associated with the action -a chronic and bilateral deficit that persisted at a 5-year follow-up assessment. Thus, CK's deficit appears to represent a specific and chronic disruption to high-level praxis systems that incorporates tactile inputs into the unfolding gesture production sequence.