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Troubles Praxiques chez l’Adulte :
Modèles Théoriques et Evaluation
François Osiurak
Laboratoire d’Etude des Mécanismes Cognitifs, Université de Lyon
Institut Universitaire de France, Paris
Les Samedis de Neuropsychologie, Nice, 21 Novembre 2015 1
Troubles Praxiques chez l’Adulte: Modèles Théoriques et Evaluation
François Osiurak
Références
Livre
- Osiurak, F. (sous presse). Apraxie et troubles d’utilisation d’outils. Presses Universitaires de France. (devrait paraître aux alentours de juin 2016)
Articles (revue de littérature/article théorique)
Général et accessible (en en français!)
- Lesourd, M., Le Gall, D., Baumard, J., Croisile, B., Jarry, C., & Osiurak, F. (2013). Apraxie et maladie d’Alzheimer. Revue de Neuropsychologie, 5, 213-222.
- Le Gall, D., Etcharry-Bouyx, F., & Osiurak, F. (2012). Les apraxies: Synthèse et nouvelles perspectives. Revue de Neuropsychologie, 4, 174-185.
Moins accessible selon moi (et en anglais)
- Osiurak, F. (2014). What neuropsychology tells us about human tool use? The four constraints theory (4CT): Mechanics, space, time, and effort.
Neuropsychology Review, 24, 88-115.
- Osiurak, F., Jarry, C., & Le Gall, D. (2011). Re-examining the gesture engram hypothesis: New perspectives on apraxia of tool use. Neuropsychologia, 49,
299-312.
- Osiurak, F., Jarry, C., & Le Gall, D. (2010). Grasping the affordances, understanding the reasoning: Toward a dialectical theory of human tool use.
Psychological Review, 117, 517-540.
Les Samedis de Neuropsychologie, Nice, 21 Novembre 2015 2
Troubles Praxiques chez l’Adulte: Modèles Théoriques et Evaluation
François Osiurak
(Liepmann, 1908, 1920)
! !
(Heilman et al., 1982)
(Geschwind, 1975)
! !
Les Samedis de Neuropsychologie, Nice, 21 Novembre 2015 3
Troubles Praxiques chez l’Adulte: Modèles Théoriques et Evaluation
François Osiurak
Entrée auditive/verbale Entrée visuelle/objet Entrée visuelle/geste
Analyse auditive Analyse visuelle Analyse visuelle
Système de reconnaissance
des objets
Lexique d’entrée Lexique d’action
phonologique d’entrée
Sémantique
(Action)
Lexique Lexique d’action
de sortie verbale de sortie
Buffer phonologique Patrons d’innervation
Systèmes moteurs Systèmes moteurs
(Rothi et al., 1991)
Les Samedis de Neuropsychologie, Nice, 21 Novembre 2015 4Troubles Praxiques chez l’Adulte: Modèles Théoriques et Evaluation
François Osiurak
Apraxie
• Utilisation d’outils
• Apraxie motrice
• Imitation de postures non symboliques
Les Samedis de Neuropsychologie, Nice, 21 Novembre 2015 5Troubles Praxiques chez l’Adulte: Modèles Théoriques et Evaluation
François Osiurak
Utilisation d’outils non spécifique à l’Homme
Spécificités:
✓ Manipulations objet-objet (McGrew, 1992)
✓ Utilisation d’un outil pour en créer un autre (Gibson, 1993)
✓ Outils complexes (Johnson-Frey, 2007)
✓ Evolution cumulative culturelle (Tomasello et al., 2005)
Les Samedis de Neuropsychologie, Nice, 21 Novembre 2015 6Troubles Praxiques chez l’Adulte: Modèles Théoriques et Evaluation
François Osiurak
Energie mécanique Type de relation
Goldenberg (2013) Osiurak (2014)
Outil-Main
(1) De la main à l’outil
Egocentrique
Outil-Objet
(2) De l’outil à l’objet
Allocentrique
Les Samedis de Neuropsychologie, Nice, 21 Novembre 2015 7Troubles Praxiques chez l’Adulte: Modèles Théoriques et Evaluation
François Osiurak
L’approche centrée sur la manipulation
Gestum ago, ergo instrumentis munio*
* Je gesticule, donc j’outille
Les Samedis de Neuropsychologie, Nice, 21 Novembre 2015 8Troubles Praxiques chez l’Adulte: Modèles Théoriques et Evaluation
François Osiurak
L’approche centrée sur la manipulation
(1) ✓ Sens commun : Travail manuel versus intellectuel
✓ Méta-théorie : Mémoire procédurale versus déclarative
✓ Cognition incarnée
✓ Apraxie : Désordres des mouvements volontaires
Les Samedis de Neuropsychologie, Nice, 21 Novembre 2015 9Troubles Praxiques chez l’Adulte: Modèles Théoriques et Evaluation
François Osiurak
ORIGINAL RESEARCH ARTICLE
published: 23 April 2014
doi: 10.3389/fpsyg.2014.00333
The left inferior parietal lobe represents stored
hand-postures for object use and action prediction
Michiel van Elk *
(1) Department of Psychology, University of Amsterdam, Amsterdam, Netherlands
Edited by: Action semantics enables us to plan actions with objects and to predict others’
François Osiurak, Université de object-directed actions as well. Previous studies have suggested that action semantics are
Lyon, France
represented in a fronto-parietal action network that has also been implicated to play a role
Reviewed by:
in action observation. In the present fMRI study it was investigated how activity within this
Fausto Caruana, Italian Institute of
Technology, Italy network changes as a function of the predictability of an action involving multiple objects
François Osiurak, Université de and requiring the use of action semantics. Participants performed an action prediction
Lyon, France task in which they were required to anticipate the use of a centrally presented object that
*Correspondence:
Michiel van Elk, Department of
Psychology, University of
Connaissances sur la
could be moved to an associated target object (e.g., hammer—nail). The availability of actor
information (i.e., presenting a hand grasping the central object) and the number of possible
Amsterdam, Weesperplein 4, target objects (i.e., 0, 1, or 2 target objects) were independently manipulated, resulting in
1018 XA Amsterdam, Netherlands
e-mail: m.vanelk@uva.nl manipulation
different levels of predictability. It was found that making an action prediction based on
actor information resulted in an increased activation in the extrastriate body area (EBA)
IPL
and the fronto-parietal action observation network (AON). Predicting actions involving a
(Buxbaum, 2001 ; Rothi et al., 1991)
target object resulted in increased activation in the bilateral IPL and frontal motor areas.
Within the AON, activity in the left inferior parietal lobe (IPL) and the left premotor cortex
(PMC) increased as a function of the level of action predictability. Together these findings
suggest that the left IPL represents stored hand-postures that can be used for planning
✓ Egocentrique
object-directed actions and for predicting other’s actions as well.
Keywords: fMRI, objects, action prediction, action semantics, inferior parietal lobe
INTRODUCTION
✓ Utilisation d’outils familiers
impairment in accessing manipulation knowledge about objects
Imagine yourself sitting in a restaurant at a romantic dinner with (i.e., knowing how to apply a correct hand posture for interacting
your partner. If your partner would lift a bottle of wine you would with objects; cf. Heilman et al., 1982).
likely infer that he wants to pour you a glass of wine. Upon offer- Behavioral studies and neuroimaging studies have underlined
ing your glass, you expect him to pour wine and to subsequently the importance of motor-related knowledge for successful object
put the bottle back in the wine cooler. You would be quite sur- interaction. Several behavioral studies have shown for instance
prised if your partner would pour wine in the wine cooler instead. that the mere observation of objects automatically results in the
Les Samedis
As this de Neuropsychologie,
example Nice,actions
illustrates, many of our everyday 21 rely
Novembre 2015
on activation of the motor programs associated with using these 10
the use of action semantic knowledge about objects, specifying objects (Klatzky et al., 1989; Ellis and Tucker, 2000; Tucker andTroubles Praxiques chez l’Adulte: Modèles Théoriques et Evaluation
François Osiurak
Les avancées récentes
Les Samedis de Neuropsychologie, Nice, 21 Novembre 2015 11Troubles Praxiques chez l’Adulte: Modèles Théoriques et Evaluation
François Osiurak
473 G[ Goldenberg and S[ Hagmann:Tool use in apraxia
!
Outils familiers Outils nouveaux Lien
Goldenberg & Hagmann (1998) HG < HD HG < HD *
Hartmann et al. (2005) HG < HD HG < HD *
Goldenberg & Spatt (2009) HG seulement HG seulement *
Fig[ 0[ Three items of the novel tool test[ The left side of each row shows the array presented to the patient for tool selection and the
Osiurak et al. (2009) HG < HD HG < HD
right side\ the use of the correctly selected tool[
*
P ⇡ 9[90#[ While LBD patients made signi_cantly more underlying poor scores on novel tool application in LBD
errors than RBD patients on novel tool selection and RBD patients[ The errors of LBD patients mostly
Osiurak et al. (2013) HG < HD "z ⌧2[4\ P ⇡ 9[990#\ there was no signi_cant di}erence
between both groups of brain damaged patients on novel
HG < HD concerned the principle of the tool!object interaction[ For
example\ they would press the outer side of a hook against
*
tool application "z ⌧0[4\ P 9[0#[ Observation of the a ring instead of inserting its tip into the opening of the
patients| performance suggested di}erent types of errors ring[ By contrast\ the di.culties of the RBD patients
Jarry et al. (2013) HG < HD HG < HD *
Les Samedis de Neuropsychologie, Nice, 21 Novembre 2015 12Troubles Praxiques chez l’Adulte: Modèles Théoriques et Evaluation
Downloaded from http://brain.oxfordjournals.org/ at Bibliotheques de l'Universite L
François Osiurak
doi:10.1093/brain/awp080 Brain 2009: 132; 1645–1655 | 1645
BRAIN
A JOURNAL OF NEUROLOGY
Downloaded from http://brain.oxfordjournals.org/ at Bi
The neural basis of tool use
G. Goldenberg1,2 and J. Spatt3
1 Klinik für Neuropsychologie, Klinikum Bogenhausen, München, Germany
Downloaded from http://brain.oxfordjournals.org/ at Bibliotheques de l'Universite Lumiere Lyon 2 o
2 Klinik für Neurologie, Technische Universität München, Germany
3 Krankenhaus Hietzing mit Neurologischem Zentrum Rosenhügel, Wien, Austria
Outils familiers
Correspondence to: Prof. Dr Georg Goldenberg, Outils nouveaux
Klinik für Neuropsychologie,
Klinikum Bogenhausen,
Englschalkingerstrasse 77,
81925 München, Germany
E-mail: Georg.Goldenberg@extern.lrz-muenchen.de
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
Les Samedis de Neuropsychologie, Nice, 21 Novembre 2015
comprehension of mechanical interactions of the tool with other tools, recipients or material rather than the selection of grip
13Troubles Praxiques chez l’Adulte: Modèles Théoriques et Evaluation
François Osiurak
Lien avec régions (pré)frontales/
syndrome dysexécutif
✓ Patients HG :
Absence de lien entre lésions frontales et résolution de problèmes
?? mécaniques
(Goldenberg & Hagmann, 1998)
✓ Patients HG :
Absence de lien entre TOL et résolution de problèmes mécaniques
(Hartmann et al., 2005 ; Jarry et al., 2013)
✓ Patients dysexécutifs :
Résolution de problèmes mécaniques relativement bien préservée
(Goldenberg et al., 2007)
Les Samedis de Neuropsychologie, Nice, 21 Novembre 2015 14Troubles Praxiques chez l’Adulte: Modèles Théoriques et Evaluation
François Osiurak
L’approche centrée sur le raisonnement
Instrumentis munio, ergo gestum ago*
* J’outille, donc je gesticule
Les Samedis de Neuropsychologie, Nice, 21 Novembre 2015 15Troubles Praxiques chez l’Adulte: Modèles Théoriques et Evaluation
François Osiurak
L’approche centrée sur le raisonnement
Osiurak (2014), Osiurak et al. (2010, 2011)
✓ Connaissances mécaniques
✓ Allocentrique
✓ Cortex pariétal inférieur gauche (IPL)
« Ce n’est pas parce que nous ne
IPL sommes pas capables d’expliquer
(2) explicitement ce que nous faisons que
nous ne comprenons pas ce que nous
faisons ! ».
Les Samedis de Neuropsychologie, Nice, 21 Novembre 2015 16Troubles Praxiques chez l’Adulte: Modèles Théoriques et Evaluation
François Osiurak
«There is no need for additional manipulation
knowledge specifying the configuration and
movement of the hand » (Goldenberg, 2013)
(1)
Hypothèse de reconstruction
SPL
Osiurak (2014) ; Osiurak et al. (2010, 2011)
IPL
Connaissances mécaniques (IPL gauche)
➤ Outil-Objet (2)
(2)
Système de production (SPL bilatéral/IPS)
➤ Main-Objet (1)
Les Samedis de Neuropsychologie, Nice, 21 Novembre 2015 17Troubles Praxiques chez l’Adulte: Modèles Théoriques et Evaluation
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(Vingerhoets, 2014)
Les Samedis de Neuropsychologie, Nice, 21 Novembre 2015 18Troubles Praxiques chez l’Adulte: Modèles Théoriques et Evaluation
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Les Samedis de Neuropsychologie, Nice, 21 Novembre 2015 19Troubles Praxiques chez l’Adulte: Modèles Théoriques et Evaluation
François Osiurak
Les Samedis de Neuropsychologie, Nice, 21 Novembre 2015 20Troubles Praxiques chez l’Adulte: Modèles Théoriques et Evaluation
François Osiurak
(1)
(2)
Appréhension catégorielle
(Goldenberg, 2009, 2013)
Les Samedis de Neuropsychologie, Nice, 21 Novembre 2015 21Troubles Praxiques chez l’Adulte: Modèles Théoriques et Evaluation
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Quid de la mémoire sémantique ?
Les Samedis de Neuropsychologie, Nice, 21 Novembre 2015 22Troubles Praxiques chez l’Adulte: Modèles Théoriques et Evaluation
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Patient FB, lésions bitemporales causées par une encéphalite herpétique, avec
déficit sémantique (Sirigu et al., 1991)
« When asked to identify a nail clipper: It can attch
several sheets of paper together. You turn the piece
on the top and tip it back (makes the precise
movement sequence). You press and it maintains
them ».
Les Samedis de Neuropsychologie, Nice, 21 Novembre 2015 23Troubles Praxiques chez l’Adulte: Modèles Théoriques et Evaluation
François Osiurak
Patiente MJC, lésions bitemporales polaires caussées par un TC, avec déficit
sémantique (Osiurak et al., 2008)
Les Samedis de Neuropsychologie, Nice, 21 Novembre 2015 24Troubles Praxiques chez l’Adulte: Modèles Théoriques et Evaluation
François Osiurak
Patiente MJC, lésions bitemporales polaires caussées par un TC, avec déficit
sémantique (Osiurak et al., 2008)
Les Samedis de Neuropsychologie, Nice, 21 Novembre 2015 25Troubles Praxiques chez l’Adulte: Modèles Théoriques et Evaluation
François Osiurak
5 patients avec lésions temporales polaires (4HE et 1 DS) (Silveri & Ciccarelli, 2009)
Les Samedis de Neuropsychologie, Nice, 21 Novembre 2015 26Troubles Praxiques chez l’Adulte: Modèles Théoriques et Evaluation
François Osiurak
9 patients avec démence sémantique (Hodges et al., 2000)
473 G[ Goldenberg and S[ Hagmann:Tool use in apraxia
Fig[ 0[ Three items of the novel tool test[ The left side of each row shows the array presented to the patient for tool selection and the
right side\ the use of the correctly selected tool[
P ⇡ 9[90#[ While LBD patients made signi_cantly more underlying poor scores on novel tool application in LBD
errors than RBD patients on novel tool selection and RBD patients[ The errors of LBD patients mostly
"z ⌧2[4\ P ⇡ 9[990#\ there was no signi_cant di}erence concerned the principle of the tool!object interaction[ For
between both groups of brain damaged patients on novel example\ they would press the outer side of a hook against
Les Samedis de Neuropsychologie, Nice, 21 Novembre 2015
tool application "z ⌧0[4\ P 9[0#[ Observation of the
patients| performance suggested di}erent types of errors
a ring instead of inserting its tip into the opening of the
ring[ By contrast\ the di.culties of the RBD patients 27Troubles Praxiques chez l’Adulte: Modèles Théoriques et Evaluation
François Osiurak
9 patients avec démence sémantique (Hodges et al., 2000)
100"
80"
U"lisa"on)isolée)
60"
40"
20"
0"
0" 20" 40" 60" 80" 100"
Appariement)
Les Samedis de Neuropsychologie, Nice, 21 Novembre 2015 28Troubles Praxiques chez l’Adulte: Modèles Théoriques et Evaluation
François Osiurak
Les Samedis de Neuropsychologie, Nice, 21 Novembre 2015 29Troubles Praxiques chez l’Adulte: Modèles Théoriques et Evaluation
François Osiurak
Apraxie
• Utilisation d’outils
• Apraxie motrice
• Imitation de postures non symboliques
Les Samedis de Neuropsychologie, Nice, 21 Novembre 2015 30Troubles Praxiques chez l’Adulte: Modèles Théoriques et Evaluation
François Osiurak
Apraxie motrice/mélo-cinétique
S’observe :
✓ Pianotage digital (1-2-1-5) (++)
✓ Paume-Tranche-Poing (+/-)
✓ Maniement d’objets en main (++++)
* Constance des troubles entre les épreuves
* Aide de la modalité visuelle pour compenser les difficultés proprioceptives
* Caractéristique des patients DCB
Les Samedis de Neuropsychologie, Nice, 21 Novembre 2015 31Troubles Praxiques chez l’Adulte: Modèles Théoriques et Evaluation
François Osiurak
Apraxie
• Utilisation d’outils
• Apraxie motrice
• Imitation de postures non symboliques
Les Samedis de Neuropsychologie, Nice, 21 Novembre 2015 32Troubles Praxiques chez l’Adulte: Modèles Théoriques et Evaluation
François Osiurak
Imitation de postures non symboliques
G[ Goldenber` : Neuropsycholo`ia 26 "0888# 448 455 450
Plusieurs types :
✓ Postures digitales
✓ Postures unimanuelles
100
✓ Postures bimanuelles 80
a b
Success rate (%)
60
Fig[ 1[ Two items of the matching test[ Patients had to indicate which of the four pictures corresponds to the picture on top[ 40 Fig[ 1[ Two items of the matching t
Les Samedis
c de Neuropsychologie,
d Nice,
e 21 Novembre 201520 33
’Fox’Troubles Praxiques chez l’Adulte: Modèles Théoriques et Evaluation
François Osiurak
Imitation de postures bimanuelles
100
100
80
80
a b
Success rate (%)
60
a b
Success rate (%)
60
40
(Yamagushi et al., 2010) 40
c d e e 20 20
c d
’Fox’ ’Fox’
’Pigeon’ ’Pigeon’
0
0
0 0.5 1 2 3
0 0.5 1 2 3
i CDR
i CDR
f g h
f g h
Fig. 1. Hand-gesture demonstration, error responses, and the success rate of the YFPIT according to the CDR.
Examiner’s demonstration
Fig. 1. of ‘fox’ (a) and ‘pigeon’
Hand-gesture (b). Subjects’error
demonstration, typicalresponses,
error patterns
andof the
palm-palm
success(crate
), dorsum-
of the YFPIT according to the CDR.
dorsum (d), and palm-dorsum (e). f Error pattern with downward direction of arms. g, h Error patterns com-
mon in CDR 3. i TheExaminer’s demonstration
success rate of ‘fox’ startedofto‘fox’ (a) and
decrease ‘pigeon’
at CDR (b). Subjects’
3, while typical
that of ‘pigeon’ error patterns
decreased at of palm-palm (c), dorsum-
CDR 0.5. dorsum (d), and palm-dorsum (e). f Error pattern with downward direction of arms. g, h Error patterns com-
mon Les
in CDR 3. i Thede
Samedis success rate of ‘fox’ startedNice,
Neuropsychologie, to decrease at CDR 3, while
21 Novembre 2015that of ‘pigeon’ decreased at 34
CDR 0.5.Troubles Praxiques chez l’Adulte: Modèles Théoriques et Evaluation
François Osiurak
Imitation de postures bimanuelles
(Lesourd et al., 2013)
Les Samedis de Neuropsychologie, Nice, 21 Novembre 2015 35Troubles Praxiques chez l’Adulte:66Modèles Théoriques et Evaluation
G. GOLDENBERG
François Osiurak RESULTS
N o significant differences on any measure were found between controls who had used their
left hand and those who had used their right hand. These two groups were therefore brought
Imitation de postures unimanuelles together to make one control group.
Figure 2 shows the scores on imitiation of meaningless gestures. In controls, there was a
THE HUMAN BODY IN IDEOMOTOR APRAXIA 65
28
26
24
ii LBD
22 r - - - I RBD
Controls
20
18
16
Fig. 1. Ten meaningless gestures of the hand for imitation.
.~ 14
0
mannikin", that is, if the patient manipulated the mannikin's left hand, the examiner demonstrated with the left hand fl_ 12
and vice versa. The gestures used, the course of examination and the criteria for scoring were the same as with the
imitation on one's own body. To ensure understanding of the instruction, imitation of a gesture not used in the 10
examination was demonstrated in the instruction, and if the first item of the examination was failed on both trials,
correct performance of this gesture was demonstrated too.
8
Deux mécanismes potentiels
Manipulation of beads
Patients were asked to take with one hand three beads from three vertical rods and to stick them on three other
6
(Goldenberg, 1995, 1997)
rods. They were not allowed to collect and transpose the beads one after another, but had to collect all three beads in
4
.1,.,I .LL
the hand before beginning to stick them on the target rods. The rods were aligned in a frontal plane. Patients who
used their left hand moved the beads from the left set of three sticks to the right one, and vice versa. Between trials,
the hand rested on a mark in front of the middle of the device. After two successful practice trials, 10 trials were run, 2
and the time from leaving the starting point until the delivery of the last bead was measured with a stopwatch. I f a
bead fell out of the hand, the trial was repeated. The mean time of the 10 trials was taken for the statistical evaluation.
0 I I I
Connaissances topographiques sur le corps
In this task, manual dexterity is challenged when one bead has to be transferred between hand and rod while at the
same time one or two beads are carried within the hand. The hand has to be divided into two functional 0 2 3 ¢ 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20
compartments, one for carrying beads and one for moving beads from and to the rod and the beads have to be moved
(+ IPL)
between these two compartments. As a further difficulty, the boring of the beads has to be aligned exactly with the
position and the direction of the rod when the bead is stuck on the rod. Score for i m i t a t i o n on the own body
Block design Fig. 2. Results of apraxia testing.
The W A I S - - R subtest block design was administered in the usual way. As a modification, testing was not
interrupted when the prescribed time limits had expired. If a patient arrived at the correct solution after that time.
Schéma dynamique du corps (+ SPL)
one point was subtracted from the m i n u m u m score. Raw scores were used for statistical evaluation.
Token-test clear ceiling effect. Ninety per cent of the control patients obtained the maximum score of 20
All patients with left hemisphere damage were administered the G e r m a n version of the Token Test [16]. The raw
number of correct responses was scored. and only one control scored as low as 2 points below the maximum. The distribution of
Procedure of testing scores of RBD patients had a similar but somewhat less steep bias and the worst score was 16.
Patients with brain damage used the hand ipsilateral to the lesion for imitation of gestures, pantomime of object
use and manipulation of beads. They moved the same hand of the mannikin, but were allowed to use both of their
Patients with L B D can be divided into two groups: 20 of them scored within a range of 17-20,
hands for the manipulation of the mannikin if this was not prevented by hemiplegia. Controls used either the right or
the left hand for all tests including the manipulation of the mannikin.
that is, as well as RBD patients and very similar to controls, while 15 scored between 2 and
14. The latter group was considered as being apractic, and further comparisons were
Subjects Les Samedis de Neuropsychologie, Nice, 21 Novembre 2015 36
Eighty-five right-handed subjects were examined. There were 35 patients with left brain damage (LBD), 20 conducted between apractic patients, LBD patients without apraxia. RBD patients, and
patients with right brain damage (RBD), and 30 controls without any evidence for brain damage. All patients withTroubles Praxiques chez l’Adulte: Modèles Théoriques et Evaluation
François Osiurak
Imitation de postures digitales
451 G[ Goldenber` : Neuropsycholo`ia 26 "0888# 448 455
` : Neuropsycholo`ia 26 "0888# 448 455 450
2[ Results
Demographic\ clinical and radiological data of all sub!
jects are displayed on Table 0[ Aphasia was classi_ed as
global in 01 LBD patients\ Broca in four\ Wernicke in
nine\ amnesic in six and as transcortical\ conduction or
non!classi_able in four[ There were no signi_cant di}er!
ences of age or gender distribution\ and the two patient
groups did not di}er with respect to the aetiology of the
CVA[
Mean timeTraitement since CVA was Visuo-spatial
signi_cantly longer in LBD
than in RBD patients "t"26[2# 2[42\
(Goldenberg, 1999)P ⇡ 9[90#[ In RBD
patients there were signi_cant correlations of time since
CVA to imitation of _nger postures "r 9[32\ P ⇡ 9[94# Fig[ 2[ Results "mean\ standard error of the mean# of experimental tests[
Proche d’une apraxie visuo-constructive?
and matching of hand postures "r 9[27\ P ⇡ 9[94#[ In
LBD patients all correlations between time since CVA
Hémisphère droit fortement impliqué
and test scores were close to zero "r between ⌧9[04 9[01#[ mode of testing "F"1\69# 4[0\ P ⇡ 9[90# and with body
On ANCOVAs comparing imitation of _nger postures part "F"1\69# 28[4\ P ⇡ 9[990#\ whereas neither the
and matching of hand positions between LBD and RBD interaction between mode of testing and body part
patients\ the covariance of time since CVA was not sig!
ad to indicate which of the four pictures corresponds to the picture on top[
"F"0\69# 1[9\ P 9[0# nor the three!way interaction
ni_cant "F "0\42# ⇡ 0\ P 9[2#[ The proportion of insular "F"1\69# 1[7\ P 9[94# were signi_cant[
lesions was higher in LBD thanLesinSamedis RBD depatients One!factorial
Neuropsychologie, Nice, 21 ANOVAs
Novembre 2015 with Tukey post!hoc tests37
"chi1 3[0\ P ⇡ 9[94#\ but there were no signi_cant "P ⇡ 9[94# were applied to analyse the group e}ects forMerci pour votre attention Les Samedis de Neuropsychologie, Nice, 21 Novembre 2015 38
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