Brain-Behavior Relationships

Overview of Topics

Oral Praxis
Speech / Language
Intransitive Body Movements
Transitive Body Movements
Graphics
References

Premotor Cortex

Responsible for kinetic organization of movement once started, transfer, smooth sequencing. According to Luria, 1973, it is responsible for the conversion of individual motor impulses into consecutive kinetic melodies.

1. Puff cheeks (1, 5).
2. Click teeth together three times (5).
3. Whistle (1, 5, 'ii,
4. Protrude tongue
5. Lick lips (2 1).
6. Pucker lips (2 1).
7. Cough (2, 1, 3).
8. Blow out a match (2, 1, 4).
9. Retract lips to show teeth (2, 4).
10. Sip on a straw (1, 4).

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B. Speech/Language

1. Spontaneous speech sample - Note agrammatism and dysprosody (6, 1, 10, 4).
2. Diadochokinetic rates - Repeat the syllable "puh" as fast as you can: then "tuh": then "kuh"; then put thon together "puh-tuh-kuh" (2, 3, 10).
3. Imitation of monosyllabic and polysyllabic words (7, 8, 3, 10).
4. Repeat words of increasing length, i.e. thick, thicker, thickening; zip, zipper, zippering; and hope, hopeful, hopefully (3, 10).
5. Imitation of sentences (10).

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C. Intransitive Body movements (Motor Sequencing)

1. Touch fingers with thumb AFAP - reveals paresis, lack of precision, pathological dystonia, ataxia (6).
2. Separate fingers & bring together AFAP (6).
3. Alternately clinch and relax fingers of both hands for a long period of time (6).
4. Bilateral clinching & relaxing fingers AFAP (6).
5. Finger tapping (6, 7, 1).
   • Tapping as fast as possible (Speed)
   • Tapping two times with one hand and one time with the other hand and then reversing the pattern (Rhythm). With premotor lesions, movement loses smoothness and each tap is produced as isolated phenomenon; patient begins to make superfluous taps or performs identically with both hands.
6. Snap your fingers (1, 3, 4).
7. Salute (1, 4);
8. Fist-Ring Test - can't do them in series; more problems when sequence is reversed (6, 7).
9. Fist-Edge-Palm Test (6, 7, 1).
10. Circle Hands In Air (1).

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D. Transitive Body Movements

1. Demonstrate playing the piano or typing; piano playing test is forward & then reversed; frontal patients can't reverse; premotor may improve with spoken commands or feedback; frontals may repeat correctly but can't make proper movements (6,7,1).
2. Thread a needle (1, 4).
3. Tie shoelaces (1).
4. Cut paper with scissors (1).
5. Unlock and open a door (4).
6. Flip a coin (4).

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E. Graphics

1. Write words from dictation - can form letters but often disarranges or transposes them (6, 9, 2,4).
2. Write sentences from dictation - words may be written correctly but may be in the wrong order (6, 9, 2, 4).
3. Spontaneous writing (7, 1, 4).
4. Drawing various shapes,(circle, square, cross)
5. Draw zig-zag line alternating pointed and rectangular elements (6, 7).

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References

1. Brown, J.W. Aphasia. Apraxia, and Agnosia, Charles C. Thomas, Springfield: Ill, 1972.
2. Clinical Examinations in Neurology, Mayo Clinic and Mayo Foundation, H. B. Saunders Co., Philadelphia, Pa., 1971.
3. Dabul, B. Apraxia Battery for Adults, C. C. Publications, Inc., Tigard, Oregon, 1976.
4. Gonyea, E.F. Focal Lesions. Neurology Clerkship Syllabus, The University of Tennessee Center for the Health Sciences, 1979.
5. La Pointe, L.L. and Wertz, R.T. Oral movement abilities and articulatory characteristics of brain-injured adults. Perceptual and Motor Skills, 39, 39-46, 1974.
6. Luria, A.R. Higher Cortical Functions in Man, Basic Books, Inc., New York, 1966.
7. Luria, A.R. Frontal Lobe Syndromes. In P.J. Vinken and G.W. Bruyn (Eds.) Handbook of Clinical Neurology II, Elsenier: New York, 1969.
8. Luria, A.R. The Working Brain: An Introduction to Neuropsychology, Basic Books,Inc., New York:1973.
9. Nielson, J.M. The cortical motor pattern apraxias, The Frontal Lobes. Association for Research in Nervous and Mental Disease, vol XXVII, Hafner Publishing Company, Inc., Hew York, New York, 1966.
10. Rosenbek, J.C. Treating apraxia of speech. In D.F. Johns (Ed.), Clinical Management of Neurogenic Communication Disorders, Little, Brown, and Co., Boston, mass., 1978.