Afazili Bireylerin Nesne Kullanımına Yönelik İdeomotor Apraksi Özelliklerinin Belirlenmesi

Yıl 2021, Cilt: 4 Sayı: 2, 138 - 158, 30.08.2021

Nurten Tiryaki , Bülent Toğram

Öz

Amaç: Bu araştırmanın amacı, serebrovasküler olay (SVO) sonrası dil kaybı yaşayan afazili katılımcılarda nesne kullanımına yönelik İdeomotor Apraksi (İMA) özelliklerini cinsiyet, afazi tipi, yaş, eğitim süresi, inme üzerinden geçen süre ve Afazi Dil Değerlendirme Testi (ADD) dil puanları değişkenleri açısından incelemektir. Yöntem: Araştırmada 30 afazili birey ile yaş ve cinsiyet uyumlu olarak oluşturulan 30 sağlıklı birey olmak üzere toplamda 60 katılımcı yer almıştır. Katılımcıların nesne kullanımına yönelik İMA özelliklerinin belirlenmesi amacıyla geliştirilen “İdeomotor Apraksi Değerlendirme Aracı” kullanılmıştır. İMA özellikleri (a) sözel uyaran, (b) görsel uyaran-resim, (c) görsel uyaran-gerçek nesne ve (d) taklit basamaklarını içeren 4 aşamada incelenmiştir. Bulgular: Afazili bireyler en düşük performansı sözel uyaran basamağında, en yüksek performansı ise taklit basamağında göstermişlerdir. Afazili bireylerin dil puanları ile sözel uyaran basamağı puanları arasında anlamlı düzeyde ilişki tespit edilmiştir (r=,92, p<,05). Sonuç: Dil puanı ile İMA özellikleri arasındaki ilişki, İMA özelliklerinin tespitinin afazi tanısı alan vakaların dil ve konuşma terapisinde kullanılacak yöntemlerin seçimindeki önemini ortaya koymaktadır.
Anahtar sözcükler: afazi, ideomotor apraksi, nesne kullanımı, pantomim, taklit.

Anahtar Kelimeler

afazi, ideomotor apraksi, nesne kullanımı, pantomim, taklit

Identifying The Ideomotor Apraxia Features Pertaining to Object Use of People With Aphasia

Öz

Summary
Purpose: This study aims to determine the ideomotor apraxia features pertaining to object use of people with aphasia, taking into account the variables of age, gender, education years, type of aphasia, post-onset time, Aphasia Language Assessment Test (ADD) total score and ADD language score. Method: The participants of the study included 30 adults diagnosed with aphasia and age and gender-matched 30 healthy individuals, 60 in total, 12 women ant 18 men in each group. 33.3 % had fluent aphasia ant 66.7 % had non-fluent aphasia. The number of weeks post-stroke ranged between four and 468 (Tables 1 and 2). The aphasic participants were all examined by a neurologist and had medical reports. The Turkish Aphasia Test (ADD) (Maviş & Toğram, 2009) was also administered by a speech and language therapist as well as the Ideamotor Apraxia Assessment Tool, prepared by the researchers. The ideomotor apraxia features of participants were examined according to the 4 steps in the Ideomotor Apraxia Assessment Tool, involving 10 objects. The 4 steps are (a) verbal stimulus “Show me how the objects I name are used”, (b) visual stimulus-image “Show me how the objects in the pictures are used”, (c) visual stimulus-actual object “Show me how the objects you see are used”, and (d) imitation “Imitate my movements after me”. The 10 objects used were tooth brush, comb, razor, cup, salt shaker, hammer, lightbulb, lemon squeezer, scissors and cork screw. The real objects were available as well as their 297x420 mm. pictures as visual stimuli. The Kolmogorov- Smirnov test revealed normal distribution therefore parametric tests were used. Results: According to the results obtained from the study, there were significant differences between the two groups an all four steps (Table 3). The individuals with aphasia showed the lowest performance in verbal stimulus and highest performance in imitation. The results revealed no gender differences (Table 4) or differences between aphasia type (Table 5). Similarly, no significant correlations were observed between scores from any of the steps and variables of age, years of education, time since stroke and ADD total score. However, scores on ADD language score and scores of verbal stimulus were related on a significant basis (r=.392, p<.05) (Table 6). Conclusion: The results of the study were discussed together with previous literature. The relationship between language scores and IMA features revealed the necessity of identifying IMA features of aphasic patients before determining the intervention method that will be used in language and speech therapy.
Keywords: aphasia, ideomotor apraxia, object use, pantomime, imitation.

Anahtar Kelimeler

aphasia, ideomotor apraxia, object use, pantomime, imitation

Kaynakça

• Alexander, M. P., Baker, E., Naeser, M. A., Kaplan, E., ve Palumbo, C. (1992). Neuropsychological and neuroanatomical dimensions of ideomotor apraxia. Brain, 115(1), 87-107.
• Atteya, A. A., Fahmy, E., ve Helmy, H. (2014). Ideomotor apraxia and activities of daily living in stroke patients. Egypt Journal of Neurology, Psychiatry, and Neurosurgery, 51(1), 69-77.
• Belanger, S. A., Duffy, R. J., ve Coelho, C. A. (1996). The assessment of limb apraxia: an investigation of task effects and their cause. Brain and Cognition, 32(3), 384-404.
• Borod, J. C., Fitzpatrick, P. M., Helm-Estabrooks, N., ve Goodglass, H. (1989). The relationship between limb apraxia and the spontaneous use of communicative gesture in aphasia. Brain and Cognition, 10(1), 121-131.
• Butler, J. A. (2002). How comparable are tests of apraxia? Clinical Rehabilitation, 16 (4), 389-398. Buxbaum, L. J., Giovannetti, T., ve Libon, D. (2000). The role of the dynamic body schema in praxis: Evidence from primary progressive apraxia. Brain and Cognition, 44, 166–191.
• De Renzi, E., Motti, F., ve Nichelli, P. (1980). Imitating gestures: A quantitative approach to ideomotor apraxia. Archives of Neurology, 37(1), 6-10.
• De Renzi, E., Faglioni, P., ve Sorgato, P. (1982). Modality-specific and supramodal mechanisms of apraxia. Brain, 105(2), 301-312.
• Dobigny‐Roman, N., Dieudonne‐Moinet, B., Tortrat, D., Verny, M., ve Forotte, B. (1998). Ideomotor apraxia test: A new test of imitation of gestures for elderly people. European Journal of Neurology, 5(6), 571-578.
• Donkervoort, M., Dekker, J., Van Den Ende, E., ve Stehmann-Saris, J. C. (2000). Prevalence of apraxia among patients with a first left hemisphere stroke in rehabilitation centres and nursing homes. Clinical Rehabilitation, 14(2), 130-136.
• Foundas, A. L., Macauley, B. L., Raymer, A. M., Maher, L. M., Heilman, K. M., ve Rothi, L. J. G. (1995). Gesture laterality in aphasic and apraxic stroke patients. Brain and Cognition, 29(2), 204-213.
• Goldenberg, G. (1996). Defective imitation of gestures in patients with damage in the left or right hemispheres. Journal of Neurology, Neurosurgery & Psychiatry, 61(2), 176-180.
• Goldenberg, G., Daumüller, M., ve Hagmann, S. (2001). Assessment and therapy of complex activities of daily living in apraxia. Neuropsychological Rehabilitation, 11(2), 147-169.
• Goldenberg, G. (2003). Pantomime of object use: A challenge to cerebral localization of cognitive function. Neuroimage, 20, 101-106.
• Goldenberg, G., Hartmann, K., ve Schlott, I. (2003). Defective pantomime of object use in left brain damage: apraxia or asymbolia?. Neuropsychologia, 41(12), 1565-1573.
• Goldenberg, G., Hentze, S., ve Hermsdörfer, J. (2004). The effect of tactile feedback on pantomime of tool use in apraxia. Neurology, 63(10), 1863-1867.
• Goldenberg, G., Hermsdorfer, J., Glindemann, R., Rorden, C., ve Karnath, H.O. (2007). Pantomime of tool use depends on integrity of left inferior frontal cortex. Cerebral Cortex, 17, 2769–2776.
• Gonzalez Rothi, L. J., Mack, L., Verfaellie, M., Brown, P., ve Heilman, K. M. (1988). Ideomotor apraxia: error pattern analysis. Aphasiology, 2(3-4), 381-387.
• Haaland, K. Y., & Flaherty, D. (1984). The different types of limb apraxia errors made by patients with left vs. right hemisphere damage. Brain and Cognition, 3(4), 370-384.
• Haaland, K. Y., Harrington, D. L., ve Knight, R. T. (1999). Spatial deficits in ideomotor limb apraxia. A kinematic analysis of aiming movements. Brain, 122, 1169–1182.
• Hanna-Pladdy, B., Heilman, K. M., ve Foundas, A. L. (2003). Ecological implications of ideomotor apraxia: evidence from physical activities of daily living. Neurology, 11(60): 487-90.
• Kammersgaard, L. P., Nakayama, H., Raaschou, H. O., ve Skyh, T. (2001). Manual and oral apraxia in acute stroke, frequency and influence on functional outcome: The Copenhagen Stroke Study. American Journal of Physical Medicine & Rehabilitation, 80(9), 685-692.
• Kertesz, A., Ferro, J. M., ve Shewan, C. M. (1984). Apraxia and aphasia: The functional‐anatomical basis for their dissociation. Neurology, 34(1), 40-40.
• Kokmen, E., Ozekmekci, F. S., Cha, R. H., ve O'Brien, P. J. (1998). Testing for apraxia in neurological patients: A descriptive study in two diverse cultures. European Journal of Neurology, 5(2), 175-180.
• Kurtulus Kaya, M. D., & Unsal-Delialioglu, S. (2006). Evaluation of ideomotor apraxia in patients with stroke: A study of reliability and validity. Journal of Rehabilitation Medicine, 38(108Á/112).
• Maviş, İ., & Toğram, B. (2009). Afazi Dil Değerlendirme Testi (ADD) kullanım yönergesi. Detay Yayınları. Macauley, B. L., & Handley, C. L. (2005). Gestures produced by patients with aphasia and ideomotor apraxia. Contemporary Issues in Communication Science and Disorders, 32(Spring), 30-37.
• McDonald, S., Tate, R. L., ve Rigby, J. (1994). Error types in ideomotor apraxia: A qualitative analysis. Brain and Cognition, 25(2), 250-270.
• Niessen, E., Fink, G. R., ve Weiss, P. H. (2014). Apraxia, pantomime and the parietal cortex, NeuroImage Clinical, 5, 42-52.
• Papagno, C., Della Sala, S., ve Basso, A. (1993). Ideomotor apraxia without aphasia and aphasia without apraxia: the anatomical support for a double dissociation. Journal of Neurology, Neurosurgery & Psychiatry, 56(3), 286-289.
• Poeck, K. (1986). The clinical examination for motor apraxia. Neuropsychologia, 24(1), 129-134. Riddoch, M. J., Humphreys, G. W., ve Price, C. J. (1989). Routes to action: Evidence from apraxia. Cognitive Neuropsychology, 6(5), 437-454.
• Rothi, L. J. G., Raymer, A. M., ve Heilman, K. M. (1997). Limb praxis assessment apraxia. The Neuropsychology of Action, 61-73.
• Roy, E. A., & Hall, C. (1992). Limb apraxia: A process approach. In Advances in Psychology (Vol. 85, pp. 261-282). North-Holland.
• Rumiati, R.I., Papeo, L., ve Corradi‐Dell’Acqua, C. (2010). Higher‐level motor processes. Annals of the New York Academy of Sciences, 1191(1), 219-241.
• Schnider, A., Hanlon, R. E., Alexander, D. N., ve Benson, D. F. (1997). Ideomotor apraxia: behavioral dimensions and neuroanatomical basis. Brain and Language, 58(1), 125-136.
• Shimizu, D., & Tanemura, R. (2017). Crossover learning of gestures in two ideomotor apraxia patients: A single case experimental design study. Neuropsychological Rehabilitation, 27(4), 563-580.
• Stamenova, V., Roy, E. A., ve Black, S. E. (2010). Associations and dissociations of transitive and intransitive gestures in left and right hemisphere stroke patients. Brain and Cognition, 72(3), 483-490.
• Ünsal-Delialioglu, S., Kurt, M., Kaya, K., Culha, C., ve Ozel, S. (2008). Effects of ideomotor apraxia on functional outcomes in patients with right hemiplegia. International Journal of Rehabilitation Research, 31(2), 177-180.
• Westwood, D. A., Schweizer, T. A., Heath, M. D., Roy, E. A., Dixon, M. J., ve Black, S. E. (2001). Transitive gesture production in apraxia: Visual and nonvisual sensory contributions. Brain and Cognition, 46(1-2), 300-304.
• Vanbellingen, T., Kersten, B., Van Hemelrijk, B., Van de Winckel, A., Bertschi, M., Müri, R., ve Bohlhalter, S. (2010). Comprehensive assessment of gesture production: a new test of upper limb apraxia (TULIA). European Journal of Neurology, 17(1), 59-66.
• Weiss, P. H., Rahbari, N. N., Hesse, M. D., ve Fink, G. R. (2008). Deficient sequencing of pantomimes in apraxia. Neurology, 70(11), 834-840.
• Wheaton, L. A., Bohlhalter, S., Nolte, G., Shibasaki, H., Hattori, N., Fridman, E., ve Hallett, M. (2008). Cortico-cortical networks in patients with ideomotor apraxia as revealed by EEG coherence analysis. Neuroscience Letters, 433(2), 87-92.
• Yoon, E. Y., & Humphreys, G. W. (2005). Direct and indirect effects of action on object classification. Memory & Cognition, 33(7), 1131-1146.
• Zwinkels, A., Geusgens, C., Van de Sande, P., ve Van Heugten, C. (2004). Assessment of apraxia: inter-rater reliability of a new apraxia test, association between apraxia and other cognitive deficits and prevalence of apraxia in a rehabilitation setting. Clinical Rehabilitation, 18(7), 819-827.