Noemi, thanks for your comments, I have come across patients with ideomotor
apraxia before and I don't think this applies to this lady. She has had
numerous tests (including MRI & CT scans) that have consistently
demonstrated no lesions. Indeed the only positive investigation she has ever
produced was a very slight change in her ECG after she had been
hyperventilating for 2 days. Interestingly, this particular incident
followed on immediately from another member of her family diverting
attention in his direction.
What experiments do you have in mind ? I will try & get hold of the book you
recommend, it sounds interesting.
Happy Christmas
Nikki Adams [log in to unmask] ---- Original Message -----
From: "Noemi Lee" <[log in to unmask]>
To: <[log in to unmask]>
Sent: Friday, December 22, 2000 8:50 PM
Subject: Re: School for Bravery
> -----Original Message-----
> From: mdne adams <[log in to unmask]>
> To: [log in to unmask] <[log in to unmask]>
> Date: 22 December 2000 17:18
> Subject: Re: School for Bravery
>
>
> >Her movement disorder is an inconsistent right "hemiplegia". She actively
> >holds her foot in a strongly inverted position when being observed and
> >claims she is unable to put her foot to the floor. On examination, it is
> >clear to me and other clinicians that this is active movement rather than
> >spasm, as she gets tired after a few minutes or if she is distracted by
eg
> >her pet dog jumping up and licking her and her foot assumes a normal
> >position. Passive movement of her knee is met with variable levels of
> >assistance and resistance from her. There is no muscle wasting. In the
days
> >when she did walk publicly, she used to stagger the width of the room and
> >land comfortably in her chair. When she was living in the hostel, she
coped
> >with an 8 inch threshold to her shower independently.
> >She also claims to be unable to use her right hand, yet impressively can
> >roll her own cigarettes ! She holds it in a variety of positions but
> >frequently little, ring & middle fingers held together in extension, but
> >flexed at the MCP joints.
> >
> >The jury is out on whether or not she is doing this in a calculated
manner
> >or whether she is unaware of what she is doing. My own view is that it is
> >probably a bit of both - and that just because we're not sure why , that
> >shouldn't stop us from trying to encourage something a little more normal
!
> >
> >If anyone out there has had a patient like this before, please let me
know
> >your ideas !
>
> Nikki, I read a very, very interesting book written by one of the leading
> neuroscientists. I think I mentioned it before: Phantoms In The Brain by
> V.S Ramachandran.
> He writes a great deal about patients after CVA on the right or left
> hemispheres. I have worked four years with hemiplegic or hemiparetic
> patients using the Bobath method and I wish the book would have been
written
> then.
>
> Your patient had a CVA on her left hemisphere. She seems to present,
> according to your description, more an hemiparetic-apraxia disorder
movement
> than a real hemiplegia.
> What is the CT showing?
> If her left hemisphere has been damaged she might not present, as
> Ramachandran describes, mechanisms of defense such as denial, repression,
or
> confabulation.
> Her symptoms seem to be close to what he describes as Ideomotor apraxia:
> "the inabililty to perform skilled movements on command ( the patient can
> write a letter independently but not wave good-bye or stir a cup tea when
> asked to do so).
> Some experiments with your patients might be interesting to do.
>
> Noemi
>
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