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March 2017

Ideomotor Apraxia: The Burden of Intentional Movement

Neurologist Dr R. sits with Mr J., a 48-year-old photographer who’d recently suffered a stroke, in his office. Dr R. asks Mr J. to demonstrate a waving motion as if he were saying hello, to which he attempts with some difficulty. When asked to point towards the ceiling, Mr J. again encounters difficulties as he finds himself clenching and unclenching his fist. Dr R. proceeds to hold his hand out in front of him with his palm facing the floor. “Try to imitate the movement,” he asks. With deliberate effort, Mr J. eventually manages. “That’s good!” praises Dr R, “Now turn your hand over.” Mr J., with increased frustration, gives this a try – only to begin repeatedly slapping his hand against his thigh instead.

Mr J. is clearly trying to reproduce the movements that are asked of him, so what’s stopping him? Is it a generalised motor problem? This does not appear to be the case; as he’s asked to remove his glasses, Mr J. smoothly proceeds, and when asked to hammer a nail into a block of wood, Mr J. ably fulfills the request.

What Mr J. appears to suffer from is apraxia, “the difficulty in carrying out purposeful movements, in the absence of paralysis or muscular weakness” (Carlson, 2010). However, Mr J’s condition is a specific form of apraxia: ideomotor apraxia, whereby goal-directed movement is impaired – patients understand how to perform movements, but cannot carry them out. In this capacity, timing, sequencing, and spatial organisation of gestures are interrupted (Rothi & Ochipa, 1991). An example of a spatial error would be where, if the patient were asked to imitate brushing their teeth, they would use their fingers to represent the toothbrush (body-part-as-object substitution), or close their fist so tightly that there is no space for the imaginary toothbrush (orientation error). Interestingly, patients are still able to perform automatic actions when cued – this is known as the automatic-voluntary dissociation. Patients can use a telephone if they hear the phone ring, for example. This deficit, therefore, is less obvious in everyday life compared to in a clinical setting.

Ideomotor apraxia typically arises due to damage in the left parietal association areas and white matter bundles from the frontal and parietal association areas (Zadikoff & Lang, 2005). More rarely, other areas may also be involved such as the premotor and supplementary motor cortex, basal ganglia, and thalamus. Indeed, Dr R. states in his report, “The left parietal lobe is involved in the control of movements – especially sequences of movements – that are not dictated by the context. Thus, he finds it almost impossible to follow verbal requests to make arbitrary movements”. More specifically, Rushworth et al. (1997) suggest that the impairment in movement sequencing may be a result of a difficulty in redirecting motor attention from movement to movement in the sequence.

Although Mr J.’s motor independence was not as proficient as before, his apraxia is unlikely to have impacted his daily activities because patients are still able to respond to automatic actions that are cued. Nonetheless, speech and physical therapies and biofeedback exist to help patients regain some control (Smania et al., 2006; McNeil et al., 1976; Wambaugh et al., 2006). More interestingly, there is evidence to suggest that right hemispheric structures in the brain could compensate for the damage in left hemispheric structures which have led to motor problems (see Wheaton & Hallett, 2007).  For example, the plasticity of higher brain areas may allow for the reorganisation of left parietal and premotor cortices with experience, and the relearning of certain activities that were previously reliant on the damaged areas (Kim et al., 2004). However, the mechanisms underlying this are not fully understood and we cannot completely determine whether the brain could compensate for the functions lost in apraxia.

This article was written by Manying Lo and edited by Robert Vilkelis. Both of them are members of the Bugle team.

References:

Carlson, N. R. (2010). Physiology of Behavior. Boston: Allyn & Bacon.

Kim, D. E., Shin, M. J., Lee, K. M., Chu, K., Woo, S. H., Kim, Y. R., & Roh, J. K. (2004). Musical training‐induced functional reorganization of the adult brain: Functional magnetic resonance imaging and transcranial magnetic stimulation study on amateur string players. Human Brain Mapping, 23(4), 188-199.

McNeil, M. R., Prescott, T. E., & Lemme, M. L. (1976). An application of electromyographic biofeedback to aphasia/apraxia treatment. In Clinical Aphasiology: Proceedings of the Conference 1976 (pp. 151-171). BRK Publishers.

Rushworth, M. F., Nixon, P. D., Renowden, S., Wade, D. T., & Passingham, R. E. (1997). The left parietal cortex and motor attention. Neuropsychologia35(9), 1261-1273.

Smania, N., Aglioti, S. M., Girardi, F., Tinazzi, M., Fiaschi, A., Cosentino, A., & Corato, E. (2006). Rehabilitation of limb apraxia improves daily life activities in patients with stroke. Neurology67(11), 2050-2052.

Wambaugh, J. L., Duffy, J. R., McNeil, M. R., Robin, D. A., & Rogers, M. A. (2006). Treatment guidelines for acquired apraxia of speech: A synthesis and evaluation of the evidence. Journal of Medical Speech-Language Pathology14(2), xv-xv.

Wheaton, L. A., & Hallett, M. (2007). Ideomotor apraxia: a review. Journal of the Neurological Sciences, 260(1), 1-10.

Zadikoff, C., & Lang, A. E. (2005). Apraxia in movement disorders. Brain128(7), 1480-1497.

The Echo Chamber: Is Social Media to Blame?

With the recent inauguration of Donald Trump and the results of the Brexit referendum, alongside a growth in support for parties like UKIP, it seems that populations of voters are becoming more extreme in their political views.

Recent theories have attributed this greater polarisation of groups to the ‘echo chamber’ effect in political opinions shared on social media. This suggests that the information we receive on our news feeds does not provide us with a diverse array of opinions or viewpoints. Instead, our feeds are tailored so as to provide us with information concurrent with our own political views. The echo chamber refers to the idea that information we put out on social media is repeated and reflected back by those within our communities, whilst contrasting views are ignored and limited.

As social media sites, such as Facebook, are the primary sources of political news information for Millennials (Mitchell et al., 2015), it has been suggested that the limited spectrum of news that we engage with is reducing the discussion that underpins democracy and political debate.

This may also predict problems in the future: if people’s political views are being mirrored on social media, they may perceive that view as the norm across the whole country. This has been used to explain why so many voters were sure that the results of the Brexit referendum or the American election would go in one direction, with some even choosing not to vote on account of this certainty, just to receive an unwelcome shock when their assumptions were mistaken. Could all this be a result of limited information, lulling social media users into a false sense of security in the belief that their view is shared by voters on a national or global level?

Whilst many have pointed the finger at the algorithms and cookies that social media sites use to adapt the information available to the user, in order to remain relevant or appealing, it is worth exploring whether this chamber is partly constructed as a result of our own choices. Social Identity Theory (Tajfel & Turner, 1979) highlights an innate desire to belong to social groups, with pride and self-esteem gained from doing so. However, this can lead people to start discriminating between group members and outsiders. The desire to enhance one’s own self-esteem leads to an ingroup bias: tending to perceive ingroup members more favourably and derogating or belittling outgroup members. This could explain a desire in people to form groups with those on social media who share similar political views, thus communicating mostly with them, valuing their opinions and negating alternative views. This, therefore, begs the question: is the information presented to us limited by technology, or is social media simply a new platform for us to selectively expose ourselves to information that reinforces our need for group belonging?

This article was written by Emily Weigold and edited by Emma Keoy. Both of them are members of the Bugle team. 

References:

Mitchell et al. (2015). Facebook top source for Political News amongst Millennials. Retrieved from: http://www.journalism.org/2015/06/01/facebook-top-source-for-political-news-among-millennials/

Tajfel, H., & Turner, J. C. (1979). An integrative theory of intergroup conflict. The social psychology of intergroup relations33(47), 74.

Say Yes to The Mess

This article was inspired by Tim Harford’s talk on “The Importance of Being Messy”, an Intelligence Squared Debate, 6th Dec. 2016

Economist Tim Harford puts forth a compelling case to put our autopilot selves on hold occasionally, and embrace the unexpected. While we derive comfort and efficiency from organization and structure, Harford proposes that structure doesn’t always help us get the best out of our abilities, that randomness and chaos force us to become the best versions of ourselves in extenuating circumstances – such as pianist Keith Jarrett’s concert in Cologne, where he gave one of his most powerful performances on an untuned rehearsal piano. Oppenheimer and colleagues (2010) carried out a study on ‘desirable difficulties’ as mechanisms to improve exam performance of students. They found that changing the font of the study material to something relatively uncommon or difficult (think comic sans ms or Ar Decode) helped those students score better than the ones who read the material in more typical fonts like Times New Roman. ‘Complex’ fonts increased attention and slowed their pace of reading, thus leading to more in-depth retention of the material.

Continue reading “Say Yes to The Mess”

Postgraduate Application Guide (PAG) #4: Work Experience and Future Careers

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As the field of academia gets increasingly more competitive, it becomes harder to impress the admissions office: there are too many intelligent people out there nowadays, so good grades alone just don’t cut it anymore. This is where work experience comes in. Not only does it enable your application to stand out, but also demonstrates your maturity, responsibility, commitment and many other important qualities that make you a worthy applicant. So, work experience is pretty much a necessity for an aspiring psychologist, but you probably already know this from all the careers lectures you had to sit through during your time at UCL. So, what can postgrads advise when it comes to work experience?

Continue reading “Postgraduate Application Guide (PAG) #4: Work Experience and Future Careers”

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