Ideomotor apraxia, visuomotor control and the explicit representation of posture.

Ideomotor apraxia is normally viewed as a disorder of the representation or execution of action. However, the evidence from gesture imitation is that apraxic patients are unable to reproduce the final posture of a gesture but may not show abnormality in movement kinematics. This supports a hypothesis that impaired gesture imitation is due to a deficit in a conceptual representation of body posture rather than indicating a disorder specific to action control. The present study evaluated whether other aspects of apraxic behaviour might also be most consistent with a deficit in the representation of posture. Patients with left hemisphere damage and apraxia on gesture imitation had difficulty in reproducing a series of actions due to failure to adopt the required configuration of the hand whereas there was no consistent reduction in speed of response once the actions had been learned. They also tended to use an abnormal, clumsy grasp when using a spoon but this dissociated from accurate performance on other tests of manual dexterity where there was less scope for variation in configuration of the hand. These data suggest that the most common deficit in ideomotor apraxia is impaired ability to perform tasks where the goal is to reproduce or adopt complex hand configurations and that impaired execution of some types of action is secondary to this problem. This is consistent with a role for the human left parietal lobe in providing an explicit representation of posture which is used to guide some actions and to supplement a more primitive system of direct visuomotor control.