Objective

This study investigates the clinical course of recovery of apraxia after left-hemisphere stroke and the underlying neuroanatomical correlates for persisting or recovering deficits in relation to the major processing streams in the network for motor cognition.

Methods

90 patients were examined during the acute (4.74 ± 2.73 days) and chronic (14.3 ± 15.39 months) stage after left-hemisphere stroke for deficits in meaningless imitation, as well as production and conceptual errors in tool use pantomime. Lesion correlates for persisting or recovering deficits were analyzed with an extension of the non-parametric Brunner–Munzel rank-order test for multi-factorial designs (two-way repeated-measures ANOVA) using acute images.

Results

Meaningless imitation and tool use production deficits persisted into the chronic stage. Conceptual errors in tool use pantomime showed an almost complete recovery. Imitation errors persisted after occipitotemporal and superior temporal lesions in the dorso-dorsal stream. Chronic pantomime production errors were related to the supramarginal gyrus, the key structure of the ventro-dorsal stream. More anterior lesions in the ventro-dorsal stream (ventral premotor cortex) were additionally associated with poor recovery of production errors in pantomime. Conceptual errors in pantomime after temporal and supramarginal gyrus lesions persisted into the chronic stage. However, they resolved completely when related to angular gyrus or insular lesions.

Conclusion

The diverging courses of recovery in different apraxia tasks can be related to different mechanisms. Critical lesions to key structures of the network or entrance areas of the processing streams lead to persisting deficits in the corresponding tasks. Contrary, lesions located outside the core network but inducing a temporary network dysfunction allow good recovery e.g., of conceptual errors in pantomime. The identification of lesion correlates for different long-term recovery patterns in apraxia might also allow early clinical prediction of the course of recovery.

中文翻译：

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失用症恢复的解剖学相关性：中风患者的纵向病变映射研究

客观的

本研究调查了左半球中风后失用症恢复的临床过程，以及与运动认知网络中的主要处理流相关的持续或恢复缺陷的潜在神经解剖学相关性。

方法

90 名患者在左半球卒中后的急性期（4.74 ± 2.73 天）和慢性期（14.3 ± 15.39 个月）接受了无意义模仿缺陷以及工具使用哑剧的制作和概念错误的检查。使用急性图像，通过对多因素设计（双向重复测量方差分析）的非参数 Brunner-Munzel 秩序检验的扩展，分析与持续或恢复缺陷的病变相关性。

结果

无意义的模仿和工具使用生产赤字持续到慢性阶段。工具使用哑剧中的概念错误显示几乎完全恢复。在背背流中的枕颞和上颞部损伤后，模仿错误仍然存​​在。慢性哑剧制作错误与缘上回有关，这是腹背流的关键结构。腹背侧流（腹侧运动前皮层）中更多的前部病变与哑剧中生产错误的恢复不良有关。颞回和缘上回损伤后哑剧的概念错误持续到慢性阶段。然而，当与角回或岛叶病变相关时，它们完全消失。

结论

不同失用症任务中不同的恢复过程可能与不同的机制有关。网络关键结构或处理流入口区域的严重损伤导致相应任务的持续缺陷。相反，位于核心网络之外但引起暂时网络功能障碍的损伤允许良好的恢复，例如哑剧中的概念错误。病灶的识别与失用症不同长期恢复模式相关，也可能允许对恢复过程进行早期临床预测。