9:59:59.000,9:59:59.000 [intro piano music] 9:59:59.000,9:59:59.000 Hi everyone, good morning. 9:59:59.000,9:59:59.000 Welcome back to the OTmiri channel. 9:59:59.000,9:59:59.000 If you're new here and we haven't met, my name is Miri. 9:59:59.000,9:59:59.000 I'm a licensed occupational therapist 9:59:59.000,9:59:59.000 and in today's video, I'll be talking to you guys about apraxia, 9:59:59.000,9:59:59.000 specifically the difference between 9:59:59.000,9:59:59.000 ideational and ideomotor apraxia. 9:59:59.000,9:59:59.000 But before I get started, I just want to say congratulations 9:59:59.000,9:59:59.000 to all of you who've found out 9:59:59.000,9:59:59.000 that you passed the NBCOT exam this morning. 9:59:59.000,9:59:59.000 I woke up so happy to all of your messages 9:59:59.000,9:59:59.000 and thoughtful, sweet notes, 9:59:59.000,9:59:59.000 whether on Instagram or on Facebook or here on this channel. 9:59:59.000,9:59:59.000 I want you guys to know that it makes such a big difference uh, 9:59:59.000,9:59:59.000 when you guys share the news with me 9:59:59.000,9:59:59.000 and to know that um, I was able to share this journey with you 9:59:59.000,9:59:59.000 leading to your success. 9:59:59.000,9:59:59.000 It uh, gives me such a great sense of satisfaction and pride for you 9:59:59.000,9:59:59.000 and it motivates me to keep going. 9:59:59.000,9:59:59.000 So much so that this is the first thing that I'm doing in the morning. 9:59:59.000,9:59:59.000 I haven't even showered. I'm still in my pajamas, 9:59:59.000,9:59:59.000 which I guess making a video in my pajamas 9:59:59.000,9:59:59.000 is not my first time so you guys are probably used to it, 9:59:59.000,9:59:59.000 but thank you, guys. 9:59:59.000,9:59:59.000 Um, I, I will be celebrating in spirit with you today. 9:59:59.000,9:59:59.000 Um, but let's get started. Apraxia. 9:59:59.000,9:59:59.000 Now if you're preparing uh, for the exam 9:59:59.000,9:59:59.000 and you're studying this content area, 9:59:59.000,9:59:59.000 you might find yourself feeling confused 9:59:59.000,9:59:59.000 or frustrated at times. I know I was. 9:59:59.000,9:59:59.000 Because, depending on the literature, 9:59:59.000,9:59:59.000 the authors, or even the country 9:59:59.000,9:59:59.000 where these articles are written, or textbooks, 9:59:59.000,9:59:59.000 you'll come across a wide range of terminologies, 9:59:59.000,9:59:59.000 ranging from oculomotor apraxia, 9:59:59.000,9:59:59.000 dressing, constructional, 9:59:59.000,9:59:59.000 limb apraxia, there's also limb kinetic apraxia, 9:59:59.000,9:59:59.000 and the list goes on and on. 9:59:59.000,9:59:59.000 And the way these are classified 9:59:59.000,9:59:59.000 are not always universally accepted, 9:59:59.000,9:59:59.000 which makes it that much more challenging. 9:59:59.000,9:59:59.000 So in this video today, and for the purposes 9:59:59.000,9:59:59.000 of making it less overwhelming for you guys, 9:59:59.000,9:59:59.000 I am going to talk about two general categories 9:59:59.000,9:59:59.000 that you'll see most often in the rehabilitation literature 9:59:59.000,9:59:59.000 as well as in your clinical setting, 9:59:59.000,9:59:59.000 which are the ideational apraxia and ideomotor apraxia. 9:59:59.000,9:59:59.000 So let's first get started by defining what apraxia is. 9:59:59.000,9:59:59.000 It's basically a dysfunction or difficulty 9:59:59.000,9:59:59.000 in execution of a skilled or purposeful activity 9:59:59.000,9:59:59.000 that cannot be attributed to or explained 9:59:59.000,9:59:59.000 by sensorimotor or cognitive comprehension deficits. 9:59:59.000,9:59:59.000 So in other words, put another way, 9:59:59.000,9:59:59.000 apraxia can occur even in the absence of weakness, 9:59:59.000,9:59:59.000 spasticity, motor or sensory loss, 9:59:59.000,9:59:59.000 memory or comprehension or cognitive deficits. 9:59:59.000,9:59:59.000 Interesting, right? 9:59:59.000,9:59:59.000 And it's typically lateralized to the left hemisphere, 9:59:59.000,9:59:59.000 meaning it's due to a damage to the left hemisphere of the brain. 9:59:59.000,9:59:59.000 And patients are oftentimes unaware of these deficits, 9:59:59.000,9:59:59.000 which makes treatment that much more challenging. 9:59:59.000,9:59:59.000 Now to really understand apraxia, 9:59:59.000,9:59:59.000 it's helpful to know what the praxis system is. 9:59:59.000,9:59:59.000 And I'm going to just talk about it very briefly. 9:59:59.000,9:59:59.000 And a lot of the information that I'm talking about today 9:59:59.000,9:59:59.000 is cited from Dr. Glen Dillon's work, 9:59:59.000,9:59:59.000 and he's a fantastic resource 9:59:59.000,9:59:59.000 so I'll list his books in the video description. 9:59:59.000,9:59:59.000 But basically he talks about the praxis system 9:59:59.000,9:59:59.000 as a two step process 9:59:59.000,9:59:59.000 that results in the execution of a purposeful activity. 9:59:59.000,9:59:59.000 The first step being ideation, or conceptualization, 9:59:59.000,9:59:59.000 so it's having the idea or the right idea 9:59:59.000,9:59:59.000 about the task and what needs to be done. 9:59:59.000,9:59:59.000 And then the second step is production, 9:59:59.000,9:59:59.000 so this is the actual execution of that task. 9:59:59.000,9:59:59.000 And together, that results in execution of a purposeful activity. 9:59:59.000,9:59:59.000 And when there is a breakdown 9:59:59.000,9:59:59.000 in either one of those steps in the praxis system, 9:59:59.000,9:59:59.000 you have apraxia, 9:59:59.000,9:59:59.000 inability to perform these purposeful movements and tasks, okay. 9:59:59.000,9:59:59.000 So now that you know what apraxia is, 9:59:59.000,9:59:59.000 let's get into a little more detail 9:59:59.000,9:59:59.000 and talk about ideational apraxia, 9:59:59.000,9:59:59.000 which is referring to the breakdown in the ideation component. 9:59:59.000,9:59:59.000 And so the patient with ideational apraxia 9:59:59.000,9:59:59.000 will have no idea 9:59:59.000,9:59:59.000 or have, don't have the right idea 9:59:59.000,9:59:59.000 about what needs to be done with the task. 9:59:59.000,9:59:59.000 And this includes not understanding the purpose of a tool or an object. 9:59:59.000,9:59:59.000 So a classic example, and you may have seen this many times 9:59:59.000,9:59:59.000 if you're in my Facebook study group 9:59:59.000,9:59:59.000 or on my Instagram page, I also have this, 9:59:59.000,9:59:59.000 um, is a photo of Ariel. [chuckles] 9:59:59.000,9:59:59.000 Not a surprise, right? 9:59:59.000,9:59:59.000 My favorite character. 9:59:59.000,9:59:59.000 I know I talk about her all the time. 9:59:59.000,9:59:59.000 But you have to remember that scene in The Little Mermaid 9:59:59.000,9:59:59.000 where she's sitting across the dining table hall with Prince Eric 9:59:59.000,9:59:59.000 and she sees a fork and enthusiastically 9:59:59.000,9:59:59.000 and unabashedly, she takes it up to her hair 9:59:59.000,9:59:59.000 and she starts brushing her hair with the fork. 9:59:59.000,9:59:59.000 This is a really good example of ideational apraxia, 9:59:59.000,9:59:59.000 inability to use the tool appropriately, 9:59:59.000,9:59:59.000 because she has lost the sense, 9:59:59.000,9:59:59.000 has no idea what the purpose of the object is, 9:59:59.000,9:59:59.000 and so she brushes her hair with a fork. 9:59:59.000,9:59:59.000 In the clinical setting, you might see this 9:59:59.000,9:59:59.000 being played out with a patient trying to write with a spoon 9:59:59.000,9:59:59.000 or trying to brush their teeth with a comb, okay. 9:59:59.000,9:59:59.000 Another component of ideational apraxia 9:59:59.000,9:59:59.000 can be seen when the patient tries to engage in tasks 9:59:59.000,9:59:59.000 that require multi steps. 9:59:59.000,9:59:59.000 So sequencing is really difficult 9:59:59.000,9:59:59.000 because patients don't have an idea 9:59:59.000,9:59:59.000 of the demands of the task, okay. 9:59:59.000,9:59:59.000 So again, idea comes into play here. 9:59:59.000,9:59:59.000 And so um, think about a patient 9:59:59.000,9:59:59.000 trying to uh, put on a shirt, 9:59:59.000,9:59:59.000 but instead of putting their arms through the sleeve, 9:59:59.000,9:59:59.000 they'll try to put their legs in instead, okay. 9:59:59.000,9:59:59.000 Or um, they might try to wear socks over their shoes, 9:59:59.000,9:59:59.000 so they've forgotten the steps and the sequence 9:59:59.000,9:59:59.000 in which these activities occur. 9:59:59.000,9:59:59.000 So uh, ideational apraxia is pretty straightforward. 9:59:59.000,9:59:59.000 You just have to remember the word "idea" in ideational 9:59:59.000,9:59:59.000 and understand that the patient with ideational apraxia 9:59:59.000,9:59:59.000 has no idea 9:59:59.000,9:59:59.000 what the task uh, requires, 9:59:59.000,9:59:59.000 so they don't know how to use the object, 9:59:59.000,9:59:59.000 they don't know how to, 9:59:59.000,9:59:59.000 how the objects work in relation to each other, 9:59:59.000,9:59:59.000 and they don't understand, they don't have an idea 9:59:59.000,9:59:59.000 of the demands of the task, okay. 9:59:59.000,9:59:59.000 Now contrast that with um, 9:59:59.000,9:59:59.000 ideomotor apraxia. 9:59:59.000,9:59:59.000 This is also known as, and used synonymously, 9:59:59.000,9:59:59.000 with motor apraxia. 9:59:59.000,9:59:59.000 And unlike ideational apraxia 9:59:59.000,9:59:59.000 where patients have no idea what the demand of the task is 9:59:59.000,9:59:59.000 and how to use an object, 9:59:59.000,9:59:59.000 in ideomotor apraxia, 9:59:59.000,9:59:59.000 patients actually do have an idea. 9:59:59.000,9:59:59.000 They have an understanding of what the task requires. 9:59:59.000,9:59:59.000 Um, and given, and if their language is intact, 9:59:59.000,9:59:59.000 they might even be able to verbalize to you 9:59:59.000,9:59:59.000 what the task is that they have to perform. 9:59:59.000,9:59:59.000 But in ideomotor apraxia, 9:59:59.000,9:59:59.000 they have lost access 9:59:59.000,9:59:59.000 to kinesthetic or kinetic memory 9:59:59.000,9:59:59.000 related to that task, 9:59:59.000,9:59:59.000 so they're no longer able to perform that task, okay. 9:59:59.000,9:59:59.000 And so uh, this is really fascinating. 9:59:59.000,9:59:59.000 Let me give you an example of a scenario. 9:59:59.000,9:59:59.000 Uh, you see a patient, 9:59:59.000,9:59:59.000 when you pass by a patient's hall, 9:59:59.000,9:59:59.000 and you notice that he is brushing his hair with a comb, okay. 9:59:59.000,9:59:59.000 20 minutes later, into the session, 9:59:59.000,9:59:59.000 you ask him to brush his hair. 9:59:59.000,9:59:59.000 You give him the verbal command and you say, 9:59:59.000,9:59:59.000 "Can you show me how you brush your hair in the morning?" 9:59:59.000,9:59:59.000 And although he was able to do it earlier in the morning, 9:59:59.000,9:59:59.000 automatically, in context, 9:59:59.000,9:59:59.000 he will no longer be able to do that upon verbal command, 9:59:59.000,9:59:59.000 where if you try to ask him 9:59:59.000,9:59:59.000 or have him mimic or imitate your movement 9:59:59.000,9:59:59.000 and say, "Can you try to do this, brush your hair?", 9:59:59.000,9:59:59.000 he won't, the patient won't be able to copy it. 9:59:59.000,9:59:59.000 So, inability to perform a movement upon verbal command 9:59:59.000,9:59:59.000 or mimic or imitate gestures. 9:59:59.000,9:59:59.000 This is a classic indeomotor apraxia. 9:59:59.000,9:59:59.000 Isn't the brain really fascinating? [laughs] 9:59:59.000,9:59:59.000 Um, so uh, that's how it's differentiated 9:59:59.000,9:59:59.000 from ideational apraxia, 9:59:59.000,9:59:59.000 and in ideomotor, they have an understanding 9:59:59.000,9:59:59.000 of what the task is and what needs to be done, 9:59:59.000,9:59:59.000 but because they have lost access to that kinetic memory, 9:59:59.000,9:59:59.000 they're no longer able to do that 9:59:59.000,9:59:59.000 um, or execute those movements. 9:59:59.000,9:59:59.000 Now clinically and in daily life, 9:59:59.000,9:59:59.000 ideomotor apraxia will present as uh, 9:59:59.000,9:59:59.000 just general uh, motor planning difficulty or in movement, 9:59:59.000,9:59:59.000 and so what you might observe 9:59:59.000,9:59:59.000 is movements that are um, 9:59:59.000,9:59:59.000 awkward or imprecise or um, 9:59:59.000,9:59:59.000 is not coordinated 9:59:59.000,9:59:59.000 or the timing of the movement may not be right, 9:59:59.000,9:59:59.000 so it might be too fast or too slow. 9:59:59.000,9:59:59.000 Or you might see uh, 9:59:59.000,9:59:59.000 a patient that has difficulty with the manipulation of objects. 9:59:59.000,9:59:59.000 A lot of tasks that require fine motor movements, 9:59:59.000,9:59:59.000 so think about what you might need to do 9:59:59.000,9:59:59.000 when you want to get food out of the vending machine. 9:59:59.000,9:59:59.000 You have to be able to manipulate coins out of your hand, 9:59:59.000,9:59:59.000 into your palm, like those translation. 9:59:59.000,9:59:59.000 Um, you won't be able to do that very well. 9:59:59.000,9:59:59.000 Opening the jar, or adjusting the grip on your hand, 9:59:59.000,9:59:59.000 fingers to use the key to open the door. 9:59:59.000,9:59:59.000 All of these things that require precise movements 9:59:59.000,9:59:59.000 will be challenging for patients with ideomotor apraxia. 9:59:59.000,9:59:59.000 Am I talking really fast? [Laughs] 9:59:59.000,9:59:59.000 My god, I'm like sweating right now. [Laughs] 9:59:59.000,9:59:59.000 It's because I'm trying to finish this video 9:59:59.000,9:59:59.000 before my baby wakes up 9:59:59.000,9:59:59.000 and still have a little bit of free time to myself. 9:59:59.000,9:59:59.000 So that's it for today. 9:59:59.000,9:59:59.000 Congratulations again to everyone who found out 9:59:59.000,9:59:59.000 that they passed. 9:59:59.000,9:59:59.000 And if you are still um, preparing for your exam 9:59:59.000,9:59:59.000 and you're still striving, 9:59:59.000,9:59:59.000 I just want to leave you with a quote 9:59:59.000,9:59:59.000 that was always a comfort to me, 9:59:59.000,9:59:59.000 um, by Winston Churchill, 9:59:59.000,9:59:59.000 which, and he once said, 9:59:59.000,9:59:59.000 "Success is not final and failure is not fatal." 9:59:59.000,9:59:59.000 And so to those of you who passed, um, 9:59:59.000,9:59:59.000 know that this is just the beginning. 9:59:59.000,9:59:59.000 This is not your final destination. 9:59:59.000,9:59:59.000 You're going to go on to achieve so much more 9:59:59.000,9:59:59.000 than just merely passing this exam. 9:59:59.000,9:59:59.000 And to those of you who did not pass today, uh, 9:59:59.000,9:59:59.000 be slow to be discouraged 9:59:59.000,9:59:59.000 but quick to be encouraged 9:59:59.000,9:59:59.000 knowing that this is not a fatal moment, 9:59:59.000,9:59:59.000 no matter how much you might think it is. 9:59:59.000,9:59:59.000 Your efforts and everything that you're learning 9:59:59.000,9:59:59.000 and all the uh, ways that you're disciplining yourself to keep going, 9:59:59.000,9:59:59.000 this, this is not going to be in vane. 9:59:59.000,9:59:59.000 It will all come back to serve you well 9:59:59.000,9:59:59.000 and serve your patients in the future. 9:59:59.000,9:59:59.000 So, keep your spirit up and um, 9:59:59.000,9:59:59.000 keep going. Alright? 9:59:59.000,9:59:59.000 Okay, guys. Until next time. 9:59:59.000,9:59:59.000 Take good care. [br]I love you guys so much. 9:59:59.000,9:59:59.000 [Blows kiss] [br]Bye. 9:59:59.000,9:59:59.000 [Outro piano music]