WEBVTT 99:59:59.999 --> 99:59:59.999 [intro piano music] 99:59:59.999 --> 99:59:59.999 Hi everyone, good morning. 99:59:59.999 --> 99:59:59.999 Welcome back to the OTmiri channel. 99:59:59.999 --> 99:59:59.999 If you're new here and we haven't met, my name is Miri. 99:59:59.999 --> 99:59:59.999 I'm a licensed occupational therapist 99:59:59.999 --> 99:59:59.999 and in today's video, I'll be talking to you guys about apraxia, 99:59:59.999 --> 99:59:59.999 specifically the difference between 99:59:59.999 --> 99:59:59.999 ideational and ideomotor apraxia. 99:59:59.999 --> 99:59:59.999 But before I get started, I just want to say congratulations 99:59:59.999 --> 99:59:59.999 to all of you who've found out 99:59:59.999 --> 99:59:59.999 that you passed the NBCOT exam this morning. 99:59:59.999 --> 99:59:59.999 I woke up so happy to all of your messages 99:59:59.999 --> 99:59:59.999 and thoughtful, sweet notes, 99:59:59.999 --> 99:59:59.999 whether on Instagram or on Facebook or here on this channel. 99:59:59.999 --> 99:59:59.999 I want you guys to know that it makes such a big difference uh, 99:59:59.999 --> 99:59:59.999 when you guys share the news with me 99:59:59.999 --> 99:59:59.999 and to know that um, I was able to share this journey with you 99:59:59.999 --> 99:59:59.999 leading to your success. 99:59:59.999 --> 99:59:59.999 It uh, gives me such a great sense of satisfaction and pride for you 99:59:59.999 --> 99:59:59.999 and it motivates me to keep going. 99:59:59.999 --> 99:59:59.999 So much so that this is the first thing that I'm doing in the morning. 99:59:59.999 --> 99:59:59.999 I haven't even showered. I'm still in my pajamas, 99:59:59.999 --> 99:59:59.999 which I guess making a video in my pajamas 99:59:59.999 --> 99:59:59.999 is not my first time so you guys are probably used to it, 99:59:59.999 --> 99:59:59.999 but thank you, guys. 99:59:59.999 --> 99:59:59.999 Um, I, I will be celebrating in spirit with you today. 99:59:59.999 --> 99:59:59.999 Um, but let's get started. Apraxia. 99:59:59.999 --> 99:59:59.999 Now if you're preparing uh, for the exam 99:59:59.999 --> 99:59:59.999 and you're studying this content area, 99:59:59.999 --> 99:59:59.999 you might find yourself feeling confused 99:59:59.999 --> 99:59:59.999 or frustrated at times. I know I was. 99:59:59.999 --> 99:59:59.999 Because, depending on the literature, 99:59:59.999 --> 99:59:59.999 the authors, or even the country 99:59:59.999 --> 99:59:59.999 where these articles are written, or textbooks, 99:59:59.999 --> 99:59:59.999 you'll come across a wide range of terminologies, 99:59:59.999 --> 99:59:59.999 ranging from oculomotor apraxia, 99:59:59.999 --> 99:59:59.999 dressing, constructional, 99:59:59.999 --> 99:59:59.999 limb apraxia, there's also limb kinetic apraxia, 99:59:59.999 --> 99:59:59.999 and the list goes on and on. 99:59:59.999 --> 99:59:59.999 And the way these are classified 99:59:59.999 --> 99:59:59.999 are not always universally accepted, 99:59:59.999 --> 99:59:59.999 which makes it that much more challenging. 99:59:59.999 --> 99:59:59.999 So in this video today, and for the purposes 99:59:59.999 --> 99:59:59.999 of making it less overwhelming for you guys, 99:59:59.999 --> 99:59:59.999 I am going to talk about two general categories 99:59:59.999 --> 99:59:59.999 that you'll see most often in the rehabilitation literature 99:59:59.999 --> 99:59:59.999 as well as in your clinical setting, 99:59:59.999 --> 99:59:59.999 which are the ideational apraxia and ideomotor apraxia. 99:59:59.999 --> 99:59:59.999 So let's first get started by defining what apraxia is. 99:59:59.999 --> 99:59:59.999 It's basically a dysfunction or difficulty 99:59:59.999 --> 99:59:59.999 in execution of a skilled or purposeful activity 99:59:59.999 --> 99:59:59.999 that cannot be attributed to or explained 99:59:59.999 --> 99:59:59.999 by sensorimotor or cognitive comprehension deficits. 99:59:59.999 --> 99:59:59.999 So in other words, put another way, 99:59:59.999 --> 99:59:59.999 apraxia can occur even in the absence of weakness, 99:59:59.999 --> 99:59:59.999 spasticity, motor or sensory loss, 99:59:59.999 --> 99:59:59.999 memory or comprehension or cognitive deficits. 99:59:59.999 --> 99:59:59.999 Interesting, right? 99:59:59.999 --> 99:59:59.999 And it's typically lateralized to the left hemisphere, 99:59:59.999 --> 99:59:59.999 meaning it's due to a damage to the left hemisphere of the brain. 99:59:59.999 --> 99:59:59.999 And patients are oftentimes unaware of these deficits, 99:59:59.999 --> 99:59:59.999 which makes treatment that much more challenging. 99:59:59.999 --> 99:59:59.999 Now to really understand apraxia, 99:59:59.999 --> 99:59:59.999 it's helpful to know what the praxis system is. 99:59:59.999 --> 99:59:59.999 And I'm going to just talk about it very briefly. 99:59:59.999 --> 99:59:59.999 And a lot of the information that I'm talking about today 99:59:59.999 --> 99:59:59.999 is cited from Dr. Glen Dillon's work, 99:59:59.999 --> 99:59:59.999 and he's a fantastic resource 99:59:59.999 --> 99:59:59.999 so I'll list his books in the video description. 99:59:59.999 --> 99:59:59.999 But basically he talks about the praxis system 99:59:59.999 --> 99:59:59.999 as a two step process 99:59:59.999 --> 99:59:59.999 that results in the execution of a purposeful activity. 99:59:59.999 --> 99:59:59.999 The first step being ideation, or conceptualization, 99:59:59.999 --> 99:59:59.999 so it's having the idea or the right idea 99:59:59.999 --> 99:59:59.999 about the task and what needs to be done. 99:59:59.999 --> 99:59:59.999 And then the second step is production, 99:59:59.999 --> 99:59:59.999 so this is the actual execution of that task. 99:59:59.999 --> 99:59:59.999 And together, that results in execution of a purposeful activity. 99:59:59.999 --> 99:59:59.999 And when there is a breakdown 99:59:59.999 --> 99:59:59.999 in either one of those steps in the praxis system, 99:59:59.999 --> 99:59:59.999 you have apraxia, 99:59:59.999 --> 99:59:59.999 inability to perform these purposeful movements and tasks, okay. 99:59:59.999 --> 99:59:59.999 So now that you know what apraxia is, 99:59:59.999 --> 99:59:59.999 let's get into a little more detail 99:59:59.999 --> 99:59:59.999 and talk about ideational apraxia, 99:59:59.999 --> 99:59:59.999 which is referring to the breakdown in the ideation component. 99:59:59.999 --> 99:59:59.999 And so the patient with ideational apraxia 99:59:59.999 --> 99:59:59.999 will have no idea 99:59:59.999 --> 99:59:59.999 or have, don't have the right idea 99:59:59.999 --> 99:59:59.999 about what needs to be done with the task. 99:59:59.999 --> 99:59:59.999 And this includes not understanding the purpose of a tool or an object. 99:59:59.999 --> 99:59:59.999 So a classic example, and you may have seen this many times 99:59:59.999 --> 99:59:59.999 if you're in my Facebook study group 99:59:59.999 --> 99:59:59.999 or on my Instagram page, I also have this, 99:59:59.999 --> 99:59:59.999 um, is a photo of Ariel. [chuckles] 99:59:59.999 --> 99:59:59.999 Not a surprise, right? 99:59:59.999 --> 99:59:59.999 My favorite character. 99:59:59.999 --> 99:59:59.999 I know I talk about her all the time. 99:59:59.999 --> 99:59:59.999 But you have to remember that scene in The Little Mermaid 99:59:59.999 --> 99:59:59.999 where she's sitting across the dining table hall with Prince Eric 99:59:59.999 --> 99:59:59.999 and she sees a fork and enthusiastically 99:59:59.999 --> 99:59:59.999 and unabashedly, she takes it up to her hair 99:59:59.999 --> 99:59:59.999 and she starts brushing her hair with the fork. 99:59:59.999 --> 99:59:59.999 This is a really good example of ideational apraxia, 99:59:59.999 --> 99:59:59.999 inability to use the tool appropriately, 99:59:59.999 --> 99:59:59.999 because she has lost the sense, 99:59:59.999 --> 99:59:59.999 has no idea what the purpose of the object is, 99:59:59.999 --> 99:59:59.999 and so she brushes her hair with a fork. 99:59:59.999 --> 99:59:59.999 In the clinical setting, you might see this 99:59:59.999 --> 99:59:59.999 being played out with a patient trying to write with a spoon 99:59:59.999 --> 99:59:59.999 or trying to brush their teeth with a comb, okay. 99:59:59.999 --> 99:59:59.999 Another component of ideational apraxia 99:59:59.999 --> 99:59:59.999 can be seen when the patient tries to engage in tasks 99:59:59.999 --> 99:59:59.999 that require multi steps. 99:59:59.999 --> 99:59:59.999 So sequencing is really difficult 99:59:59.999 --> 99:59:59.999 because patients don't have an idea 99:59:59.999 --> 99:59:59.999 of the demands of the task, okay. 99:59:59.999 --> 99:59:59.999 So again, idea comes into play here. 99:59:59.999 --> 99:59:59.999 And so um, think about a patient 99:59:59.999 --> 99:59:59.999 trying to uh, put on a shirt, 99:59:59.999 --> 99:59:59.999 but instead of putting their arms through the sleeve, 99:59:59.999 --> 99:59:59.999 they'll try to put their legs in instead, okay. 99:59:59.999 --> 99:59:59.999 Or um, they might try to wear socks over their shoes, 99:59:59.999 --> 99:59:59.999 so they've forgotten the steps and the sequence 99:59:59.999 --> 99:59:59.999 in which these activities occur. 99:59:59.999 --> 99:59:59.999 So uh, ideational apraxia is pretty straightforward. 99:59:59.999 --> 99:59:59.999 You just have to remember the word "idea" in ideational 99:59:59.999 --> 99:59:59.999 and understand that the patient with ideational apraxia 99:59:59.999 --> 99:59:59.999 has no idea what the task uh, requires, 99:59:59.999 --> 99:59:59.999 so they don't know how to use the object, 99:59:59.999 --> 99:59:59.999 they don't know how to, 99:59:59.999 --> 99:59:59.999 how the objects work in relation to each other, 99:59:59.999 --> 99:59:59.999 and they don't understand, they don't have an idea 99:59:59.999 --> 99:59:59.999 of the demands of the task, okay. 99:59:59.999 --> 99:59:59.999 Now contrast that with um, 99:59:59.999 --> 99:59:59.999 ideomotor apraxia. 99:59:59.999 --> 99:59:59.999 This is also known as, and used synonymously, 99:59:59.999 --> 99:59:59.999 with motor apraxia. 99:59:59.999 --> 99:59:59.999 And unlike ideational apraxia 99:59:59.999 --> 99:59:59.999 where patients have no idea what the demand of the task is 99:59:59.999 --> 99:59:59.999 and how to use an object, 99:59:59.999 --> 99:59:59.999 in ideomotor apraxia, 99:59:59.999 --> 99:59:59.999 patients actually do have an idea. 99:59:59.999 --> 99:59:59.999 They have an understanding of what the task requires. 99:59:59.999 --> 99:59:59.999 Um, and given, and if their language is intact, 99:59:59.999 --> 99:59:59.999 they might even be able to verbalize to you 99:59:59.999 --> 99:59:59.999 what the task is that they have to perform. 99:59:59.999 --> 99:59:59.999 But in ideomotor apraxia, 99:59:59.999 --> 99:59:59.999 they have lost access 99:59:59.999 --> 99:59:59.999 to kinesthetic or kinetic memory 99:59:59.999 --> 99:59:59.999 related to that task, 99:59:59.999 --> 99:59:59.999 so they're no longer able to perform that task, okay. 99:59:59.999 --> 99:59:59.999 And so uh, this is really fascinating. 99:59:59.999 --> 99:59:59.999 Let me give you an example of a scenario. 99:59:59.999 --> 99:59:59.999 Uh, you see a patient, 99:59:59.999 --> 99:59:59.999 when you pass by a patient's hall, 99:59:59.999 --> 99:59:59.999 and you notice that he is brushing his hair with a comb, okay. 99:59:59.999 --> 99:59:59.999 20 minutes later, into the session, 99:59:59.999 --> 99:59:59.999 you ask him to brush his hair. 99:59:59.999 --> 99:59:59.999 You give him the verbal command and you say, 99:59:59.999 --> 99:59:59.999 "Can you show me how you brush your hair in the morning?" 99:59:59.999 --> 99:59:59.999 And although he was able to do it earlier in the morning, 99:59:59.999 --> 99:59:59.999 automatically, in context, 99:59:59.999 --> 99:59:59.999 he will no longer be able to do that upon verbal command, 99:59:59.999 --> 99:59:59.999 where if you try to ask him 99:59:59.999 --> 99:59:59.999 or have him mimic or imitate your movement 99:59:59.999 --> 99:59:59.999 and say, "Can you try to do this, brush your hair?", 99:59:59.999 --> 99:59:59.999 he won't, the patient won't be able to copy it. 99:59:59.999 --> 99:59:59.999 So, inability to perform a movement upon verbal command 99:59:59.999 --> 99:59:59.999 or mimic or imitate gestures. 99:59:59.999 --> 99:59:59.999 This is a classic indeomotor apraxia. 99:59:59.999 --> 99:59:59.999 Isn't the brain really fascinating? [Laughs] 99:59:59.999 --> 99:59:59.999 Um, so uh, that's how it's differentiated 99:59:59.999 --> 99:59:59.999 from ideational apraxia, 99:59:59.999 --> 99:59:59.999 and in ideomotor, they have an understanding 99:59:59.999 --> 99:59:59.999 of what the task is and what needs to be done, 99:59:59.999 --> 99:59:59.999 but because they have lost access to that kinetic memory, 99:59:59.999 --> 99:59:59.999 they're no longer able to do that 99:59:59.999 --> 99:59:59.999 um, or execute those movements. 99:59:59.999 --> 99:59:59.999 Now clinically and in daily life, 99:59:59.999 --> 99:59:59.999 ideomotor apraxia will present as uh, 99:59:59.999 --> 99:59:59.999 just general uh, motor planning difficulty or in movement, 99:59:59.999 --> 99:59:59.999 and so what you might observe 99:59:59.999 --> 99:59:59.999 is movements that are um, 99:59:59.999 --> 99:59:59.999 awkward or imprecise or um, 99:59:59.999 --> 99:59:59.999 is not coordinated 99:59:59.999 --> 99:59:59.999 or the timing of the movement may not be right, 99:59:59.999 --> 99:59:59.999 so it might be too fast or too slow. 99:59:59.999 --> 99:59:59.999 Or you might see uh, 99:59:59.999 --> 99:59:59.999 a patient that has difficulty with the manipulation of objects. 99:59:59.999 --> 99:59:59.999 A lot of tasks that require fine motor movements, 99:59:59.999 --> 99:59:59.999 so think about what you might need to do 99:59:59.999 --> 99:59:59.999 when you want to get food out of the vending machine. 99:59:59.999 --> 99:59:59.999 You have to be able to manipulate coins out of your hand, 99:59:59.999 --> 99:59:59.999 into your palm, like those translation. 99:59:59.999 --> 99:59:59.999 Um, you won't be able to do that very well. 99:59:59.999 --> 99:59:59.999 Opening the jar, or adjusting the grip on your hand, 99:59:59.999 --> 99:59:59.999 fingers to use the key to open the door. 99:59:59.999 --> 99:59:59.999 All of these things that require precise movements 99:59:59.999 --> 99:59:59.999 will be challenging for patients with ideomotor apraxia. 99:59:59.999 --> 99:59:59.999 Am I talking really fast? [Laughs] 99:59:59.999 --> 99:59:59.999 My god, I'm like sweating right now. [Laughs] 99:59:59.999 --> 99:59:59.999 It's because I'm trying to finish this video 99:59:59.999 --> 99:59:59.999 before my baby wakes up 99:59:59.999 --> 99:59:59.999 and still have a little bit of free time to myself. 99:59:59.999 --> 99:59:59.999 So that's it for today. 99:59:59.999 --> 99:59:59.999 Congratulations again to everyone who found out 99:59:59.999 --> 99:59:59.999 that they passed. 99:59:59.999 --> 99:59:59.999 And if you are still um, preparing for your exam 99:59:59.999 --> 99:59:59.999 and you're still striving, 99:59:59.999 --> 99:59:59.999 I just want to leave you with a quote 99:59:59.999 --> 99:59:59.999 that was always a comfort to me, 99:59:59.999 --> 99:59:59.999 um, by Winston Churchill, 99:59:59.999 --> 99:59:59.999 which, and he once said, 99:59:59.999 --> 99:59:59.999 "Success is not final and failure is not fatal." 99:59:59.999 --> 99:59:59.999 And so to those of you who passed, um, 99:59:59.999 --> 99:59:59.999 know that this is just the beginning. 99:59:59.999 --> 99:59:59.999 This is not your final destination. 99:59:59.999 --> 99:59:59.999 You're going to go on to achieve so much more 99:59:59.999 --> 99:59:59.999 than just merely passing this exam. 99:59:59.999 --> 99:59:59.999 And to those of you who did not pass today, uh, 99:59:59.999 --> 99:59:59.999 be slow to be discouraged 99:59:59.999 --> 99:59:59.999 but quick to be encouraged 99:59:59.999 --> 99:59:59.999 knowing that this is not a fatal moment, 99:59:59.999 --> 99:59:59.999 no matter how much you might think it is. 99:59:59.999 --> 99:59:59.999 Your efforts and everything that you're learning 99:59:59.999 --> 99:59:59.999 and all the uh, ways that you're disciplining yourself to keep going, 99:59:59.999 --> 99:59:59.999 this, this is not going to be in vane. 99:59:59.999 --> 99:59:59.999 It will all come back to serve you well 99:59:59.999 --> 99:59:59.999 and serve your patients in the future. 99:59:59.999 --> 99:59:59.999 So, keep your spirit up and um, 99:59:59.999 --> 99:59:59.999 keep going. Alright? 99:59:59.999 --> 99:59:59.999 Okay, guys. Until next time. 99:59:59.999 --> 99:59:59.999 Take good care. I love you guys so much. 99:59:59.999 --> 99:59:59.999 [Blows kiss] Bye. 99:59:59.999 --> 99:59:59.999 [Outro piano music]