3019PSY Module 7 Disorders of Everyday Action

everyday actions

actions we do all the time without really thinking about it

top down guidance

requires access to stored information, which involves higher-order processes

bottom-up processes

noticing cues in the environment relevant to the task, and ignoring those that arent

executive functions

higher order processes that control and regulate behaviour

functional independence measure (FIM)

assesses whether a person can physically complete daily movements and a few cognitions

instrumental activities of daily living scale (IADLS)

measures ability to carry out complex everyday tasks (eg shopping, managing finances) either from the clients perspective or those close to them

multiple objects test (MOT)

assessed planning and execution of everyday tasks while the patient is completing the task (eg wrapping a present)

multi-level action test (MLAT)

an extension of the MOT that uses naturalistic tasks (eg making toast with butter and jam) while noting the number and types of errors made

naturalistic obersation test (NAT)

assesses for naturalistic action impairments and rates the severity of the problem; shorter and more simplified scoring than the MOT and MLAT

action disorganisation syndrome (ADS)

where a patient has difficulty performing routine, everyday, multi-step tasks not due to a motor or object recognition deficit

object substitution errors

using objects innapropriately even when the patient knows what it is

omission errors

leaving out actions needed to complete a task

addition errors

adding in extra uneccesary actions when completing a task

wrong order errors

completing the steps of a task in the incorrect sequence

preservation errors

repeating the same step of a task multiple times uneccesarily

wrong spatial plane errors

using a tool in the wrong spatial plane while completing a task

action coding scheme

suggests that multi-step tasks are performed in a hierarchical; split into A2 and A1 tasks

A2 tasks

the larger goal of the action, generally split by the objects needed to perform the task

A1 tasks

the sub-steps of the A2 tasks

place and object substitution errors

putting an object in the wrong place

anticipation errors

performing actions in the wrong sequence

tool substitution errors

using the incorrect tool for the given task

quality error

performing an action correctly but clumsily

omission error

forgetting a step of an action sequence

competitive queuing model

proposes a hierarchical model of action execution comprising of a goal unit, basic level components, and object representations

competitive queuing model explanation for object substitution errors

impaired connection between object representations and basic level components; impaired top-down activation of the goal unit

competitive queuing model explanation for omission errors

impaired activation from the goal unit to basic level components

competitive queuing model explanation for preservation errors (immediate preservations)

impaired links between basic level components

competitive queuing model explanation of preservation errors (delayed preservations)

impaired activation gradient bewteen goal unit and basic level components

competitive queuing model explanation for stored knowledge impairments for routine actions

impaired long-term knowledge of action sequences / goal units

utilisation behaviour disorder (UBD)

intact actions for using objects, but using them in innapropriate contexts

toying

object manipulation that is not purposeful or useful (eg picking up a pencil without using it)

complex toying

using 2 objects in a related but unintended way (eg pushing a wiiden block with a pencil)

normal & shallice model of control and action control

explains how humans regulate and control their actions, particularly in complex or novel situations

special purpose cognitive subsystems

a series of actions we all know how to do (eg object recognition)

schema control units

the programs that run certain behaviours based on information coming from the special prupose cognitive subsystems

triggers

perecptual inputs/ outputs of other schemata that activate new schemata

contention scheduling system

a system that chooses which schemata to control behaviour out of competing ones that are activated

supervisory attention system

active in novel situations when the active schemata dont provide an appropriate response, and either activates/ inhibits these schema more to ensure the appropriate actions are carried out

frontal lobe damage

associated with UBD; inhibits the supervisory attention system

apraxia

higher order disorders that causes the loss of ability to perform well-learned pruposeful movements, not due to motor, comprehension, or cooperation deficits

ideomotor apraxia

disorder in the planning and sequencing of actions as well as generating and controlling the motor activity necessary to perform them; with normal conceptual praxis

ideational apraxia

disturbance in the conceptual organisation of actions resulting in a loss of knowledge about how to use tools

conceptual apraxia

a type of ideational apraxia involving semantic errors in performing single actions, common in people with Alzheimers

conduction apraxia

patient is better at actioning gestures for verbal commands compared to mimicking someone elses

visuo-imitative apraxia

an extreme form of conduction apraxia where a person has normal ability actioning gestures for verbal commands but cannot mimic those of someone else

constructional apraxia

issues spontaneously drawing, coping drawings, or constructing objects with wooden blocks

oral apraxia

inability to perform mouth movements

ocular apraxia

impaired saccadic eye movements

speech / verbal apraxia

problems with word articulation

limb-kinetic apraxia

slow, stiff movements; loss of fine motor movements in the fingers

developmental apraxia

apraxia in children

visuo-motor apraxia

disruption of actions requiring visual support (eg reaching for and grasping a cup)

dressing apraxia

issues getting dressed

mirror apraxia

inability to reach for objects in a mirror / using a mirror correctly

Roy & Square (1985) model of limb praxis

proposes the conceptual and production systems of limb praxis, predicts ideational apraxia is caused by deficits at the conceptual, and ideomotor apraxia by deficits in the ideomotor systems

conceptual system

processes abstract representations of actions

production system

incorporates sensorimotor representations of action and mechanisms for motor control

Cabelli et al (2000) model of limb praxis

proposes apraxia can be modality specific and different pathways are used for the completion of actions; has a semantic and nonsemantic route

deficit in the action input lexicon (A)

causes problems in understanding seen gestures, but can perform them on verbal command and immitate them via the VMCM

deficit in the action semantic system (B)

causes problems in understanding gestures and inability to perform gestures via the semantic route, but can imitate them via the VMCM

deficits in the action output lexicon (C)

causes problems executing actions when directed, but can understand actions and mimic them via the VMCM

deficit in the visuo-motor conversion mechanism (VMCM) (E)

causes inability to imitate meaningful gestures but can perform on command / understand them

deficit in the gestural buffer (E)

causes impairment in all gestural executions but can understand them via the semantic system