失語を伴う左半球損傷患者の観念失行に関する非言語的課題による検討

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  • 緒方 敦子
    鹿児島大学医学部リハビリテーション医学講座

書誌事項

タイトル別名
  • Non-verbal Examination on Tool Perception and Cognition in Aphasic Patients with Ideational Apraxia due to Left Brain Damage.
  • シツゴ オ トモナウ ヒダリ ハンキュウ ソンショウ カンジャ ノ カンネン シッコウ ニ カンスル ヒゲンゴテキ カダイ ニ ヨル ケントウ

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説明

Ideational apraxia was defined as “Difficulties or errors of tool utility without motor palsy and disturbed tool perception and cognition.” In aphasic patients, however, the tool perception and cognition of the patients have not well been examined. In the present study, we investigated tool perception and cognition with non-verbal method using pictures and photographs. The subjects were 53 patients with left brain damage (mean age: 58.6±11.0 years; 36 men and 17 women). All had different types and degrees of aphasia and r-hemiplegia. Test trial: To choose a drawing out of 6 drawings same to offered one. Test 1: Evaluation of actual use of single tool and serial multiple tools. Test 2: Visual perception was examined to choose the same figure or picture as the offered one. Test 3: Cognition on single tool utility was examined to select a photograph showing the correct utility. Cognition on sequential tool handling was examined to arrange correctly the photographs showing the sequential procedure. The insight was also evaluated by counting the time of demonstration repeated to understand the patients what to do. Ideational apraxia (IA) who showed the disturbance in serial tool utility were observed in 25 patients out of 53 patients. Twenty-three patients out of 25 patients with IA also failed actual use of single tool. Although 25 patients with IA showed no errors in single tool perception and cognition, 18 patients failed the arrangements of multiple serial tools. The insight of apraxic patients was inferior to non-apraxic patients. The foci in apraxic patients on CT were greater than in non-apraxic patients showing wide distribution including the parietal lobe and the frontal lobe. From these results, as the tool perception and cognition was preserved even in aphasic patients with IA, IA was considered to be derived from the lesions of the pathway leading to the set up of motor program at frontal lobe.

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