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Manual Approach During Hand Gesture Imitation
Jay C. Kwon, MD;
Sue J. Kang, MS;
Byung H. Lee, MA;
Juhee Chin, MA;
Kenneth M. Heilman, MD;
Duk L. Na, MD
Arch Neurol. 2002;59:1468-1475.
Background Patients' tendency to draw near or into the target when copying figures,
a phenomenon termed closing-in, has been previously
described. That the closing-in could occur when copying hand gestures has
also been noted.
Objectives To study a patient with corticobasal degeneration to quantify his manual
approach behavior and to test a possible working memory hypothesis.
Methods The subject of this study is a patient with severe ideomotor apraxia
from probable corticobasal degeneration. Fluorine 18–labeled deoxyglucose–positron
emission tomographic findings revealed a hypometabolism involving the bilateral
parietotemporal and the right frontal lobes. When asked to copy an examiner's
(J.C.K.) hand gesture, the patient approached, touched, or grasped the examiner's
hand, a behavior mostly consistent with the closing-in behavior previously
proposed. To investigate the frequency and severity of closing-in, the patient
was asked to copy 20 meaningless hand gestures (10 simple and 10 complex).
Copying the 20 hand gestures was performed with either the left or the right
hand while the patient was seated opposite the examiner (across condition)
or on the same side of the examiner (lateral condition).
Results Of the 80 trials, closing-in occurred in 43 (53.8%) (35 with approaching,
6 with touching, and 2 with grasping). The closing-in was more frequent and
more severe when gesturing with the left than the right hand, but it did not
differ between the lateral and across conditions and between simple and complex
gestures.
Conclusions Corticobasal degeneration might be associated with aberrant manual approach
behavior. Although our results do not support the working memory hypothesis,
frontal dysfunction might have led to a loss of voluntary control of ontologically
primitive propensity to move the forelimb in the direction to which one attends.
From the Departments of Neurology, Samsung Medical Center, Sungkyunkwan
University School of Medicine, Seoul, Korea (Drs Kwon and Na, Mss Kang, Lee,
and Chin), and the University of Florida and the Veterans Affairs Medical
Center, Gainesville (Dr Heilman). Dr Kwon is now affiliated with the Department
of Neurology, Changwon Fatima Hospital, Changwon, Korea.
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ABSTRACT
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