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Kenneth M. Heilman - One of the best experts on this subject based on the ideXlab platform.
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unilateral apraxic agraphia without Ideomotor Apraxia in a patient with callosal and frontal lobe lesions p3 198
Neurology, 2018Co-Authors: Tigran Kesayan, Kenneth M. HeilmanAbstract:Objective: NA Background: Injury to the areas that store the spatial-temporal movement representations required to write, or a disconnection of these engrams from the motor areas can cause apraxic agraphia. Apraxic agraphia along with Ideomotor Apraxia (IMA) of the left hand has been described from callosal lesions. We report a woman with apraxic agraphia of her left hand who did not demonstrate IMA. Design/Methods: Case Report: A 37 year-old right-handed woman with a history of alcohol abuse developed an apraxic agraphia of her left hand, and a limb-kinetic Apraxia (LKA), a loss of precise, independent and coordinated finger movements of both hands, as determined by the coin rotation test. However, she was without an IMA. MRI imaging reveal lesions of the genu and splenium of the corpus callosum (CC) and leukoaraiosis in the frontal lobes. Results: NA Conclusions: Discussion: These CC changes may be a form of Marchifava-Bignami disease. Injury to the CC can cause left hand LKA, and LKA can impair writing. However, this woman had a LKA of both hands, but her apraxic agraphia was limited to left hand. Diffusion tensor imaging studies have shown that patients with alcohol abuse can develop changes in the frontal white matter, and our patient did reveal some leukoaraiosis of her frontal white matter. Therefore, it is possible that frontal white matter injury was responsible for this patient’s bilateral LKA, and these white matter or callosal injuries may have also disconnected the letter spatial-temporal movement engrams from the motor areas of the right hemisphere causing an apraxic agraphia of her left hand. However, additional studies assessing patients with alcohol abuse for LKA and apraxic agraphia are needed Study Supported by: NA Disclosure: Dr. Kesayan has nothing to disclose. Dr Heilman has nothing to disclose.
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unilateral apraxic agraphia without Ideomotor Apraxia from a callosal lesion in a patient with marchiafava bignami disease
Neurocase, 2018Co-Authors: Tigran Kesayan, Kenneth M. HeilmanAbstract:ABSTRACTApraxic agraphia can be caused by left hemispheric cerebral lesions in the area that contains the spatial representations of the movements required to write, from a lesion in, or connections to, the frontal premotor cortex that converts these spatial representations to motor programs (Exner’s area). A right-handed woman with Marchiafava Bignami disease and lesions of the genu and splenium of her corpus callosum had apraxic agraphia without Ideomotor Apraxia of her left. A disconnection of Exner’s area in the left hemisphere from the right hemisphere’s premotor and motor areas may have led to her inability to write with her left hand.
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callosal Ideomotor Apraxia in alzheimer s disease
Journal of Clinical and Experimental Neuropsychology, 2017Co-Authors: Ann Marie Ciminoknight, Leslie Gonzalez J Rothi, Ying He, Kenneth M. HeilmanAbstract:ABSTRACTBackground/objective: Impaired ability to perform skilled movements with the left upper limb in patients with corpus callosum injury has been well described (callosal Apraxia) with some displaying spatial–temporal errors primarily in response to verbal commands (verbal callosal disconnection Apraxia), with imitation, and when using actual tools (callosal Ideomotor Apraxia). Additionally some patients with callosal injury also make content errors when selecting and using the incorrect tool with their left upper limb (callosal conceptual Apraxia). Interestingly, patients with Alzheimer’s disease (AD) reveal anatomic evidence of callosal degeneration but callosal Apraxia in AD has not been described. The purpose of this study was to learn whether patients with AD display forms of callosal Apraxia. Method: Participants were 22 right-handed patients with AD and 24 matched controls. Both upper limbs were tested by having subjects pantomime transitive movements to command and imitation. Participants also...
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A Brief History of Upper Limb Ideomotor Apraxia
The Oxford Handbook of History of Clinical Neuropsychology, 2016Co-Authors: Kenneth M. HeilmanAbstract:To successfully interact with the environment, goal-oriented movements made by human limbs must be guided by instructions from the brain. Loss of the ability to program purposeful skilled movements, in the absence of any motor, sensory, or cognitive deficit that could fully account for this disability, is called Apraxia. Several types of Apraxia were described by Hugo Liepmann in the beginning of the 20th century: Ideomotor Apraxia, where patients make spatial movement and postural errors as well as temporal errors, limb-kinetic Apraxia, where patients are unable to perform precise independend and coordinated finger movements and ideational Apraxia, where patients fail to correctly sequence a series of action. More recently, three other types of Apraxia have been described: conceptual Apraxia, where patients have a loss of mechanical knowledge; dissociation Apraxia, where patients are impaired at performing a skilled act in response to stimuli in one modality but can perform normally when the stimulus is given in another modality; and conduction Apraxia, where patients are impaired at action imitation. This chapter, using an historical approach, reviews the signs associated with each of these forms of Apraxia, as well as their pathophysiology.
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Cognitive–motor dysfunction after severe traumatic brain injury: A cerebral interhemispheric disconnection syndrome
Journal of Clinical and Experimental Neuropsychology, 2015Co-Authors: Adam D. Falchook, Eric C. Porges, Stephen E. Nadeau, Susan A. Leon, John B. Williamson, Kenneth M. HeilmanAbstract:Background/Objectives: In most right-handed people, the left hemisphere is dominant for programming the temporal and spatial “how” (praxis) aspects of purposeful skilled movements, and the right hemisphere is dominant for control of the intentional “when” aspects of actions that mediate initiation, persistence, termination, and inhibition. Since the interhemispheric axons of the corpus callosum are especially susceptible to shearing from torsional forces during traumatic brain injury (TBI), the goal of this study was to learn whether participants with a history of severe traumatic brain injury demonstrate three types of cognitive–motor impairments that may result from callosal injury: Ideomotor Apraxia of the left hand, limb kinetic Apraxia of the left hand, and hypokinesia of the right hand in response to left hemispatial stimuli. Method: Nine participants with severe TBI and nine healthy control participants were studied for the presence of Ideomotor Apraxia, limb kinetic Apraxia, and hypokinesia. Resul...
Jordan Grafman - One of the best experts on this subject based on the ideXlab platform.
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association of Ideomotor Apraxia with frontal gray matter volume loss in corticobasal syndrome
JAMA Neurology, 2009Co-Authors: Edward D Huey, Matteo Pardini, Alyson L Cavanagh, Eric M Wassermann, Dimitrios Kapogiannis, Salvatore Spina, Bernardino Ghetti, Jordan GrafmanAbstract:Objective To determine the brain areas associated with specific components of Ideomotor Apraxia (IMA) in corticobasal syndrome (CBS). Design Case-control and cross-sectional study. Participants Forty-eight patients with CBS and 14 control subjects. Intervention Administration of the Test of Oral and Limb Apraxia. Main Outcome Measures Differences between patients with CBS and healthy controls and associations between areas of gray matter volume and IMA determined by voxel-based morphometry in patients with CBS. Results Overall, IMA was associated with decreased gray matter volume in the left supplemental motor area, premotor cortex, and caudate nucleus of patients with CBS. The overall degree of Apraxia was independent of the side of motor impairment. Praxis to imitation (vs command) was particularly impaired in the patients with CBS. Patients demonstrated equal impairment in transitive and intransitive praxis. Conclusions In patients with CBS, IMA is associated with left posterior frontal cortical and subcortical volume loss. Despite showing left frontal volume loss associated with IMA, patients with CBS have particularly impaired imitation of gestures. These findings suggest either that the IMA of CBS affects a route of praxis that bypasses motor engrams or that motor engrams are affected but that they exist in areas other than the inferior parietal cortex.
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cortico cortical networks in patients with Ideomotor Apraxia as revealed by eeg coherence analysis
Neuroscience Letters, 2008Co-Authors: Lewis A Wheaton, Jordan Grafman, Stephan Bohlhalter, Guido Nolte, Hiroshi Shibasaki, Noriaki Hattori, Esteban A Fridman, Sherry Vorbach, Mark HallettAbstract:We sought to determine whether coherent networks which circumvent lesioned cortex are seen in patients with Ideomotor Apraxia (IMA) while performing tool-use pantomimes. Five normal subjects and five patients with IMA (three patients with corticobasal degeneration and two with left hemisphere stroke) underwent 64-channel EEG recording while performing three tool-use pantomimes with their left hand in a self-paced manner. Beta band (20-22 Hz) coherence indicates that normal subjects have a dominant left hemisphere network responsible for praxis preparation, which was absent in patients. Corticobasal degeneration patients showed significant coherence increase between left parietal-right premotor areas. Left hemisphere stroke patients showed significant coherence increases in a right parietofrontal network. The right hemisphere appears to store useable praxis representations in IMA patients with left hemisphere damage.
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comparison of Apraxia in corticobasal degeneration and progressive supranuclear palsy
Neurology, 2001Co-Authors: V Pharr, B Fantie, Bob Uttl, M Stark, Irene Litvan, Jordan GrafmanAbstract:Objective: To describe Ideomotor Apraxia in patients with corticobasal degeneration and those with progressive supranuclear palsy, two parkinsonian disorders that are often misdiagnosed due to the overlap in their clinical features, and to determine whether systematic Apraxia testing is useful for differential diagnosis. Methods: Fourteen patients fulfilling National Institute of Neurological Disorders and Stroke–Society for Progressive Supranuclear Palsy clinical criteria for progressive supranuclear palsy, 13 patients fulfilling modified Lang criteria for corticobasal degeneration, and 12 normal healthy control subjects were given the Test of Oral and Limb Apraxia, which was scored according to the Florida Apraxia Battery for occurrence of various types of apraxic errors. Results: Both patients with progressive supranuclear palsy and corticobasal degeneration committed a greater number of apraxic errors than normal healthy control subjects on both transitive and intransitive tasks (p Conclusions: Patients with corticobasal degeneration show more severe Ideomotor Apraxia than patients with progressive supranuclear palsy, and systematic assessment of Ideomotor Apraxia facilitates the differential diagnosis between patients with progressive supranuclear palsy and those with corticobasal degeneration.
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Comparison of Apraxia in corticobasal degeneration and progressive supranuclear palsy.
Neurology, 2001Co-Authors: V Pharr, B Fantie, Bob Uttl, M Stark, Irene Litvan, Jordan GrafmanAbstract:OBJECTIVE: To describe Ideomotor Apraxia in patients with corticobasal degeneration and those with progressive supranuclear palsy, two parkinsonian disorders that are often misdiagnosed due to the overlap in their clinical features, and to determine whether systematic Apraxia testing is useful for differential diagnosis. METHODS: Fourteen patients fulfilling National Institute of Neurological Disorders and Stroke-Society for Progressive Supranuclear Palsy clinical criteria for progressive supranuclear palsy, 13 patients fulfilling modified Lang criteria for corticobasal degeneration, and 12 normal healthy control subjects were given the Test of Oral and Limb Apraxia, which was scored according to the Florida Apraxia Battery for occurrence of various types of apraxic errors. RESULTS: Both patients with progressive supranuclear palsy and corticobasal degeneration committed a greater number of apraxic errors than normal healthy control subjects on both transitive and intransitive tasks (p < 0.001 in both cases), but Apraxia was much more severe in patients with corticobasal degeneration than progressive supranuclear palsy (p < 0.001). The index of Apraxia severity, in combination with the assessment of the two key features of progressive supranuclear palsy (falls and vertical gaze palsy), correctly classified all patients. CONCLUSIONS: Patients with corticobasal degeneration show more severe Ideomotor Apraxia than patients with progressive supranuclear palsy, and systematic assessment of Ideomotor Apraxia facilitates the differential diagnosis between patients with progressive supranuclear palsy and those with corticobasal degeneration.
Keith A Josephs - One of the best experts on this subject based on the ideXlab platform.
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Nonverbal oral Apraxia in primary progressive aphasia and Apraxia of speech
Neurology, 2014Co-Authors: Hugo Botha, Jennifer L Whitwell, Joseph R Duffy, Edyth A Strand, Mary M. Machulda, Keith A JosephsAbstract:Objective: The goal of this study was to explore the prevalence of nonverbal oral Apraxia (NVOA), its association with other forms of Apraxia, and associated imaging findings in patients with primary progressive aphasia (PPA) and progressive Apraxia of speech (PAOS). Methods: Patients with a degenerative speech or language disorder were prospectively recruited and diagnosed with a subtype of PPA or with PAOS. All patients had comprehensive speech and language examinations. Voxel-based morphometry was performed to determine whether atrophy of a specific region correlated with the presence of NVOA. Results: Eighty-nine patients were identified, of which 34 had PAOS, 9 had agrammatic PPA, 41 had logopenic aphasia, and 5 had semantic dementia. NVOA was very common among patients with PAOS but was found in patients with PPA as well. Several patients exhibited only one of NVOA or Apraxia of speech. Among patients with Apraxia of speech, the severity of the Apraxia of speech was predictive of NVOA, whereas Ideomotor Apraxia severity was predictive of the presence of NVOA in those without Apraxia of speech. Bilateral atrophy of the prefrontal cortex anterior to the premotor area and supplementary motor area was associated with NVOA. Conclusions: Apraxia of speech, NVOA, and Ideomotor Apraxia are at least partially separable disorders. The association of NVOA and Apraxia of speech likely results from the proximity of the area reported here and the premotor area, which has been implicated in Apraxia of speech. The association of Ideomotor Apraxia and NVOA among patients without Apraxia of speech could represent disruption of modules shared by nonverbal oral movements and limb movements.
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Ideomotor Apraxia in agrammatic and logopenic variants of primary progressive aphasia
Journal of Neurology, 2013Co-Authors: Anahita Adeli, Jennifer L Whitwell, Joseph R Duffy, Edyth A Strand, Keith A JosephsAbstract:There are few studies examining praxis in subjects with primary progressive aphasia. The aim of this study was to examine the pattern and severity of Ideomotor Apraxia in subjects with logopenic and agrammatic variants of primary progressive aphasia and to determine if the presence of Ideomotor Apraxia correlated with specific neuroanatomical structural abnormalities. Subjects with primary progressive aphasia were prospectively recruited and classified according to published criteria. Using the Apraxia subtest of the Western Aphasia Battery, pattern and severity of Ideomotor Apraxia was examined in all subjects diagnosed with agrammatic and logopenic variants of primary progressive aphasia. The study included 47 subjects, 21 diagnosed with agrammatic variant of primary progressive aphasia and 26 with logopenic variant primary progressive aphasia. Subjects with agrammatic aphasia were older at onset than the logopenic variant (67.2 vs. 61.7 years, p = 0.02), but there was no difference in illness duration prior to evaluation. Those with logopenic aphasia showed more cognitive impairment on the Mini-Mental Status Examination (agrammatic = 26.7/30, logopenic = 22/30, p = 0.002), and a trend for more severe language impairment as measured by the Western Aphasia Battery-Aphasia Quotient (agrammatic = 82.3, logopenic = 75.2, p = 0.11). Strong correlations were found between Western Aphasia Battery-Aphasia Quotient and total Apraxia, instrumental Apraxia, and complex Apraxia, while average to modest correlations were seen with upper limb Apraxia and facial Apraxia. After adjusting for age, mental status performance, and Western Aphasia Battery-Aphasia Quotient score, those with agrammatic aphasia had a higher degree of total Apraxia (p = 0.004), facial Apraxia (p = 0.03), instrumental Apraxia (p = 0.0006), and complex Apraxia (p = 0.0006) than those with logopenic aphasia. The agrammatic variant of primary progressive aphasia was associated with greater praxis deficits but less cognitive impairment than the logopenic variant. The presence of Ideomotor Apraxia was associated with grey matter loss in the left lateral premotor cortex with extension into the motor cortex. These findings suggest that although some affected areas in the agrammatic and logopenic variants of primary progressive aphasia overlap, there exists an area that is more affected in the agrammatic variant than the logopenic variant that accounts for the greater association of agrammatic aphasia with Ideomotor Apraxia.
V Pharr - One of the best experts on this subject based on the ideXlab platform.
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comparison of Apraxia in corticobasal degeneration and progressive supranuclear palsy
Neurology, 2001Co-Authors: V Pharr, B Fantie, Bob Uttl, M Stark, Irene Litvan, Jordan GrafmanAbstract:Objective: To describe Ideomotor Apraxia in patients with corticobasal degeneration and those with progressive supranuclear palsy, two parkinsonian disorders that are often misdiagnosed due to the overlap in their clinical features, and to determine whether systematic Apraxia testing is useful for differential diagnosis. Methods: Fourteen patients fulfilling National Institute of Neurological Disorders and Stroke–Society for Progressive Supranuclear Palsy clinical criteria for progressive supranuclear palsy, 13 patients fulfilling modified Lang criteria for corticobasal degeneration, and 12 normal healthy control subjects were given the Test of Oral and Limb Apraxia, which was scored according to the Florida Apraxia Battery for occurrence of various types of apraxic errors. Results: Both patients with progressive supranuclear palsy and corticobasal degeneration committed a greater number of apraxic errors than normal healthy control subjects on both transitive and intransitive tasks (p Conclusions: Patients with corticobasal degeneration show more severe Ideomotor Apraxia than patients with progressive supranuclear palsy, and systematic assessment of Ideomotor Apraxia facilitates the differential diagnosis between patients with progressive supranuclear palsy and those with corticobasal degeneration.
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Comparison of Apraxia in corticobasal degeneration and progressive supranuclear palsy.
Neurology, 2001Co-Authors: V Pharr, B Fantie, Bob Uttl, M Stark, Irene Litvan, Jordan GrafmanAbstract:OBJECTIVE: To describe Ideomotor Apraxia in patients with corticobasal degeneration and those with progressive supranuclear palsy, two parkinsonian disorders that are often misdiagnosed due to the overlap in their clinical features, and to determine whether systematic Apraxia testing is useful for differential diagnosis. METHODS: Fourteen patients fulfilling National Institute of Neurological Disorders and Stroke-Society for Progressive Supranuclear Palsy clinical criteria for progressive supranuclear palsy, 13 patients fulfilling modified Lang criteria for corticobasal degeneration, and 12 normal healthy control subjects were given the Test of Oral and Limb Apraxia, which was scored according to the Florida Apraxia Battery for occurrence of various types of apraxic errors. RESULTS: Both patients with progressive supranuclear palsy and corticobasal degeneration committed a greater number of apraxic errors than normal healthy control subjects on both transitive and intransitive tasks (p < 0.001 in both cases), but Apraxia was much more severe in patients with corticobasal degeneration than progressive supranuclear palsy (p < 0.001). The index of Apraxia severity, in combination with the assessment of the two key features of progressive supranuclear palsy (falls and vertical gaze palsy), correctly classified all patients. CONCLUSIONS: Patients with corticobasal degeneration show more severe Ideomotor Apraxia than patients with progressive supranuclear palsy, and systematic assessment of Ideomotor Apraxia facilitates the differential diagnosis between patients with progressive supranuclear palsy and those with corticobasal degeneration.
Cynthia Ochipa - One of the best experts on this subject based on the ideXlab platform.
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selective deficit of praxis imagery in Ideomotor Apraxia
Neurology, 1997Co-Authors: Cynthia Ochipa, Leslie Gonzalez J Rothi, Steven Z Rapcsak, Lynn M Maher, Dawn Bowers, Kenneth M. HeilmanAbstract:We studied imagery for learned, skilled movements (praxis imagery) in a patient with severe Ideomotor Apraxia and intact language abilities. This patient, who made predominantly spatial and movement errors when performing transitive movements demonstrating the use of tools (transitive gestures), was also impaired in her ability to answer imagery questions about joint movement or the spatial position of the hands during action. However, visual object imagery was spared. The finding of parallel praxis production and praxis imagery deficits in this patient suggests that the same representations used for gesture production are also activated during imagery of motor acts. Our findings also suggest that certain aspects of motor imagery may be dissociable from general object imagery.
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selective deficit of praxis imagery in Ideomotor Apraxia
Annual meeting of the International Neuropsychological Society, 1997Co-Authors: Cynthia Ochipa, Leslie Gonzalez J Rothi, Steven Z Rapcsak, Lynn M Maher, Dawn Bowers, Kenneth M. HeilmanAbstract:Article abstract-We studied imagery for learned, skilled movements (praxis imagery) in a patient with severe Ideomotor Apraxia and intact language abilities. This patient, who made predominantly spatial and movement errors when performing transitive movements demonstrating the use of tools (transitive gestures), was also impaired in her ability to answer imagery questions about joint movement or the spatial position of the hands during action. However, visual object imagery was spared. The finding of parallel praxis production and praxis imagery deficits in this patient suggests that the same representations used for gesture production are also activated during imagery of motor acts. Our findings also suggest that certain aspects of motor imagery may be dissociable from general object imagery.
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progressive Ideomotor Apraxia evidence for a selective impairment of the action production system
Brain and Cognition, 1995Co-Authors: Steven Z Rapcsak, Cynthia Ochipa, Kathleen C Anderson, Howard PoiznerAbstract:Abstract We report a patient with slowly progressive bilateral limb Apraxial associated with an asymmetrical focal degenerative process of the parietal lobes. Clinical assessment of praxis production suggested a striking deficit in controlling the spatiotemporal attributes of purposeful skilled limb movements, consistent with Ideomotor Apraxia. The precise nature of the action production impairment was further defined by objective three-dimensional computergraphic analysis of transitive movements which demonstrated significant kinematic deficits in spatial accuracy, timing, spatiotemporal coupling, and joint coordination. Gesture comprehension and discrimination were spared. Furthermore, detailed evaluation of the conceptual praxis system revealed that despite an almost complete inability to perform transitive movements accurately, abstract knowledge of tool function and action was remarkably well preserved. The critical dissociation between intact conceptual knowledge of action and impaired movement execution documented in this case points to a fundamental competence/performance dichotomy in Apraxia and provides empirical support for cognitive models of praxis that divide the action system into distinct conceptual and production subcomponents. Within this theoretical framework, our patients severe Ideomotor Apraxia is interpreted to represent a selective disruption of the action production system.
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Conceptual Apraxia in Alzheimer's disease.
Brain, 1992Co-Authors: Cynthia Ochipa, Leslie J. Gonzalez Rothi, Kenneth M. HeilmanAbstract:: Theoretical models of praxis have two major components, a praxis conceptual system that includes knowledge of tool use and mechanical knowledge and a praxis production system that includes the information needed to program skilled motor acts. Because patients with Alzheimer's disease may have an impairment of the central conceptual system, we wanted to learn if they had a conceptual Apraxia by testing their knowledge of the type of actions associated with tool use, their ability to associate tools with objects that receive their action, their ability to understand the mechanical nature of problems and the mechanical advantages tools may afford. We studied 32 subjects with probable Alzheimer's disease and 32 controls by examining tool-action relationships and tool-object associations. We tested mechanical knowledge by having subjects select alternative tools and solve mechanical puzzles by developing new tools. The Alzheimer's group was subdivided into four groups based on the presence or absence of Ideomotor Apraxia and a lexical-semantic deficit. Results indicated that each of the four Alzheimer's groups differed from normal controls on at least some measures of conceptual Apraxia, suggesting that Alzheimer's patients do have a disturbance of the praxis conceptual system and that impairment of this system is not directly related to language impairment or Ideomotor Apraxia.
