AXIAL MOVEMENTS ARE RELATIVELY PRESERVED WITH RESPECT TO LIMB MOVEMENTS IN APHASIC PATIENTS Robert E. Hanlon, Daniel Mattson, Jason A. Demery and Alexander W. Dromerick (Department of Neurology, Washington University School of Medicine) ABSTRACT Apraxia is commonly manifested during the acute stage following left hemisphere cerebrovascular accident and typically co-occurs with aphasia. We examined 30 acute stroke patients with aphasia and apraxia in order to determine if such patients show evidence of preservation of selective subclasses of movements. Although Geschwind noted the preservation of axial movements to command in aphasic apraxic patients, his views were subsequently refuted. However, we found that aphasic apraxic patients of varying degrees of severity, including patients with global aphasia, showed relative preservation of axial movements to command and imitation. Theoretical interpretations and implications for acute neurologic rehabilitation are discussed. Key words: apraxia, aphasia, stroke INTRODUCTION Despite recent attempts to provide updated definitions of the disorder (Alexander, Baker, Naeser et al., 1992; Heilman and Gonzalez-Rothi, 1993; Hanlon and Brown, 1994; Schnider, Hanlon, Alexander and Benson, 1997), the clinical manifestations of apraxia remain confusing to many clinicians. One controversial issue in the study of apraxia entails the preservation of axial movements, relative to limb movements. Geschwind (1975) noted that aphasic patients with apraxia often demonstrate the relative preservation of axial movements (i.e., eye, neck, trunk, and whole body movements) to command, despite showing marked comprehension deficits and limb apraxia. He proposed that axial movements involving the trunk and midline structures, including the eyes, are preserved because such movements are mediated by nonpyramidal motor systems, unlike appendicular movements which are mediated by the pyramidal motor system. However, he also hypothesized that the right hemisphere may have a special capacity for the comprehension of axial commands and that such specialization may be due to a phylogenetically older capacity of both hemispheres to comprehend axial commands, which evolved prior to the development of cerebral dominance. Cortex, (1998) 34, 731-741