Results from apraxia rehabilitation are not considered to be sufficient evidence in stroke treatment guidelines, as there are no high-quality research reports. In other words, it is necessary to consider approaches that go beyond conventional thinking.
Conventional examination and observation of apraxia have focused on the action of the primary right hand and have revealed the involvement of the left cerebral hemisphere in the conceptual aspect of the action. However, actions in daily life activities usually involve both hands, and it is necessary to consider the role of the right cerebral hemisphere involved in the motor representation of the left hand which has supporting function in almost all daily life activities. In addition, since apraxia patients with paralysis from left hemisphere damage need to perform daily activities with their intact left hand, it is meaningful to clarify the function of the right hemisphere in generating actions from the viewpoint of rehabilitation.
I would like to propose that we consider action generation not only as a left hemisphere function, but also as a mechanism of the whole brain by using the vertical process of language generation in Yamadori (1997a) and considering action generation as a motor output that goes through "judgment based on social context," "generation of action purpose," and "generation of action program" from comprehension of environment (see the Fig.1).
