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case_images: Diffusion-weighted MRI showing acute ischemic stroke lesions. Axial DWI on day 12 post-onset reveals hyperintense ischemic lesions (yellow arrows) in the left temporal and parietal lobes. (A-D) Lesions are visible in the posterior superior temporal gyrus (Wernicke's area) and the middle temporal gyrus. (E-H) Involvement extends to the left parietal lobe, specifically affecting the supramarginal and angular gyri, which are linked to praxis and action sequencing. (I-L) Lesions are also observed near the parietal cortex, close to the sensorimotor area, correlating with motor deficits and apraxia symptoms. These findings align with the patient's severe receptive aphasia, apraxia, and motor planning impairments. An MRI was taken on the second day of illness, but the image quality was poor, and the MRI on the 12th day clearly showed an infarct lesion in the parietal lobe and an infarction in the temporal lobe. Therefore, I posted a 12-day MRI scan.. MRI: magnetic resonance imaging; DWI: diffusion-weighted imaging
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case_images: FIG1
case_images: On day 12, diffusion-weighted magnetic resonance imaging (MRI) revealed infarcts extending from the parietal lobe (supramarginal gyrus and angular gyrus) to the temporal lobe (Wernicke's area, superior temporal gyrus, and parts of the temporal pole) (Figure 1).
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case_images: Timeline of gesture training and sequencing tasks during rehabilitation. The timeline illustrates the structured rehabilitation program from day 22 to day 147 post-onset. Gesture training, starting on day 22, targeted intransitive and transitive gestures essential for ADLs. Sequencing tasks were introduced on day 28, focusing first on oral care, followed by body washing (day 61) and hair washing (day 71). On day 103, a selection task combining text cards and photographs was added to further improve cognitive integration and task execution. This timeline highlights the progression of interventions aimed at enhancing gesture performance, action sequencing, and functional independence.. ADLs: activities of daily living
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case_images: FIG2
case_images: The intervention content and timeline are summarized in Figure 2.
case_images: Photographs of intransitive and transitive gestures used in gesture training. (A) Intransitive gestures involve tool-free movements, such as waving (1) and bowing (2). (B) Transitive gestures require tools and are critical for ADLs, including brushing teeth (3), eating with chopsticks (4), washing the face (5), combing hair (6), and shaving with an electric razor (7). Patients performed these gestures by referencing the photographs. Errors were corrected through therapist demonstrations, imitation, or stepwise manual guidance to ensure accuracy. Emphasis was placed on transitive gestures to reinforce ADL-related motor planning and facilitate functional recovery.. Images are used under license, and no additional attribution is required as per photoAC's terms of use. Photo source:photoAC (https://www.photo-ac.com/). ADLs: activities of daily living
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case_images: FIG3
case_images: However, Figure 3 presents seven representative examples from this set: photos 1-2 (intransitive gestures) and photos 3-7 (selected transitive gestures).
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case_images: Photographs and text cards used in sequencing and text card matching tasks. Photographs and text cards were utilized in sequencing and text card matching tasks to improve action planning and execution. (A, B) Oral care tasks, including steps such as "apply toothpaste to the toothbrush," "brush teeth," and "rinse mouth." (C, D) Body washing tasks, illustrating steps like "apply soap to a towel," "wash the body," and "rinse off the foam with a shower." In the sequencing task, patients arranged the photographs and text cards in the correct order to match procedural steps. In the text card matching task, patients matched individual text cards to corresponding photographs presented on a tabletop. These tasks reinforced stepwise cognitive integration and functional sequencing of ADLs. . All photographs and text cards were created by the authors.. ADLs: activities of daily living
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case_images: FIG4
case_images: Gesture training was further integrated into this phase, requiring the patient to identify and execute gestures corresponding to the photographs and to match text cards to the appropriate steps (Figure 4).
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