Rehabilitation of stroke patients with apraxia: the role of additional cognitive and motor impairments.
OBJECTIVE
The present study investigated which additional cognitive and motor impairments were present in stroke patients with apraxia and which of these factors influenced the effects of treatment.


METHODS
A group of 33 patients with apraxia were treated according to the guidelines of a therapy programme based on teaching patients strategies to compensate for the presence of apraxia. Patients were treated at occupational therapy departments in general hospitals, rehabilitation centres and nursing homes. The outcome of the strategy training was studied in a pre-post test design; measurements were conducted at baseline and after 12 weeks of therapy. The pretreatment scores of the patients with apraxia were compared to normscores and scores of a control group of patients without apraxia (n = 36) to investigate which impairments are present. The following variables were analysed in order to determine which factors influence outcome: additional neuropsychological deficits (comprehension of language, cognitive impairments due to dementia, neglect and short term memory), level of motor functioning, severity of apraxia and performance on activities of daily living (ADL), and some relevant patient characteristics (gender, age, type of stroke, time since stroke, and location of treatment).


RESULTS
The results showed that the presence of apraxia is associated with the presence of additional cognitive and motor impairments. The successful outcome of strategy training was not negatively influenced by cognitive comorbidity. The outcome seemed to be more prominent in patients who were more severely impaired at the start of rehabilitation in terms of the degree of motor impairments, the severity of apraxia and the initial ADL dependence. The ADL observations, however, displayed a ceiling effect, which was taken into account in discussing the results. Demographic variables, especially age, did not predict the outcome of treatment.


CONCLUSIONS
We suggest that the effect of this training is stronger in more severely disabled patients. However, neither the presence of additional cognitive impairments nor the severity of motor problems nor old age should be an indication for refraining from treating apraxia.
van Heugten
C M
CM
Netherlands Institute of Primary Health Care (NIVEL), Utrecht. c.vanheugten@irv.nl
Dekker
J
J
Deelman
B G
BG
Stehmann-Saris
J C
JC
Kinebanian
A
A
D000203:Activities of Daily Living; D000223:Adaptation, Psychological; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D001072:Apraxias / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology / Q000523:psychology / Q000534:rehabilitation*; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D009788:Occupational Therapy / Q000379:methods*; D010353:Patient Education as Topic / Q000379:methods*; D011379:Prognosis; D015397:Program Evaluation; D011597:Psychomotor Performance; D020521:Stroke / Q000150:complications*; D016896:Treatment Outcome