Role of semantic control of action in the comprehensive rehabilitation of patients recovering from prolonged post-traumatic coma.
BACKGROUND
Apraxia, broadly understood as the acquired inability to perform learned, skilled movements not caused by paresis or incomprehension, occurs with greater frequency among patients recovering from prolonged post-traumatic coma than has previously been reported. The present article prevents an evaluation of the effectiveness of a rehabilitation program called Semantic Priming, aimed at rebuilding praxis in these patients.


METHODS
Out of a consecutive series of 51 patients with post-traumatic coma lasting longer than 4 weeks treated at the centers represented by the authors, 24 were found to have pathological scores on the Boston Test of Praxis. These patients were divided into two matched groups, of whom the experimental group received the Semantic Priming program (involving the systematic use of verbal cues to prime movement activation patterns), and the control group did not. Progress was measured by the Boston Test of Praxis and a test developed by the authors on the basis of Luria's procedure for testing praxis.


RESULTS
After 5 weeks of therapy the patients in the experimental group showed significantly greater improvement in all measured parameters (p<0.001).


CONCLUSIONS
Apraxia in the broader sense is a more common problem among post-coma patients than heretofore recognized, and causes concrete problems in rehabilitation and adjustment to daily living. Our program based on the use of semantic priming of activation proved to be highly successful in remediating apraxia in these patients.
Pachalska
Maria
M
Department of Medical Rehabilitation, Cracow Rehabilitation Center, Cracow, Poland. fundacja@alpha.net.pl
Talar
Jan
J
MacQueen
Bruce
B
D000203:Activities of Daily Living; D000293:Adolescent; D000328:Adult; D001072:Apraxias / Q000534:rehabilitation*; D001930:Brain Injuries; D020207:Coma, Post-Head Injury / Q000534:rehabilitation*; D003463:Cues; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009415:Nerve Net; D009483:Neuropsychological Tests; D012660:Semantics; D016896:Treatment Outcome; D014705:Verbal Behavior