title: Functional rehabilitation of upper limb apraxia in poststroke patients: study protocol for a randomized controlled trial.
abstract: BACKGROUND
  Upper limb apraxia is a common disorder associated with stroke that can reduce patients' independence levels in activities of daily living and increase levels of disability. Traditional rehabilitation programs designed to promote the recovery of upper limb function have mainly focused on restorative or compensatory approaches. However, no previous studies have been completed that evaluate a combined intervention method approach, where patients concurrently receive cognitive training and learn compensatory strategies for enhancing daily living activities.
  
  
  METHODS
  This study will use a two-arm, assessor-blinded, parallel, randomized controlled trial design, involving 40 patients who present a left- or right-sided unilateral vascular lesion poststroke and a clinical diagnosis of upper limb apraxia. Participants will be randomized to either a combined functional rehabilitation or a traditional health education group. The experimental group will receive an 8-week combined functional program at home, including physical and occupational therapy focused on restorative and compensatory techniques for upper limb apraxia, 3 days per week in 30-min intervention periods. The control group will receive a conventional health education program once a month over 8 weeks, based on improving awareness of physical and functional limitations and facilitating the adaptation of patients to the home. Study outcomes will be assessed immediately postintervention and at the 2-month follow-up. The primary outcome measure will be basic activities of daily living skills as assessed with the Barthel Index. Secondary outcome measures will include the following: 1) the Lawton and Brody Instrumental Activities of Daily Living Scale, 2) the Observation and Scoring of ADL-Activities, 3) the De Renzi Test for Ideational Apraxia, 4) the De Renzi Test for Ideomotor Apraxia, 5) Recognition of Gestures, 6) the Test of Upper Limb Apraxia (TULIA), and 7) the Quality of Life Scale For Stroke (ECVI-38).
  
  
  CONCLUSIONS
  This trial is expected to clarify the effectiveness of a combined functional rehabilitation approach compared to a conservative intervention for improving upper limb movement and function in poststroke patients.
  
  
  BACKGROUND
  Clinical Trial Gov number NCT02199093 . The protocol registration was received 23 July 2014. Participant enrollment began on 1 May 2014. The trial is expected to be completed in March 2016.
authors.affiliation: Department of Physical Therapy, University of Granada (UGR), Granada, Spain. josemapm@ugr.es.
authors.forename: Jose Manuel
authors.initials: JM
authors.lastname: Pérez-Mármol
authors.affiliation: Department of Physical Therapy, University of Granada (UGR), Granada, Spain. mcgrios@ugr.eses.
authors.forename: M Carmen
authors.initials: MC
authors.lastname: García-Ríos
authors.affiliation: Hospital Clínico San Cecilio, Granada, Spain. fjbarreroh@ugr.eses.
authors.forename: Francisco J
authors.initials: FJ
authors.lastname: Barrero-Hernandez
authors.affiliation: Department of Nursing and Physical Therapy, University of Almeria (UAL), Almeria, Spain. guada_805@hotmail.comes.
authors.forename: Guadalupe
authors.initials: G
authors.lastname: Molina-Torres
authors.affiliation: Department of Occupational Therapy, School of Primary Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia. ted.brown@monash.edues.
authors.forename: Ted
authors.initials: T
authors.lastname: Brown
authors.affiliation: Department of Physical Therapy, University of Granada (UGR), Granada, Spain. encaguilar@hotmail.com.|Fisioterapia, Universidad de Granada, Granada, Spain. encaguilar@hotmail.com.
authors.forename: María Encarnación
authors.initials: ME
authors.lastname: Aguilar-Ferrándiz
mesh_terms: D000203:Activities of Daily Living; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001072:Apraxias / Q000175:diagnosis / Q000503:physiopathology / Q000534:rehabilitation*; D002985:Clinical Protocols; D003131:Combined Modality Therapy; D004185:Disability Evaluation; D004311:Double-Blind Method; D005260:Female; D007839:Functional Laterality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009043:Motor Activity; D009788:Occupational Therapy; D026741:Physical Therapy Modalities; D020127:Recovery of Function; D012107:Research Design; D013030:Spain; D020521:Stroke / Q000175:diagnosis / Q000503:physiopathology; D000071939:Stroke Rehabilitation; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome; D034941:Upper Extremity / Q000294:innervation*