Upper Limb Apraxia Is Related to Role Participation Among Patients With Mild to Moderate Stroke

Poststroke, patients often experience decreased role participation, partially because of cognitive impairment. However, the potential relationship between upper limb apraxia (ULA), a cognitive dysfunction, and role participation remains unclear.

To evaluate whether ULA is related to role participation among patients with mild to moderate stroke.

Cross-sectional study.

Randomly selected Spanish public primary care centers.

One hundred fifty-three patients with mild to moderate poststroke.

Role participation was assessed with the Role Checklist; ULA, with the TULIA Apraxia test and the ADL Observations scale. ULA construct included the components of nonsymbolic imitation, intransitive imitation, transitive imitation, nonsymbolic pantomime, intransitive pantomime, transitive pantomime, and praxis function in daily life activities. Regression analyses were conducted to assess the potential relationship between ULA and role participation.

Transitive pantomime explained 20.5% of the variance of the current level of role participation, R2 = .205, F(3, 152) = 12.795, p < .001. Nonsymbolic imitation and transitive imitation explained 15.8% of the variance in changes in role participation after stroke, R2 = .158, F(4, 152) = 6.957, p < .001. Intransitive pantomime accounted for 17.8% of the variance in expectations for future role participation, R2 = .178, F(3, 152) = 10.776, p < .001. Nonsymbolic imitation and intransitive pantomime explained 16.2% of the variance of the assigned value to role participation, R2 = .162, F(4, 152) = 7.170, p < .01.

ULA is related to role participation after mild to moderate stroke. These findings serve as the foundation for designing and developing novel clinical interventions in occupational therapy. Plain-Language Summary: After a stroke, patients often experience difficulties participating in roles that provide a sense of purpose in daily activities. This decrease in participation is partly because of cognitive factors. Upper limb apraxia (ULA) is a cognitive sequela of stroke that hinders the ability to perform deliberate and essential movements. ULA can affect daily life by posing challenges in the execution of daily tasks and activities, which can affect a person's independence, participation, and community reintegration. Because ULA is a cognitive dysfunction that affects intentional movements, this study investigated the potential relationship between ULA and role participation. Based on the evaluation of 153 patients with mild to moderate poststroke, the results revealed that ULA is associated with role participation after a stroke. These findings serve as the foundation for occupational therapists to design and develop novel clinical interventions.