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Outcome of strategy training in stroke patients with apraxia: a phase II study
C M van Heugten1, J Dekker, B G Deelman
1Netherlands Institute of Primary Health Care and the Institute for Rehabilitation Research, Hoensbroek.
Objective:
Evaluation of a therapy programme for stroke patients with apraxia. The programme is based on teaching patients strategies to compensate for the presence of apraxia. This programme was designed for assessment and treatment by occupational therapists.
Design:
The outcome was studied in a pre-post test design. Measurements were conducted at baseline and 12 weeks later.
Subjects:
Thirty-three stroke patients with apraxia were treated at occupational therapy departments n general hospitals, rehabilitation centres and nursing homes.
Main Outcome Measures:
The following measurements were conducted: an apraxia test, a motor functioning test, observation of activities of daily living (ADL), Barthel Index, and an ADL questionnaire for the therapist and the patient.
Results:
The patients showed large improvements in ADL functioning on all measures and small improvements on the apraxia test and the motor functioning test. The effect sizes for the disabilities, ranging from 0.92 to 1.06, were large compared to the effect sizes for apraxia (0.34) and motor functioning (0.19). The significant effect of treatment is also seen when individual improvement and subjective improvement are considered. Measured with the Barthel Index for instance, 71% of the patients improved.
Conclusions:
These results suggest that the programme seems to be successful in teaching patients compensatory strategies that enable them to function more independently, despite the lasting presence of apraxia.