This study describes change in functional performance and self-perception after participation in combined training with physical practice followed by mental practice. The patient was a 44-yr-old White man who experienced a single left ischemic stroke 7 mo before enrollment in the study. He engaged in physical and mental practice of two functional tasks: (1) reaching for and grasping a cup and (2) turning pages in a book with the more-affected arm. Practice took place 3 times per week during 60-min sessions for 6 consecutive wk. Primary outcome measures were the Arm Motor Ability Test (AMAT) and the Canadian Occupational Performance Measure (COPM). An abbreviated version of the Florida Apraxia Battery gesture-to-verbal command test approximated severity of ideomotor apraxia. After intervention, the patient demonstrated increased functional performance (AMAT) and self-perception of performance (COPM) despite persistent ideomotor apraxia. The results of this single-case report indicate functional benefit from traditional rehabilitation techniques despite comorbid, persisting ideomotor apraxia.

Objective Mental practice has been suggested as an adjunctive therapy to physical practice in stroke, but ensuring actual engagement is one of the challenges clinical settings may encounter. The purpose of this study is to determine whether chronometry is appropriate for monitoring engagement in mental practice by comparing the time taken for individuals with chronic stroke to mentally and physically practice 5 tasks. Method Eighteen stroke participants were allotted 120 seconds to rehearse each task: reaching for and grasping a cup, turning a page in book, comb hair, writing, and eating with a spoon. The participants mentally and physically practiced tasks 3 times with each arm. Time to complete tasks was recorded for each of the 3 trials per task. Results Statistical analyses revealed that participants required significantly less time to mentally practice versus physically practice tasks, especially among patients with hemorrhagic stroke (p < 0.05). Conclusions Since there was not agreement between the time taken to mentally and physically practice the tasks, chronometry does not appear to be valid for monitoring mental practice use in this population. However, participants appear to validly represent deficits in the more-affected versus less-affected arms during mental practice, although the extent of motor deficit may be underestimated.

Although conventional paretic upper extremity training strategies are ineffective in patients at this level, electrical stimulation training incorporating a neuroprosthesis appears promising.

This study of acute patients found those with apraxia to be significantly less independent upon admission to inpatient rehabilitation compared to patients without apraxia. Although both groups improved a similar amount during rehabilitation, patients with apraxia discharged at a level of independence comparable to patients without apraxia upon admission. Such disparity in independence is of concern, and apraxia as a factor in stroke rehabilitation and recovery deserves further attention.

Date Presented 4/8/2016 This study evaluated tooth-brushing ability in people after left stroke, using their ipsilateral, nondominant, left limb. Rehabilitation of the ipsilateral hand and specific skills such as tooth brushing warrants additional consideration. Primary Author and Speaker: Andy Wu Additional Authors and Speakers: Dua’a Alwawi, Bonnie Branson