Functional rehabilitation of upper limb apraxia in poststroke patients: study protocol for a randomized controlled trial

Abstract

BackgroundUpper 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/DesignThis 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).DiscussionThis 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.Trial registrationClinical 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.Electronic supplementary materialThe online version of this article (doi:10.1186/s13063-015-1034-1) contains supplementary material, which is available to authorized users.

Prognostic Factors of Functional Recovery from Left Hemispheric Stroke

“…Evidence predicting stroke outcome by side of hemisphere is still inconclusive from previous studies. Considering terms of anatomical and hemodynamic aspects, left-sided hemispheric infarction, both atherosclerotic and cardioembolic stroke with underlying hypertension, has been revealed as being more frequent and more severe and having worse outcome than right-sided hemispheric infarction [ 10 , 19 ]. This could be due to higher intima-media thickness and mean flow velocity of circulation in the left carotid artery, which reflects greater hemodynamic stress in the left cerebrovascular system and finally enhances atherogenesis, as evidenced from hemodynamic study [ 20 ].…”

“…Apraxia is the inability to perform skilled and purposeful motor tasks despite having the physical ability to do. This phenomenon was assessed by observing patient behavior such as inability to perform purposeful movements, errors when asked to demonstrate how to use an object or common instruments, and problems imitating abstract and symbolic gestures (e.g., wave goodbye and salute like a soldier) [ 19 ]. Speech and communication impairment were assessed by difficulty in fluency, comprehension, and repetition.…”

Prognostic Factors of Functional Outcome Assessed by Using the Modified Rankin Scale in Subacute Ischemic Stroke

“…line bisection or copy drawing test) [19]. Apraxia was assessed by observing patients’ characteristics, including an inability to perform purposeful movements with one’s arms or hands, errors when asked to demonstrate how to use an object or how to carry out actions involving a single or series of components of movements, and problems imitating abstract and symbolic gestures [20]. Speech and communication impairment were assessed via the problems in fluency, comprehension and repetition.…”

Abordagens específicas da Terapia Ocupacional na Reabilitação após acidente vascular encefálico/Specifc approaches of Occupational Therapy in the rehabilitation after Stroke

“…Os resultados aqui destacados demostram certa relevância em associar diferentes abordagens da Terapia Ocupacional no decorrer da reabilitação, nesse caso a Cinesioatividade e o treino de AVD, utilizados no presente estudo. Este último reconhecido por prover ganhos ao desempenho ocupacional, retomada de papeis, hábitos e rotina de forma mais independente possível, como compreendido da literatura 15 .…”