Systematic Review of Apraxia Treatments to Improve Occupational Performance Outcomes

Abstract

The objective was to assess effectiveness of apraxia treatments using a systematic review. In contrast to previous reviews, each study was rated as to its applicability to occupational therapy practice and its focus on occupational performance using the FAME rating system (defined by four categories: Feasibility, Appropriateness, Meaningfulness, Effectiveness). This systematic review included eight studies: four randomized controlled trials (level 1 evidence) and four pre-post designs (level 3 evidence). Three treatment approaches were reported: errorless learning with training of details; gesture training; and strategy training. FAME scores ranged from A to C. All studies reported significant treatment effects, but only one demonstrated an impact on observed occupational performance that transferred from clinic to home.

Limb Apraxias: The Influence of Higher Order Perceptual and Semantic Deficits in Motor Recovery After Stroke

“…The focus of the deficits that are targets for compensatory strategies involve patients' ADLs. 110,114,124 These strategies capitalize on the use of preserved domaingeneral cognitive processes, which are usually represented bilaterally in the brain. 125,126 Compensatory or strategy training first involves the observation of how patients with apraxia perform in their ADL tasks.…”

“…Interventions are focused on training patients with strategies such as providing instruction, assistance, or feedback to compensate for any deficits observed. 110…”

“…In the sections below, we outline some therapy options which have been trialed, noting that as shown in metaanalyses, there remains insufficient evidence for one therapy option over others, due to heterogeneity in the condition and treatments proposed. 109,110…”

“…Interventions are focused on training patients with strategies such as providing instruction, assistance, or feedback to compensate for any deficits observed. 110 Most studies involving compensatory training, which were delivered over 8 or 12-weeks, have reported benefit in ADL performance or self-report with effect sizes ranging from small (0.37 in Donkervoort et al, 124 who measured actual ADL performance) to larger (1.07 in van Heugten et al, 127 on self-reported ADL questionnaires). In the studies by Geusgens et al, 128,129 there were also transfer of training effects to other untrained ADLs.…”

“…Restorative strategies may seem to be less effective due to poor evidence base (level 3 evidence with pre-post designs), compared to strategy training (level 1 evidence with randomized controlled trials). 109,110 Two confounding factors may have affected the results, which seem in favor of compensatory strategies: (1) treatment duration: most restorative training studies involved less training time than strategy training (eg, 50-minutes training sessions in Smania et al 107 compared to 12 weeks in Donkervoort et al 124 ); and (2) the focus of training being on patient ADLs in compensatory training (versus other outcome measures rather than ADL being used in restorative training). As a result, restorative training techniques still require further evaluation to identify which ones may impact on patient’s ability to recover function on the most basic tasks for independence.…”