Transfer effects of a cognitive strategy training for stroke patients with apraxia

Abstract

The objective of this study was to evaluate transfer effects of cognitive strategy training for stroke patients with apraxia. During 8 weeks, 29 apraxic patients received cognitive strategy training to teach them how to perform activities of daily living (ADL) as independently as possible. ADL functioning was assessed at the rehabilitation centre at baseline and after 8 weeks of training. In addition, assessment took place at the patients' own homes after 8 weeks of training and 5 months after the start of the training. The performance of both trained and nontrained tasks was observed. Patients performed trained tasks and nontrained tasks at the same level of independency at the rehabilitation centre as well as at home, indicating transfer of training effects. These effects turned out to be stable over time.

The cognitive rehabilitation of limb apraxia in patients with stroke

“…The last study (Geusgens et al, 2007) by the same group reviewed here, found that 29 apraxic patients who were trained for 8 weeks acquired compensatory strategies that could be transferred to non-trained activities. Moreover, the improvement was maintained 5 months after the start of the training and was observed when patients were treated at the rehabilitation centre as well as at home.…”

“…In fact, patients improved not only in performing a wide range of gestures (Smania et al, 2006) and other outcome measures such as ADL observation or Barthel Index, but also gained functional independence from caregivers during ADLs as established by questionnaires administered to caregivers (Smania et al, 2006), occupational therapists or patients (Donkervoort et al, 2001;Geusgens et al, 2006). Moreover, while compensatory strategies led to patients' generalised improvement of the training treatment to activities that were not treated (Geusgens et al, 2007), both compensatory and restorative methods assured an enduring benefit (Geusgens et al, 2007;Goldenberg et al, 2001;Smania et al, 2006). These findings constitute a further step with respect to previous studies in which the improvement of apraxia was found to be restricted to the items included in the training programme.…”

“…The same strategy treatment was used in subsequent studies conducted by the same working group with many patients (Donkervoort et al, 2001;Geusgens et al, 2006Geusgens et al, , 2007van Heugten et al, 2000).…”

“…A different category may contain compensatory treatments, whereby the patients' spared systems/processes are exploited in order to induce strategies that compensate for the apraxic deficit (see Table 2). The more widely used compensatory method is the strategy training developed by the Dutch group (Donkervoort, Dekker, Stehmann-Saris, & Deelman, 2001;Geusgens et al, 2006;Geusgens, van Heugten, Cooijmans, Jolles, & van den Heuvel, 2007;van Heughten et al, 1998;van Heughten, Dekker, Deelman, Stehmann-Saris, & Kinebanian, 2000). Similar methods are those used to train aphasic people to communicate by means of gesturing (e.g., Cubelli, Trentini, & Mantagna, 1991;Daumüller & Goldenberg, 2010).…”

Aerobic, Resistance, and Cognitive Exercise Training Poststroke

“…However, positive transfer effects of cognitive training in performing ADLs were observed in 29 stroke patients with apraxia (duration 8 weeks; <4 weeks and >2 years poststroke). 52 Another review 53 identified only 2 small randomized trials (n=<15), with isolated improvements in trained memory task and immediate and delayed recalls.…”