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Effectiveness of a Functional Rehabilitation Program for Upper Limb Apraxia in Poststroke Patients: A Randomized Controlled Trial

Published:January 21, 2021DOI:https://doi.org/10.1016/j.apmr.2020.12.015

      Abstract

      Objective

      To analyze the effectiveness of a home-based restorative and compensatory upper limb apraxia (ULA) rehabilitation program.

      Design

      Randomized controlled trial.

      Setting

      Neurology Unit of San Cecilio Hospital and 2 private and specialized health care centers.

      Participants

      Community dwelling participants (N=38) between the ages of 25 and 95 years old (sex ratio, 1:1) with unilateral mild-to-moderate poststroke lesions (time of evolution since stroke, 12.03±8.98mo) and secondary ULA.

      Interventions

      Participants were randomly assigned to an 8-week combined ULA functional rehabilitation group (n=19) 3 days per week for 30 minutes or to a traditional health care education protocol group (n=19) once a month for 8 weeks. Both interventions were conducted at home.

      Main Outcome Measures

      Sociodemographic and clinical data, Barthel Index (primary outcome), Lawton and Brody Scale, observation and scoring activities of daily living, the De Renzi tests for ideational and ideomotor apraxia and imitating gestures test, recognition of gestures, test for upper limb apraxia , and stroke-specific quality of life scale were assessed at 3 time points: baseline, posttreatment (8wk), and follow-up (8wk).

      Results

      There were statistically significant differences among the groups regarding ideomotor apraxia, imitating gestures, global recognition of gestures, intransitive gestures, and comprehension of gesture production (P<.05) in favor of the experimental group. However, no statistically significant differences were found between the groups regarding functionality or quality of life (P>.05). Regarding the within-group effect, statistically significant differences were found in all neuropsychological outcomes at posttreatment and follow-up (P<.05).

      Conclusion

      A functional rehabilitation program was found to be superior to a traditional health care education program and resulted in improvements in neuropsychological functioning in ULA poststroke. Conventional education showed an insufficient effect on apraxia recovery. Further studies with larger sample sizes are needed to determine the effect of rehabilitation strategies on functionality and quality of life of poststroke ULA patients.

      Keywords

      List of abbreviations:

      ADL (activities of daily living), BI (Barthel Index), IADL (Instrumental Activities of Daily Living scale), MANOVA (multivariate analysis of variance), OT (occupational therapy), QOL (quality of life), RCT (randomized controlled trial), SSQOL-38 (stroke-specific quality of life scale), THEP (traditional healthcare education protocol), TULIA (test for upper limb apraxia), ULA (upper limb apraxia)
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      Linked Article

      • Erratum
        Archives of Physical Medicine and RehabilitationVol. 103Issue 6
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          In the article by Aguilar-Ferrandiz et al, Effectiveness of a Functional Rehabilitation Program for Upper Limb Apraxia in Poststroke Patients: A Randomized Controlled Trial, published in Archives of Physical Medicine and Rehabilitation 2021;102 (5):940-50, Table 1 contained some incorrect values. The correct values are shown in the corrected version of Table 1 below.
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