A comparison of two approaches in the treatment of perceptual problems after stroke. The rehabilitation of limb apraxia: a study in left-brain-damaged patients.
To compare the effectiveness of the transfer of training and functional approaches in improving perceptual and functional abilities after stroke.
                Patients identified as having perceptual problems were randomly allocated to either the transfer of training approach or the functional approach for perceptual treatment. On completion of six weeks of treatment, each patient was reassessed for perceptual and functional abilities.
                Eighty inpatients on the Nottingham Stroke Unit.
                Perceptual treatment was given for 2.5 hours per week for six weeks.
                Rivermead Perceptual Assessment Battery, Barthel ADL Index and Edmans ADL index.
                There was no significant difference between the treatment groups on patient characteristics or impairments. The results also showed no significant difference between the treatment groups before and after treatment on perceptual ability total scores, individual perceptual subtest scores, or functional ability total scores (Mann-Whitney U 642.5-798.0, p > 0.05). Wilcoxon matched pairs signed ranks tests showed a significant improvement in both groups after treatment on perceptual and functional abilities (perceptual z = 6.02, p < 0.001, functional z = 6.72, p < 0.001).
                These results indicated that the improvement in perceptual abilities was equivalent using either of the two approaches. This could be due to spontaneous recovery or the effects of the Stroke Unit. To assess the effectiveness of a rehabilitative training program for patients with limb apraxia.
                Randomized, controlled trial.
                Neurologic rehabilitation unit of a university hospital.
                Thirteen patients with acquired brain injury and limb apraxia (lasting more than 2 months) as a result of lesions involving the left cerebral hemisphere. Patients were assigned to a study group or to a control group following a randomization scheme. The study group underwent an experimental training for limb apraxia. The control group received conventional treatment for aphasia.
                A behavioral training program consisting of gesture-production exercises. The rehabilitative program was made up of 3 sections dedicated to the treatment of gestures with or without symbolic value and related or nonrelated to the use of objects. Thirty-five experimental sessions, each lasting 50 minutes, were given.
                Neuropsychologic tests for assessment of aphasia, verbal comprehension, "general intelligence," oral apraxia, constructional apraxia, and 3 tests concerning limb praxic function (ideational apraxia, ideomotor apraxia, gesture recognition). Scores related to each test were used to measure the outcome. Video recordings of ideational and ideomotor apraxia tests allowed us to register type and number of praxic errors. All outcome measures, except the aphasia test, were recorded before and after the experimental (or control) treatment time interval.
                The patients in the study group achieved a significant improvement of performance in both ideational (p = .039) and ideomotor (p = .043) apraxia tests. They also showed a significant reduction of errors in ideational (p = .001) and ideomotor (p < .001) apraxia tests. A trend toward improvement was found in the gesture comprehension test (p = .058), while other outcome measures did not show any significant amelioration. Control patients did not show any significant change in performance.
                The results show the possible effectiveness of a specific training program for the treatment of limb apraxia.
There is insufficient evidence to support or refute the effectiveness of specific therapeutic interventions for motor apraxia after stroke. Further research of higher quality is required. As we did not review whether patients with apraxia benefit from rehabilitation input in general, they should continue to receive general stroke rehabilitation services.