A combined therapy for limb apraxia and related anosognosia

Abstract

Left hemisphere stroke frequently leads to limb apraxia, a disorder that has been reported to impact independence in daily life and rehabilitation success. Nonetheless, there is a shortcoming in research and availability of applicable trainings. Further, to date, anosognosia for limb apraxia has largely been neglected. Therefore, we developed a Naturalistic Action Therapy that trains object selection and application with an errorless learning approach and which includes supported self-evaluation. The current study presents the results of two stroke patients participating in the training. The procedure entailed two baseline and one post-training sessions including standardized limb apraxia and anosognosia assessments as well as 18 naturalistic action tasks. The training consisted of 15 sessions during which 4-6 of the 18 naturalistic action tasks (e.g., pour water into a glass, make a phone call) were trained. Both patients showed improvement in trained and untrained tasks as well as in standardized apraxia and anosognosia assessments. Training effects appeared strongest for the trained items. The procedure is documented in detail and easy to administer and thus may have the potential to be applied by relatives. The results of this pilot-study are promising and suggest that the approach is suitable for further evaluation.

Anosognosia for limb and bucco‐facial apraxia as inferred from the recognition of gestural errors

“…Finally, it is interesting to note that in contrast to AHP, the judgements of the apraxic participants did not change when they watched themselves performing the action in a video (Canzano et al , 2014). Thus, it seems that neither the observation perspective (the first or third person perspectives, Besharati, Kopelman, Avesani, Moro, & Fotopoulou, 2015; Fotopoulou, Rudd, Holmes, & Kopelman, 2009) nor the attempt to act (D'Imperio, Bulgarelli, Bertagnoli, Avesani, & Moro, 2017; Moro, Scandola, Bulgarelli, Avesani, & Fotopoulou, 2015; but see Buchmann et al , 2019) modulates AA.…”

Interventions to improve the occupational performance of people with post stroke upper limb apraxia – A systematic review and meta-analysis

“…Recent studies excluded from this review due to study design included a study of Naturalistic Action Therapy that trains object selection and application with an errorless learning approach (Buchmann et al, 2019), an evaluation of occupational therapy delivered combined training with physical practice followed by mental practice (e.g. reaching for a cup with a person-specific graded approach followed by mental practice of the same task using an audiotape) (Wu et al, 2011) and an action semantics intervention which targets the action knowledge deficit observed in many individuals with apraxia by strengthening the associations between tools, their related actions and other information in a putative semantic network (Stoll et al, 2020).…”

“…These studies may indicate future directions in the field of post-stroke limb apraxia rehabilitation. Of concern, it is not clear who delivered the intervention in the studies by Buchmann et al (2019) and Stoll et al (2020). Reporting guidelines for intervention studies specify that the expertise, background and training of those who provided/delivered the intervention should be reported (Hoffman et al, 2014).…”

Apraxie

“…In einer erfolgversprechenden Pilotstudie von Buchmann et al 27 wurde ein ähnlicher Ansatz eingesetzt. Der Ansatz beinhaltet jedoch zusätzlich zum Training verschiedener Alltagsaktivitäten die Selbstevaluation von Defiziten und Erfolgen sowie Rückmeldungen der Therapeut*innen 28 .…”