4.6 Article

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

Journal

ARCHIVES OF PHYSICAL MEDICINE AND REHABILITATION
Volume 102, Issue 5, Pages 940-950

Publisher

W B SAUNDERS CO-ELSEVIER INC
DOI: 10.1016/j.apmr.2020.12.015

Keywords

Activities of daily living; Apraxias; Quality of life; Rehabilitation; Stroke; Upper extremity

Funding

  1. Fondo Social Europeo (European union)-Junta de Andalucia (Regional Government of Andalusia, Spain) youth employment initiative 2018-2019 [CTS-526]
  2. Plan Propio of University of Granada 2019-2020
  3. Programa operativo de Garantia Juvenil
  4. Department of Physical Therapy at the University of Granada (Spain)
  5. the Own Research Plan 2019 of the University of Granada [Beca de inicio a la investigacion para estudiantes de masteres oficiales del plan propio 2019 de la Universidad de Granada.]

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The study found that a functional rehabilitation program was superior to a traditional health care education program in improving neuropsychological functioning in post-stroke ULA patients. However, there were no significant differences in functionality or quality of life between the two groups. Statistically significant differences were found in all neuropsychological outcomes at posttreatment and follow-up.
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. (C) 2021 by the American Congress of Rehabilitation Medicine.

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