Therapy of Activities of Daily Living in Patients with Apraxia

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Abstract
A test of three activities of daily living (ADL) was administered to 35 patients who had aphasia and right-sided hemiplegia after left hemisphere stroke. The number of errors correlated strongly with clinical measures of limb apraxia. Evaluation of the test distinguished between fatal errors, which prevented successful completion of the activity, and reparable errors. Fifteen patients who had made fatal errors on at least two of the three activities were admitted to a therapy study: each week they completed an ADL test. Between tests, one of the three activities was trained whereas maximal support but no therapeutic advice was given when the patients had to perform the other activities in their daily routines. In the following week anotheractivity was trained, and in the thirdweek the remaining activity. The cycle was repeated if there were still fatal errors after a first run. At the end of therapy, 10 of the patients could perform all three activities without fatal errors, and three made only one fatal error. Fatal errors were eliminated exclusively in the weeks when an activity was trained. The absence of any simultaneous improvement in non-trained activities indicates that there was no generalisation of training effects from trained to non-trained activities. We were able to re-examine seven patients more than six months later. The success of ADL training was preserved only in those patients who had practised the activities in their daily routines at home. The results are discussed in relation to a distinction between knowledge about prototypical use of familiar objects and the ability to infer directly function from structure. We believe that ADL training taught the patients “instructions of use” adapted to the constraints posed by hemiplegia but did not restore their ability to solve mechanical problems by inferring functions from structure.

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