national-clinical-guidelines-for-stroke-fourth-edition

● have the impairment explained to them, their carers and their treating team
● be offered a perceptual intervention, ideally within the context of a clinical
trial.
6.42.2 Sources
A Consensus
B Bowen et al 2011; consensus
6.43 Apraxia
Apraxia is an inability to perform purposeful actions such as using everyday tools (called
transitive actions) and/or making meaningful gestures not involving tools (called
intransitive actions). It is the loss or disturbance of the conceptual ability to organise
actions to achieve a goal. People with apraxia often have difficulty carrying out everyday
activities such as making a hot drink despite adequate muscle strength and sensation.
They may also have difficulties in selecting the right object at the right time and/or in
using objects (such as a spoon) correctly. It is usually associated with damage to the left
cerebral hemisphere, although it can arise after right hemisphere damage (see section
6.20.3).
Evidence to recommendations
A high-quality systematic review examined the evidence for strategy training, transfer of
training and gesture training (West et al 2008). There was insufficient evidence to
support or refute the effectiveness of any intervention. There have been no subsequent
high-quality research studies to alter that conclusion. Case series research suggests that
the types of observed action errors are important clues for the type of retraining needed
(Sunderland et al 2006). Future research needs to provide detailed descriptions of the
interventions and measure the impact on everyday function.
6.43.1 Recommendations
A Any person who has difficulties in executing tasks despite apparently adequate limb
movement should be assessed formally for the presence of apraxia.
B Any person found to have apraxia should:
6.43.2 Sources
● have their profile of impaired and preserved action abilities determined using a
standardised approach (eg Test of Upper Limb Apraxia (TULIA))
● have the impairment and the impact on function explained to them, their family,
and their treating team
6 Recovery phase from impairments and limited activities: rehabilitation
● be given therapies and/or taught compensatory strategies specific to the deficits
identified ideally in the context of a clinical trial.
A Consensus
B Vanbellingen et al 2010; Vanbellingen et al 2011; West et al 2008
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