Assessment and therapy of complex activities of daily living in apraxia
Assessment and therapy of complex activities of daily living in apraxia
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DOI：
10.1080/09602010042000204
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发表时间：
2001-05-01
影响因子：
2.7
通讯作者：
Hagmann, S
中科院分区：
文献类型：
--
作者：
Goldenberg, G;Daumüller, M;Hagmann, S
对六名左半球梗死后慢性失用症患者、六名左半球梗死但无失用症的患者以及仅使用左手的对照组进行了四项复杂的日常生活活动（ADL）评估，例如准备咖啡或固定和启动录音机。性能进行了评级的错误数量和完成任务所需的援助量，并对错误进行分类。虽然有良好的评分员之间的协议的错误总数和援助金额，错误分类的可靠性低。失用症患者比没有失用症的左脑损伤患者有更多的困难，而左脑损伤患者又比健康对照组有更多的困难。两种治疗方法进行了比较：直接训练的活动的基础上的指导性能的整个活动和探索训练，旨在教导患者的结构功能关系的正确性能，但不涉及实际完成的活动。在初始基线期间，通过重复测试未经训练的活动，性能得到改善，但在其他活动的训练期间，错误或未经训练的活动所需的协助量没有减少。探索训练对表现没有影响，而直接训练的活动减少了错误和需要帮助。训练效果在随访时基本保持不变，但当训练活动与部分不同的对象进行测试时，错误率增加。由于治疗结果仅限于训练活动，甚至在某种程度上仅限于用于训练的对象，因此复杂ADL的治疗应根据患者及其亲属的特定需求和愿望进行调整，并且它应该尽可能地与患者的日常生活的正常程序联系在一起。
Four complex activities of daily living (ADL) such as preparing coffee or fixing and starting a tape recorder were assessed in six patients with chronic apraxia after left hemisphere infarction, six patients with left hemisphere infarction but without apraxia, and controls using only their left hand. Performance was rated for the number of errors and for the amount of assistance needed to complete the task, and errors were categorised. Whereas there was good inter-rater agreement on the total numbers of errors and amount of assistance, reliability of error categorisation was low. Apraxic patients had more difficulties than left brain damaged patients without apraxia, who in turn had more difficulties than the healthy controls.The six apraxic patients were part of a therapy study aimed at restoring the ability to perform the four ADL. Two methods of treatment were compared: Direct training of the activity based on the guided performance of the whole activity and exploration training aimed at teaching the patient structure-function relationships underlying correct performance but which did not involve actual completion of the activity. Performance improved with repeated testing of untrained activities during an initial baseline, but there was no reduction of errors or amount of assistance required for untrained activities during training of other activities. Exploration training had no effect on performance, whereas direct training of the activity reduced errors and need for assistance. Training effects were largely preserved at follow up, but the rate of errors increased when the trained activities were tested with a partially different set of objects.As therapeutic results were restricted to the trained activity and to some degree even to the very objects that were used for training, therapy of complex ADL should be tailored to the specific needs and desires of patients and their relatives, and it should be tied as closely as possible to the normal routine of the patient's daily life.