A new bedside test of gestures in stroke: the apraxia screen of TULIA (AST)
A new bedside test of gestures in stroke: the apraxia screen of TULIA (AST)
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DOI：
10.1136/jnnp.2010.213371
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发表时间：
2011-04-01
影响因子：
11
通讯作者：
Bohlhalter, S.
中科院分区：
文献类型：
--
作者：
Vanbellingen, T.;Kersten, B.;Bohlhalter, S.
背景脑卒中患者的失用症可能被忽视，因为笨拙和手势交流不足通常归因于经常共存的感觉运动缺陷和失语症。通过床旁测试早期可靠地检测失用症与卒中患者的功能结局相关。本研究的目的是在上肢失用综合标准化测试（TULIA）的基础上，构建一种新的失用症床旁筛查测试，称为TULIA失用症筛查（AST）。（48个手势），本研究采用经典的测验理论方法，在脑卒中患者（n=133）和匹配的健康对照（n=50）的较大样本上进行。逐步消除的项目导致一组12个项目，表现出较高的内部一致性（克朗巴赫α =0.92）。TULIA的6分评分方法分为通过和不通过两个评分级别。在本研究的第二部分中，AST的有效性进行了前瞻性评估，在一个新的队列中的中风患者（n=31）通过使用皮尔逊相关分析和二元分类显示与TULIA.Results和讨论验证的12项AST与TULIA显示了显着的诊断可靠性与高特异性，敏感性和阳性预测值，失用症的存在和严重程度。AST被证明是中风患者可靠和有效的床边测试，允许在几分钟内直接评估失用症。
Background Apraxia in patients with stroke may be overlooked, as clumsiness and deficient gestural communication are often attributed to frequently coexisting sensorimotor deficits and aphasia. Early and reliable detection of apraxia by a bedside test is relevant for functional outcome in patients with stroke. The present study was aimed at constructing a new bedside screening test for apraxia, called the Apraxia Screen of TULIA (AST), based on the comprehensive standardised Test for Upper-Limb Apraxia (TULIA).Methods First, an item-reduction analysis of the TULIA (48 gestures) was performed, based on the methods of classical test theory and on a larger sample of patients with stroke (n=133) and matched healthy controls (n=50). Stepwise elimination of items resulted in a set of 12 items, demonstrating high internal consistency (Cronbach alpha=0.92). The six-point scoring method of the TULIA was dichotomised to the score levels pass and fail. In the second part of this study the validity of the AST was assessed prospectively in a new cohort of patients with stroke (n=31) by using the Pearson correlation analysis and binary classification display with the TULIA.Results and discussion Validation of the 12-item AST with the TULIA showed a remarkable diagnostic reliability with high specificity, sensitivity and positive predictive value, for the presence and severity of apraxia. The AST is shown to be a reliable and valid bedside test in patients with stroke, allowing a straightforward assessment of apraxia within a few minutes.