Upper limb
apraxia is a common disorder associated with
stroke that can reduce patients' independence levels in
activities of daily living and increase levels of disability. Traditional rehabilitation programs designed to promote the recovery of upper limb function have mainly focused on restorative or compensatory approaches. However, no previous studies have been completed that evaluate a combined intervention method approach, where patients concurrently receive
cognitive training and learn compensatory strategies for enhancing
daily living activities.
METHODS/DESIGN: This study will use a two-arm, assessor-blinded, parallel, randomized controlled trial design, involving 40 patients who present a left- or right-sided unilateral vascular lesion poststroke and a clinical diagnosis of upper limb
apraxia. Participants will be randomized to either a combined functional rehabilitation or a traditional health education group. The experimental group will receive an 8-week combined functional program at home, including physical and
occupational therapy focused on restorative and compensatory techniques for upper limb
apraxia, 3 days per week in 30-min intervention periods. The control group will receive a conventional health education program once a month over 8 weeks, based on improving awareness of physical and functional limitations and facilitating the adaptation of patients to the home. Study outcomes will be assessed immediately postintervention and at the 2-month follow-up. The primary outcome measure will be basic
activities of daily living skills as assessed with the Barthel Index. Secondary outcome measures will include the following: 1) the Lawton and Brody Instrumental
Activities of Daily Living Scale, 2) the Observation and Scoring of
ADL-Activities, 3) the De Renzi Test for
Ideational Apraxia, 4) the De Renzi Test for
Ideomotor Apraxia, 5) Recognition of Gestures, 6) the Test of Upper Limb
Apraxia (TULIA), and 7) the Quality of Life Scale For
Stroke (ECVI-38).
DISCUSSION: This trial is expected to clarify the effectiveness of a combined functional rehabilitation approach compared to a conservative intervention for improving upper limb movement and function in poststroke patients.
TRIAL REGISTRATION: Clinical Trial Gov number NCT02199093 . The protocol registration was received 23 July 2014. Participant enrollment began on 1 May 2014. The trial is expected to be completed in March 2016.