From the Guidelines
Conceptual apraxia is a condition that significantly impacts daily life activities, and despite its incidence, there is a paucity of research on therapeutic interventions, with current evidence suggesting that interventions may have immediate postintervention improvements but limited lasting advantages 1. When considering the management of conceptual apraxia, it's essential to understand that it is characterized by the inability to perform purposeful, skilled movements, which cannot be attributed to hemiplegia or lack of effort. This condition is more common after left hemispheric stroke than right hemispheric stroke. The current guidelines for adult stroke rehabilitation and recovery from the American Heart Association/American Stroke Association highlight the association between apraxia and reduced independence in daily life activities 1.
Key Points in Management
- The condition affects daily life function, contrary to traditional beliefs.
- Therapeutic interventions for limb apraxia are limited, with few systematic reviews and no recent RCTs published since 2005.
- Some studies suggest immediate postintervention improvements on apraxia tests or in daily life activities, but lasting advantages for the trained groups are rare.
- Rehabilitation therapy, including occupational therapy with functional training, may be beneficial, although the evidence is not strong.
Given the limited evidence and the potential for immediate postintervention improvements, rehabilitation therapy, including occupational therapy, should be considered for patients with conceptual apraxia, focusing on functional training and repetitive practice with everyday objects 1. However, it's crucial to set realistic expectations regarding the potential for lasting improvements. Early intervention is vital, as it may help develop new neural pathways through neuroplasticity, potentially allowing the brain to adapt and recover some lost function.
From the Research
Definition and Characteristics of Conceptual Apraxia
- Conceptual apraxia is a cognitive-motor planning disorder that affects an individual's ability to perform purposeful and skilled movements, despite the absence of sensory or motor loss 2.
- It is characterized by an inability to plan and execute complex movements, resulting in difficulties with activities of daily living (ADL) 2, 3.
- Conceptual apraxia can occur after stroke, with studies suggesting that it affects 20% of right brain-damaged patients and 50% of left brain-damaged patients 4.
Diagnosis and Assessment of Conceptual Apraxia
- The diagnosis of conceptual apraxia relies mainly on exclusion criteria, such as elementary motor or sensory deficits, and aphasia 5.
- However, the diversity of apraxia definitions and assessment methods can make diagnosis challenging, and patients may or may not show apraxia depending on the chosen assessment method or theory 5.
- Researchers suggest focusing on symptoms and using two complementary definition criteria: specificity and consistency, to improve diagnosis and definition of conceptual apraxia 5.
Treatment and Rehabilitation of Conceptual Apraxia
- Various interventions are used to treat conceptual apraxia, including strategy training, physiotherapy, and speech therapy 2, 4, 3.
- Strategy training is an evidence-based standardized occupational therapy program that teaches patients compensatory strategies to improve ADL performance 2.
- However, the effectiveness of specific therapeutic interventions for conceptual apraxia is still uncertain, and further research is needed to determine the best approach 4, 3.