This project explored two main areas: the assessment of apraxia and the intervention effectiveness in rehabilitation of the apraxic condition. This was achieved through a group study and a series of single case designs. Three experimental groups were used to investigate clinical tests and the kinematics ofmovement~ apraxic (n=17) and non-apraxic (n=13) left hemisphere damaged patients, and normal control subjects (n=ll). Using computergraphic techniques, the data provided evidence of disruption to the temporalspatial aspects of movement in apraxic people, which was not related to modality of testing, though some normal kinematic profiles were found within the apraxic group. Clinical assessments used to identify apraxia showed no relationship one with another which suggested each was identifying different aspects, or sub-types of a heterogeneous condition. Some tests were found to have low internal consistency, though inter-rater reliability through the observer-judgment process was high. A test devised for identifying agnosia was shown to relate to possible cognitive-perceptual processes or intact vision-to-action routes in the apraxic movement output. Dissociations found between clinical assessments for apraxia and kinematics of movement were explained in relation to different compensatory movement strategies employed by the apraxic patients, and/or as evidence for possible 'sub-types' of the apraxic condition. Analysis also suggested that different task demands might determine compensatory movement strategies and produce altered movement kinematics. This group study was followed by a series of single cases, two of which charted the 'natural history' process in recovery of apraxia using task performance and kinematic analysis as outcome measures. Evidence for spontaneous recovery over a six week period was shown in one case. Four single case ABA design investigations were then carried out on individuals with ideomotor and ideational apraxia to determine the effectiveness of intervention strategies. Specific sensory stimulation protocols were evaluated with no convincing evidence for effectiveness of the intervention, though both natural recovery improvements and learning effects were seen in the outcome measures. Variability of performance was a feature of all cases studied and could be considered a feature of the apraxic condition. Task break-down strategies were also evaluated in functional activities and demonstrated some effectiveness in a case of ideomotor apraxia, though a case with an ideational component indicated a more intractable condition. The strategy was not seen to generalise to other unpracticed tasks. In conclusion, the associations and dissociations found between movement kinematics and the clinical assessment tests for apraxia suggested the presence of 'sub-types' within the blanket diagnosis of the condition. Identification of such sub-types might be facilitated by the development of the agnosia test newly devised for this project. Finally, research into intervention effectiveness in apraxia calls for further investigation to determine what procedures might be used with different sub-types of the condition.
Butler, Jennifer A.
Faculty of Health and Life SciencesDepartment of Biological and Medical Sciences
Year: 1998
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