The rehabilitation of limb apraxia: a study in left-brain-damaged patients.

OBJECTIVE To assess the effectiveness of a rehabilitative training program for patients with limb apraxia. DESIGN Randomized, controlled trial. SETTING Neurologic rehabilitation unit of a university hospital. PATIENTS Thirteen patients with acquired brain injury and limb apraxia (lasting more than 2 months) as a result of lesions involving the left cerebral hemisphere. Patients were assigned to a study group or to a control group following a randomization scheme. The study group underwent an experimental training for limb apraxia. The control group received conventional treatment for aphasia. INTERVENTION A behavioral training program consisting of gesture-production exercises. The rehabilitative program was made up of 3 sections dedicated to the treatment of gestures with or without symbolic value and related or nonrelated to the use of objects. Thirty-five experimental sessions, each lasting 50 minutes, were given. MAIN OUTCOME MEASURES Neuropsychologic tests for assessment of aphasia, verbal comprehension, "general intelligence," oral apraxia, constructional apraxia, and 3 tests concerning limb praxic function (ideational apraxia, ideomotor apraxia, gesture recognition). Scores related to each test were used to measure the outcome. Video recordings of ideational and ideomotor apraxia tests allowed us to register type and number of praxic errors. All outcome measures, except the aphasia test, were recorded before and after the experimental (or control) treatment time interval. RESULTS The patients in the study group achieved a significant improvement of performance in both ideational (p = .039) and ideomotor (p = .043) apraxia tests. They also showed a significant reduction of errors in ideational (p = .001) and ideomotor (p < .001) apraxia tests. A trend toward improvement was found in the gesture comprehension test (p = .058), while other outcome measures did not show any significant amelioration. Control patients did not show any significant change in performance. CONCLUSIONS The results show the possible effectiveness of a specific training program for the treatment of limb apraxia.