Occupation-Focused Assessments of Apraxia
Assessment of Disabilities in Stroke Patients with Apraxia
- Author: van Heugten, Dekker, Deelman, Stehmann-Saris, & Kinebanian (1999)
- The purpose of this assessment is threefold: "to access the presence of disabilities resulting from apraxia, to gain an insight in the style of action of the patient and the sort of errors made, and to prepare treatment goals for specific training" (van Heugten et al., 1999).
- The population the assessment is meant for is adults living with apraxia.
- The therapist observes four activities: washing face and upper body, putting on a shirt or blouse, preparing food, and an individualized task chosen by the occupational therapist (OT).
- For each task, a score from 0 to 3 is given based on initiation, execution, and control, with a lower score indicating more independence. There is no cutoff point given to differentiate a client who has a problem with apraxia, so the examiner has to interpret their observations. The examiner can compare scores those provided in the research study: patients with apraxia had a mean score of 1.0 (range 0.19-2.88) on ADL observations vs. patients without apraxia had a mean score of 0.2 (range 0.0-1.25) (data from Table 3, van Heugten et al., 2000- pdf link below).
- This assessment is discriminative of apraxia, has high construct validity and inter-rater reliability (0.98), and is valid for stroke survivors (Gillen, 2009). This assessment provides information about how apraxia affects everyday living, yet warrants further investigation (Gillen, 2009). A strength of the assessment is that it is occupation-based, however it does require the assessor to have a strong understanding of apraxia in order to interpret observations. A useful table of structured observations can be found at the bottom of this page.
Original Research Article:
- van Heugten, C.M. Dekker, J., Deelman, B. G., Stehmann-Saris, J. C., & Kinebanian, A. (1999). Assessment of disabilities in stroke patients with apraxia: Internal consistency and inter-observer reliability. The Occupational Therapy Journal of Research, 19(1), 55.
- van Heugten, C. M., Dekker, J., Deelman, B. G., van Dijk, A. J., Stehmann-Saris, F. C., & Kinebanian, A. (2000). Measuring disabilities in stroke patients with apraxia: A validation study of an observational method. Neuropsychological Rehabilitation, 10(4), 401-414.
The ADL Test for those with Apraxia
- Assessment done with adults with apraxia by observing 3 activities: spreading margarine on bread, putting on a T-shirt, and brushing teeth (or, if client has false teeth, putting cream on hands) (Goldenberg & Hagmann, 1998).
- Performance is scored based on reparable or fatal errors related to selection of objects, movements, or sequencing. For reparable errors, the client succeeds in continuing with the tasks (Goldenberg & Hagmann, 1998). For fatal errors, the client is unable to continue without help or is unable to accomplish the essential purpose of the task due to the error (Goldenberg & Hagmann, 1998).
- In terms of validity, the ADL Test has significant correlations with five impairment tests of apraxia (Gillen, 2009).
- Inter-rater reliability was 0.83 for reparable errors, and 0.96 for fatal errors (Goldenberg & Hagmann, 1998). A fatal error is considered to be a fail rating for the task (Goldenberg & Hagmann, 1998). Goldenberg & Hagmann found a significant correlation between the number of fatal errors and tests of apraxia (1998, See Table 2 and 3).
- A strength of the assessment is that it provides information on how apraxia affects everyday living (Gillen, 2009), however it does require the assessor to have a strong understanding of apraxia in order to interpret observations.
- Goldenberg, G., & Hagmann, S. (1998). Therapy of activities of daily living in patients with apraxia. Neuropsychological Rehabilitation, 8(2), 123-141.
Árnadóttir Occupational Therapy-ADL Neurobehavioral Evaluation (A-ONE)
- "Structured observation of basic ADL including feeding, grooming and hygiene, dressing, transfers and mobility to detect the impact of multiple underlying impairments including ideational and motor apraxia on these tasks" (Gillen, 2009, p.125).
- The assessment takes approximately 25 minutes to administer and was standardized for patients with cortical central nervous system dysfunction (Vining Radomski, 2008). The assessment is occupation-based and includes items that are related to both ideational and motor apraxia (Gillen, 2009).
- This assessment is standardized and norm-referenced. The content validity of the assessment is based on expert review, and it is valid for multiple diagnosis, including stroke, dementia, and brain tumours (Gillen, 2009). The inter-rate reliability of the assessment is 0.84 and the test-retest reliability is 0.86 (Gillen, 2009).
- The A-ONE (and the norms) can be found in the textbook "The Brain and Behavior: Assessing Cortical Dysfunction Through Activities of Daily Living" by Árnadóttir.
- It is recommended that therapists attend a training session before using the tool (Vining Radomski, 2008). Information about the training session can be found at the following link: http://glengillen.com/a-one/
- Further summary information on this assessment can be found at the following links: http://www.health.utah.edu/occupational-therapy/files/evalreviews/aone.pdf; http://strokengine.ca/assess/module_a_2d_one_indepth-en.html
Potential Errors made during Functional Task Performance
Gillen (2009) provides a summary (as found below) of potential apraxic errors identified in the literature that can be seen during structured observations of functional tasks (Table 5-1, p. 121), specifically the assessments above.
1)Difficulties initiating the task
Difficulty choosing the proper plan of action
Difficulty choosing the correct objects
2) Difficulty executing the task
3) Difficulty controlling the task
4) Content/object errors
5) Temporal errors
6) Spatial errors
Difficulty performing the plan
Inability to evaluate the results of the task
Inability to make corrections for mistakes
Related errors: uses knife instead of fork
Nonrelated errors: eats soap
Perseverative errors: integrates a component of the previous task into a new task (e.g., after eating soup from a bowl with a spoon, brings spoon toward the glass of milk)
Difficulty sequencing movements
Increased, decreased, or irregular speed of movements
Increased or decreased amplitude of movement
Difficulty configuring the hand to hold an object
Difficulty orienting the limbs and trunk to an object
Sits too far away from workspace or body is improperly aligned