- A limitation of many interventions for apraxia is the lack of generalization. In response to this limitation, Goldenberg, Daumüller, & Hagmann suggest intervention “should be tailored to the specific needs and desires of the clients and their relatives, and it should be tied as closely as possible to the normal environment of the client’s daily life. Otherwise, it runs the danger of remaining a pure exercise of therapeutic efficiency which does not help the client to master the challenges of daily life” (2001, p.168).
- Strategy training is the only intervention found to result in generalization across measures of ADL function (Gillen, 2009).
- Overall, more high quality research into therapeutic interventions for limb apraxia is needed. Research that explicitly defines interventions with outcome measures that include how apraxia affects the client's everyday life is particularly needed.
Intervention Tips for Clinicians
Gillen (2009) provides a helpful summary entitled "Potential Interventions for Those Living with Functional Limitations Secondary to Apraxia" (Box 5-4, p. 130). Here are a few of the suggestions taken from this resource.
- “Tap into” an individual’s routines and habits."
- "Collaborate with the client and significant others/ caregivers in order to choose the tasks that will be focused on and that will become the goals of therapy (i.e., a client-centered approach)."
- Whenever possible, "practice activities in the appropriate environments and at the appropriate time of day"
- "Encourage practice of learned skills outside of therapy and throughout the day".
- "For those with ideomotor apraxia, experiment with decreasing the degrees of freedom (i.e., number of joints) used to perform the task. For example, encourage a woman who is attempting to apply makeup to keep her elbow on the table. Grade required functional movements from simple to complex such as grading from smoothing out a bedspread, to removing a pillow from a pillowcase, to placing a pillow into a pillowcase, to folding a large sheet, to making a bed, etc."
- "Grade the number of tools and distracters used in a task. For example, finger feeding (no tools), followed by eating applesauce with only a spoon available, followed by eating applesauce with the choice of one to three utensils, followed by eating a meal requiring the choice of various tools for different aspects of the task (spoon to stir coffee, knife to cut and spread butter, etc.), followed by a meal with the necessary and usual utensils in addition to distracter tools such as comb, toothbrush, etc."
- "Use clear and short directions."
- "Encourage verbalization of what is to be done."
- "Demonstrate the task while sitting parallel to the person with apraxia to help develop a visual model of the task at hand."