Long-term recovery from apraxia and its relation to severe apraxic-aphasic syndrome in left hemisphere stroke – a systematic review

ABSTRACT

Background and aims: Along with aphasia, apraxia is a common disorder in left hemisphere stroke, which can have a profound influence on a person’s ability to communicate by gestures (e.g. Goldenberg 2013, Goldenberg & Randerath 2015). Apraxia of speech has long been seen as a communication barrier (e.g. Wertz et al., 1991), while limb apraxia has been seen more as a functional problem in activities of daily living (e.g. Rothi & Heilman 1997), and discussion about its non-verbal influence to communication has been scarce. Clinical experience shows that communication skills of a person with a severe apraxic-aphasic syndrome are slow to recover. The purpose of this study is to provide an overview on research of a long-term recovery from apraxia, and provide a possibility to discuss the meaning of these findings in observing recovery of communication abilities of a person with a severe apraxic-aphasic syndrome.

Methods: This study applied a scoping review method which enables a literature search from a broader perspective without rejecting studies as long as their subject is relevant to the topic (Arksey & O’Malley 2005). The search and screening was done by the first author. The search had no time limit, and it was conducted on 18.12.2017 from the databases of Ovid Medline, Psycinfo and Scopus. Used keywords were apraxia AND stroke which were linked to following; gesture, pantomime, pointing, visuomotor, head move, recovery, rehab*, lesion, follow-up, communication, writing, painting, drawing, understanding, comprehension OR evaluation. The search produced 805 references. Based on titles or abstracts, they were rejected if the article was not published in English, if the article did not address apraxia, or if apraxia was not caused by the stroke. Abstracts that were chosen for a full text review, were clearly related to the recovery of apraxia or provided background for the subject of apraxia and its influence to behaviour, and were mostly found from e-resources. Some additional relevant articles were identified outside the original search. In the end, 72 articles were viewed, but after the actual subject of recovery of apraxia, 23 articles proceeded for a full text review. Furthermore, apraxia was not a focus of some of these remaining studies, or they were summaries or book chapters.

Results and main contribution: The study found seven long-term follow-up studies of apraxia; one case study of apraxia of speech, one case study of ideomotor apraxia (and aphasia), one group study of limb apraxia and aphasia, and four group studies of ideomotor apraxia. The reviewed studies indicated that the steepest recovery from apraxia of any type happened within the first few months post-stroke. Imitation skills and actions using a real tool in activities of daily functions showed the best recovery. Recovery of gesturing after verbal command did not show clear signs of recovery in chronic stage post-stroke. Recovery from apraxia and aphasia seemed not to correlate.

Conclusions: Scientific research on long-term recovery from apraxia in severe apraxic-aphasic syndrome is mostly absent. None of the follow-up studies discussed apraxia from a communicative point of view. Also, some of the studies used only imitation to assess changes in gesturing, which cannot be compared with gesturing in natural communicative situations.

Implications: According to clinical experience, along with speech output, the observation of recovery from a severe apraxic-aphasic syndrome should involve many different communication methods such as voluntary gesturing, writing, drawing or showing objects from the environment, pictures or text. The long-term follow-up research of a severe apraxic-aphasic syndrome is needed in planning speech and language therapy to develop patients’ communication skills.


References:
Arksey, H. & O'Malley, L. (2005). Scoping Studies: Towards a Methodological Framework. International Journal of Social Research Methodology. 11 Routledge Vol. 8, No. 1, pp. 19-32.
Goldenberg, G. (2014). Apraxia – The cognitive side of motor control. Oxford University Press.
Rothi, L. & Heilman, K. (1997). Apraxia-The Neuropsychology of Action. Psychology Press.
Goldenberg, G. & Randerath, J. (2015). Shared neural substrates of apraxia and aphasia. Neuropsychologia 75, 40-49.
Wertz, R., LaPointe, L. & Rosenbek, J. (1991). Apraxia of Speech in Adults. The disorder and its Management. Singular Publishing Group, Inc. San Diego, California.