The efficacy of a task model approach to ADL rehabilitation in stroke apraxia and action disorganisation syndrome:A randomised controlled trial


Background: Apraxia and action disorganization syndrome (AADS) after stroke can disrupt activities of daily living (ADL). Occupational therapy has been effective in improving ADL performance, however, inclusion of multiple tasks means it is unclear which therapy elements contribute to improvement. We evaluated the efficacy of a task model approach to ADL rehabilitation, comparing training in making a cup of tea with a stepping training control condition. Methods: Of the 29 stroke survivors with AADS who participated in this cross-over randomized controlled feasibility trial, 25 were included in analysis [44% females; mean(SD) age = 71.1(7.8) years; years post-stroke = 4.6(3.3)]. Participants attended five 1-hour weekly tea making training sessions in which progress was monitored and feedback given using a computerbased system which implemented a Markov Decision Process (MDP) task model. In a control condition, participants received five 1-hour weekly stepping sessions. Results: Compared to stepping training, tea making training reduced errors across 4 different tea types. The time taken to make a cup of tea was reduced so the improvement in accuracy was not due to a speed-accuracy trade-off. No improvement linked to tea making training was evident in a complex tea preparation task (making two different cups of tea simultaneously), indicating a lack of generalisation in the training. Conclusions: The clearly specified but flexible training protocol, together with information on the distribution of errors, provide pointers for further refinement of task model approaches to ADL rehabilitation. It is recommended that the approach be tested under errorless learning conditions with more impaired patients in future research.

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Divisions: College of Health & Life Sciences > Aston Pharmacy School
Additional Information: © 2022 Howe et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Funding: Funding: The work presented in this manuscript was supported by the European Commission under grant FP7-ICT-2011-288912 (CogWatch) and BBSRC BB/R003971/1 to AW. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Publication ISSN: 1932-6203
Last Modified: 04 Jul 2024 07:09
Date Deposited: 25 Jul 2022 10:27
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Related URLs: http://www.scop ... tnerID=8YFLogxK (Scopus URL)
https://journal ... al.pone.0264678 (Publisher URL)
PURE Output Type: Article
Published Date: 2022-03-03
Accepted Date: 2021-11-16
Authors: Howe, Jo (ORCID Profile 0000-0002-7567-075X)
Chua, Winnie
Sumner, Emily
Drozdowska, Bogna
Laverick, Rosanna
Bevins, Rachel L.
Jean-Baptiste, Emilie
Russell, Martin
Rotshtein, Pia
Wing, Alan M.



Version: Published Version

License: Creative Commons Attribution

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