Diagnostik und Therapie der Gliedmaßenapraxie

Zusammenfassung

Apraxien sind Störungen der höheren motorischen Kognition, die durch basale sensomotorische Defizite nicht hinreichend erklärt werden. Häufige apraktische Symptome sind eine fehlerhafte Imitation abstrakter und symbolischer Gesten sowie Fehler beim Gebrauch von Gegenständen und Werkzeugen. Trotz der Relevanz der Apraxien für die Rehabilitationsbehandlung und ambulante Versorgung von Schlaganfallpatienten werden Apraxien nach wie vor zu selten diagnostiziert und behandelt. In diesem Übersichtsartikel werden die diagnostischen Instrumente zur Feststellung einer Apraxie evaluiert. Zudem werden ein Apraxie-Screening-Instrument und ein diagnostisches Testverfahren für die klinische Anwendung empfohlen. Darüber hinaus werden die publizierten Ansätze zur Apraxie-Therapie dargestellt. Trotz der aktuell noch eingeschränkten Evidenz kann das Gesten-Training von Smania und Mitarbeitern zur Behandlung einer Apraxie empfohlen werden, da bei diesem Training sowohl ein Transfer des Therapieeffekts auf alltagsrelevante Tätigkeiten als auch eine Nachhaltigkeit des Therapieeffekts beobachtet werden konnte. Dieser Übersichtsartikel soll die Aufmerksamkeit auf die Bedeutung der Gliedmaßenapraxie im klinischen Alltag lenken und dem interessierten Leser Instrumente an die Hand geben, mit deren Hilfe Apraxien zuverlässig diagnostiziert und therapiert werden können. Dies sind wichtige Voraussetzungen für die weitere Erforschung der neurobiologischen Grundlagen der Apraxien und die Entwicklung neuer Therapiestrategien für eine evidenzbasierte Behandlung von Apraxien.

Abstract

Apraxia is a disorder of higher motor cognition. Deficits in imitating abstract and symbolic gestures as well as deficits in appropriate tool use are common apraxic symptoms which, importantly, cannot be explained by primary sensorimotor deficits alone. In spite of the relevance of apraxia for neurorehabilitation and the individual stroke patient’s prognosis, apraxia is to date still too rarely diagnosed and treated. In this review the currently published assessments for the diagnosis of apraxia are evaluated. Based on this, an apraxia screening instrument as well as a diagnostic test for clinical use are recommended. In addition, different published approaches to the therapy for apraxia are described. Although current evidence is scarce, the gesture training suggested by Smania and co-workers can be recommended as a therapy for apraxia, because its effects were shown to extend to activities of daily living and to persist for at least two months after completion of the training. This review aims at directing the clinician’s attention to the importance of apraxia. Moreover, it provides the interested reader with instruments for a reliable diagnosis and effective treatment of apraxia. These are also important prerequisites for further research into the neurobiological mechanisms underlying apraxia and the development of new therapy strategies leading to an evidence-based effective treatment of apraxia.

Schlüsselwörter

Apraxien - motorische Kognition - Schlaganfall - Neuropsychologie

Key words

apraxia - motor cognition - stroke - neuropsychology

Literatur

• 1 Zwinkels A, Geusgens C, Sande van de P et al. Assessment of apraxia: inter-rater reliability of a new apraxia test, association of apraxia and other cognitive deficits and prevalence of apraxia in a rehabilitation setting.  Clinical Rehabilitation. 2004;  18 819-827
• 2 Donkervoort M, Dekker J, Ende van den E et al. Prevalence of apraxia among patients with a first left hemisphere stroke in rehabilitation centres and nursing homes.  Clinical Rehabilitation. 2000;  14 130-136
• 3 Kaya K, Unsal-Delialioglu S, Kurt M et al. Evaluation of ideomotor apraxia in patients with stroke: A study of reliability and validity.  J Rehabil Med. 2006;  38 108-112
• 4 Goldenberg G. Apraxia. In Goldenberg G, Miller B L, eds Neuropsychology and behavioral neurology.. Amsterdam: Elsevier B. V; 2008: 323-338
• 5 Goldenberg G. The neuropsychological assessment and treatment of disorders of voluntary movement. In Halligan P, Kischka U, Marshall J C, eds Handbook of clinical neurpsychology. Oxford: Oxford University Press; 2003: 387-400
• 6 Giaquinto S, Buzzelli S, Di Francesco L et al. On the prognosis of outcome after stroke.  Acta Neurologica Scandinavica. 1999;  100 202-208
• 7 Hanna-Pladdy B, Heilman K M, Foundas A L. Ecological implications of ideomotor apraxia.  Neurology. 2003;  60 487-490
• 8 Sundet K, Finset A, Reinvang I. Neuropsychological predictors in stroke rehabilitation.  Journal of Clinical and Experimental Neuropsychology. 1988;  10 363-379
• 9 Saeki S, Ogata H, Okubo T et al. Return to work after stroke.  Stroke. 1995;  26 399-401
• 10 Foundas A L, Macauley B L, Raymer A M et al. Ecological implications of limb apraxia: Evidence from mealtime behavior.  Journal of the International Neuropsychological Society. 1995;  1 62-66
• 11 Goldenberg G, Hagmann S. Therapy of activities of daily living in patients with apraxia.  Neuropsychological Rehabilitation. 1998;  8 123-141
• 12 Almeida Q J, Black S E, Roy E A. Screening for apraxia: A short assessment for stroke patients.  Brain and Cognition. 2002;  48 253-258
• 13 De Renzi E, Pieczuro A, Vignolo L A. Ideational apraxia: a quantitative study.  Neuropsychologia. 1968;  6 41-52
• 14 De Renzi E, Motti F, Nichelli P. Imitating gestures. A quantitative approach to ideomotor apraxia.  Arch Neurol. 1980;  37 6-10
• 15 Goldenberg G. Defective imitation of gestures in patients with damage in the left or right hemispheres.  Journal of Neurology, Neurosurgery, and Psychiatry. 1996;  61 176-180
• 16 Goodglass H, Kaplan E. Assessment of aphasia and related disorders. Philadelphia: Lea and Febinger; 1972
• 17 Kertesz A, Ferro J M. Lesion size and location in ideomotor apraxia.  Brain. 1984;  107 921-933
• 18 Kokmen E, Ozekmekci F S, Cha R H et al. Testing for apraxia in neurological patients: a descriptive study in two diverse cultures.  European Journal of Neurology. 1998;  5 175-180
• 19 Poeck K. The clinical examination for motor apraxia.  Neuropsychologia. 1986;  24 129-134
• 20 Dobigny-Roman N, Dieudonne-moinet B, Tortrat D et al. Ideomotor apraxia test: a new test of imitation of gestures for elderly people.  European Journal of Neurology. 1998;  5 571-578
• 21 Duffy J R, Duffy R J. The assessment of limb apraxia: the limb apraxia test. In ed Hammond G R Cerebral control of speech and limb movements. Amsterdam: North-Holland; 1990
• 22 Rothi L JG, Heilman K M. Acquisition and retention of gestures by apraxic patients.  Brain and Cognition. 1984;  3 426-437
• 23 Roy E A, Black S E, Blair N et al. Analyses of deficits in gestural pantomime.  Journal of Clinical and Experimental Neuropsychology. 1998;  20 628-643
• 24 Alexander M P, Baker E, Naeser M A et al. Neuropsychological and neuroanatomical dimensions of ideomotor apraxia.  Brain. 1992;  115 87-107
• 25 Bartolo A, Cubelli R, Della Sala S. Cognitive approach to the assessment of limb apraxia.  The Clinical Neuropsychologist. 2008;  22 27-45
• 26 Liepelt I, Trenner M U, Freund S et al. Der Berliner-Apraxie-Test für ideomotorische und ideatorische Apraxie.  Zeitschrift für Neuropsychologie. 2007;  18 193-206
• 27 Power E, Code C, Croot K et al. Florida apraxia battery-extended and revised Sydney (FABERS): design, description, and a healthy control sample.  Journal of Clinical and Experimental Neuropsychology. 2010;  32 1-18
• 28 Goldenberg G. Imitating gestures and manipulating a mannikin – the representation of the human body in ideomotor apraxia.  Neuropsychologia. 1995;  33 63-72
• 29 Basso A, Capitani E, Della Sala S et al. Recovery from ideomotor apraxia. A study on acute stroke patients.  Brain. 1987;  110 747-760
• 30 West C, Bowen A, Hesketh A et al. Interventions for motor apraxia following stroke.  Cochrane Database of Systematic Reviews. 2008;  1 CD004132
• 31 Cappa S F, Benke T, Clarke S et al. EFNS guidelines on cognitive rehabilitation: report of an EFNS task force.  European Journal of Neurology. 2005;  12 665-680
• 32 Weiss-Blankenhorn P H, Fink G R. Neue Erkenntnisse zur Pathophysiologie der Apraxien durch funktionelle Bildgebung.  Fortschritte Neurologie Psychiatrie. 2008;  76 402-412
• 33 Bartolo A, Cubelli R, Della Sala S et al. Double dissociation between meaningful and meaningless gesture reproduction in apraxia.  Cortex. 2001;  37 696-699
• 34 Goldenberg G, Hagmann S. The meaning of meaningless gestures: A study of visuo-imitative apraxia.  Neuropsychologia. 1997;  35 333-341
• 35 Rothi L JG, Ochipa C, Heilman K M. A cognitive neuropsychological model of limb praxis.  Cognitive Neuropsychology. 1991;  8 443-458
• 36 Rumiati R I, Weiss P H, Tessari A et al. Common and differential neural mechanisms supporting imitation of meaningful and meaningless actions.  Journal of Cognitive Neuroscience. 2005;  17 1420-1431
• 37 Rothi L JG, Ochipa C, Heilman K M. A cognitive neuropsychological model of limb praxis and apraxia. In Rothi L JG, Heilman K M, eds Apraxia: The neuropsychology of action.. Hove: Psychology Press; 1997: 29-49
• 38 Cubelli R, Marchetti M, Boscolo G et al. Cognition in action: Testing a model of limb apraxia.  Brain and Cognition. 2000;  44 144-165
• 39 Heilman K M. Ideational apraxia - A re-definition.  Brain. 1973;  96 861-864
• 40 Rothi L JG, Mack L, Heilman K M. Pantomime agnosia.  Journal of Neurology, Neurosurgery, and Psychiatry. 1986;  49 451-454
• 41 Heilman K M, Rothi L JG, Valenstein E. Two forms of ideomotor apraxia.  Neurology. 1982;  32 342-346
• 42 Kertesz A, Hooper P. Praxis and language: The extent and variety of apraxia in aphasia.  Neuropsychologia. 1982;  20 275-286
• 43 Vanbellingen T, Kersten B, Van de Winckel A et al. A new bedside test of gestures in stroke: the apraxia screen of TULIA (AST).  Journal of Neurology, Neurosurgery, and Psychiatry. 2010;  DOI: 10.1136 /jnnp.2010.213371
• 44 Weiss P H, Kalbe E, Scherer A et al. Das Kölner Apraxie Screening. , in press ed. Göttingen: Hogrefe Verlag; 2011
• 45 Goldenberg G, Hartmann K, Schlott I. Defective pantomime of object use in left brain damage: apraxia or asymbolia?.  Neuropsychologia. 2003;  41 1565-1573
• 46 Donkervoort M, Dekker J, Stehmann-Saris J C et al. Efficacy of strategy training in left hemisphere stroke patients with apraxia: A randomized clinical trial.  Neuropsychological Rehabilitation. 2001;  11 549-566
• 47 Smania N, Girardi F, Domenicali C et al. The rehabilitation of limb apraxia: a study in left-brain-damaged patients.  Arch Phys Med Rehabil. 2000;  81 379-388
• 48 Smania N, Aglioti S M, Girardi F et al. Rehabilitation of limb apraxia improves daily life activities in patients with stroke.  Neurology. 2006;  67 2050-2052
• 49 Goldenberg G, Daumüller M, Hagmann S. Assessment and therapy of complex activities of daily living in apraxia.  Neuropsychological Rehabilitation. 2001;  11 147-169
• 50 Heugten C M, Dekker van J, Deelman B G et al. Outcome of strategy training in stroke patients with apraxia: a phase II study.  Clinical Rehabilitation. 1998;  12 294-303
• 51 Buxbaum L J, Haal K Y, Hallett M et al. Treatment of limb apraxia: Moving forward to improve action.  American Journal of Physical Medicine & Rehabilitation. 2008;  87 149-161
• 52 Rossetti Y, Rode G, Goldenberg G. Perspectives in higher-order motor deficit rehabilitation. Which approach for which ecological result?. In Freund H J, Jeannerod M, Hallett M, eds Higher-order motor disorders. From neuroanatomy and neurobiology to clinical neurology.. Oxford, New York: Oxford University Press; 2005: 475-498
• 53 Heugten C M, Dekker van J, Deelman B G et al. Assessment of disabilities in stroke patients with apraxia: Internal consistency and interobserver reliability.  Occupational Therapy Journal of Research. 1999;  19 55-73
• 54 Heugten C M, Dekker van J, Deelman B G et al. Measuring disabilities in stroke patients with apraxia: a validation study of an observational method.  Neuropsychological Rehabilitation. 2000;  10 401-414
• 55 Wade D T, Collin C. The Barthel ADL Index: a standard measure of physical disability?.  International Disability Studies. 1988;  10 64-67
• 56 Demeurisse G, Demol O, Robaye E. Motor evaluation in vascular hemiplegia.  European Neurology. 1980;  19 382-389
• 57 Lyle R C. A performance test for assessment of upper limb function in physical rehabilitation treatment and research.  International Journal of Rehabilitation Research. 1981;  4 483-492
• 58 Goldenberg G, Hagmann S. Tool use and mechanical problem solving in apraxia.  Neuropsychologia. 1998;  36 581-589
• 59 Vanbellingen T, Kersten B, Van Hemelrijk B et al. Comprehensive assessment of gesture production: a new test of upper limb apraxia (TULIA).  European Journal of Neurology. 2010;  17 59-66
• 60 Goldenberg G. Apraxien.  Aktuelle Neurologie. 2008;  35 34-48
• 61 Heugten C M, Dekker van J, Deelman B G et al. A diagnostic test for apraxia in stroke patients: internal consistency and diagnostic value.  The Clinical Neuropsychologist. 1999;  13 182-192
• 62 Schwartz M F, Segal M, Veramonti T et al. The naturalistic action test: A standardised assessment for everyday action impairment.  Neuropsychological Rehabilitation. 2002;  12 311-339
• 63 Roßmüller J. Theoriegeleitetes Assessment von Praxiefunktionen bei Schlaganfall-Patienten.  Neurologie & Rehabilitation. 2007;  13 305-311