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Diagnosis and treatment of upper limb apraxia

机译:上肢失用的诊断和治疗

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摘要

Upper limb apraxia, a disorder of higher motor cognition, is a common consequence of left-hemispheric stroke. Contrary to common assumption, apraxic deficits not only manifest themselves during clinical testing but also have delirious effects on the patients’ everyday life and rehabilitation. Thus, a reliable diagnosis and efficient treatment of upper limb apraxia is important to improve the patients’ prognosis after stroke. Nevertheless, to date, upper limb apraxia is still an underdiagnosed and ill-treated entity. Based on a systematic literature search, this review summarizes the current tools of diagnosis and treatment strategies for upper limb apraxia. It furthermore provides clinicians with graded recommendations. In particular, a short screening test for apraxia, and a more comprehensive diagnostic apraxia test for clinical use are recommended. Although currently only a few randomized controlled studies investigate the efficacy of different apraxia treatments, the gesture training suggested by Smania and colleagues can be recommended for the therapy of apraxia, the effects of which were shown to extend to activities of daily living and to persist for at least 2 months after completion of the training. This review aims at directing the reader’s attention to the ecological relevance of apraxia. Moreover, it provides clinicians with appropriate tools for the reliable diagnosis and effective treatment of apraxia. Nevertheless, this review also highlights the need for further research into how to improve diagnosis of apraxia based on neuropsychological models and to develop new therapeutic strategies.
机译:上肢失用症是一种较高的运动认知障碍,是左半球卒中的常见结果。与普遍的假设相反,高血糖缺乏症不仅在临床测试中表现出来,而且对患者的日常生活和康复产生不良影响。因此,可靠的诊断和有效的上肢失用症治疗对改善卒中后患者的预后至关重要。然而,迄今为止,上肢失用仍然是一个未被充分诊断和治疗的实体。在系统检索文献的基础上,本综述总结了当前上肢失用症诊断和治疗策略的工具。此外,它还为临床医生提供了分级建议。特别是,建议进行简短的失用症筛查测试,以及更全面的临床性失用性诊断测试。尽管目前只有少数随机对照研究调查了各种失用症治疗方法的疗效,但可以建议由Smania及其同事建议的手势训练来治疗失用症,该方法的作用已扩展到日常生活活动并持续存在。完成培训后至少2个月。本文旨在引导读者注意失用症的生态相关性。此外,它为临床医生提供了可靠的诊断和有效治疗失用症的适当工具。尽管如此,这篇综述也强调了需要进一步研究如何基于神经心理学模型改善失用症的诊断并开发新的治疗策略。

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