Strategies to Cope with Cognitive Difficulties After a Stroke (SCOPE – Apraxia)

UoM administered thesis: Master of Philosophy

  • Authors:
  • Daisy Clark

Abstract

Apraxia is a cognitive disorder of purposeful movement where errors cannot be accounted for by physical disability, comprehension of task or willingness to participate. Interventions for motor apraxia are traditionally delivered by Occupational Therapists. The clinical evidence around interventions is lacking, and there is no evidence to support the use of any specific therapeutic strategy over standard care. This project aims to guide intervention development and clinical practice around apraxia through research from two key perspectives. I present an update of the Cochrane Review of randomised controlled trials of therapeutic intervention for motor apraxia in stroke, with a broadening of the scope to incorporate apraxia as a result of other adult-acquired non-progressive brain injury and to incorporate all relevant and up-to-date data in the analysis. Three trials including a total of 156 participants were included in the review. The review did not find evidence of a lasting difference in functional performance following apraxia intervention (the primary outcome): mean difference 0.17, (95% CI) = 0.17 (-1.40 to 1.74); p = 0.83, in favour of the experimental group Secondly, I present a qualitative research project into patient and carer’s perspectives of apraxia. Interview transcripts from 13 stroke survivors (9m4f) were analysed using Thematic Analysis. The key themes emerged were Manifestation, Mitigating Factors, Emotional Impact, Practical Solutions and Making sense of Illness/Recovery. Findings included a range of strategies used by participants, and an insight into their own understanding of the condition. These findings can be used to guide clinical practice and as a basis for further research in the area.

Details

Original languageEnglish
Awarding Institution
Supervisors/Advisors
Award date31 Dec 2020