Acquiring and maintaining self-care skills after stroke. The predictive value of apraxia.

The degree of self-care in 120 patients who had suffered unilateral cerebrovascular accident (CVA) was assessed at different stages of recovery. The level of ADL (activities of daily living) function was determined on admission and discharge. Patients with right-sided hemiplegia (r. hem.) were given a set of apraxia tests on admission to the hospital. The results of ADL evaluation showed improved ADL function between admission and discharge, but a worsening after returning home. There were some significant relationships between ADL function in hospital and apraxia. All the apraxia variables are significant as predictors of subsequent dependency. The results show the seriousness of problems related to apraxia in rehabilitation of stroke patients with a lesion in the left hemisphere. One conclusion is that the treatment procedure ought to be directed to the various symptoms of apraxia. The effect of apraxia on ADL in the domestic situation has to be given more attention. More treatment should be given in the home, as patients seem to have difficulty in transferring the skills learned in hospital to the home situation and in maintaining them.