Brief research report 177 Effects of ideomotor apraxia on functional outcomes in patients with right hemiplegia Sibel Unsal-Delialioglu a , Murat Kurt b , Kurtulus Kaya a , Canan Culha a and Sumru Ozel a The aim of this study was to investigate the effect of ideomotor apraxia on activities of daily living and to determine if the presence of apraxia interferes with rehabilitation. This study was conducted on 47 patients with right hemiplegia. All the patients were assessed at their admission and discharge, respectively, for apraxia by Ideomotor Apraxia Test, for daily living activities by Functional Independence Measure (FIM, Santa Clara Valley Medical Center, San Jose, California, USA), for cognitive functions by Mini Mental State Examination (MMSE), and for language components by Gulhane Aphasia Test (GAT). The effects of apraxia presence and time course on FIM, MMSE, and GAT scores were investigated. Presence of apraxia was found to have significant effect on all test scores (P < 0.05). Time course had the main significant effect on FIM, MMSE, and GAT scores (P < 0.05). Interaction effect of both presence of apraxia and time course on the test scores was not significant either. In other words, apraxic and nonapraxic patients seemed to gain benefits from the neurological rehabilitation. However, mean FIM scores of apraxic patients during discharge have failed to reach the mean FIM scores of nonapraxic patients during admission. Apraxia is considered as an important determinant in the dependence of patients with stroke in their activities of daily living. For this reason, during the initial assessment of patients with right hemiplegia, apraxia should be tested, and the presence of apraxia as well as its severity should be determined. International Journal of Rehabilitation Research 31:177–180  c 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins. International Journal of Rehabilitation Research 2008, 31:177–180 Keywords: activities of daily living, cerebrovascular accident, cognitive functions, ideomotor apraxia, language functions a Ankara Physical Medicine and Rehabilitation Education and Research Hospital, 3rd PMR Clinics, Ankara and b Department of Psychology, Faculty of Art and Science, Ondokuz Mayis University, Samsun, Turkey Correspondence to Sibel Unsal-Delialioglu, MD, Yenicag Mah. Miralay Nazımbey Sok, No: 145/7, 06170 Yenimahalle, Ankara,Turkey Tel: + 90 312 310 3230 x329; fax: + 90 312 310 4242 x329; e-mail: sibelunsal74@yahoo.com Received 10 June 2007 Accepted 10 October 2007 Introduction Apraxia is one of the most frequent consequences of brain damage (De Renzi, 1989). One of the first definitions of apraxia was given by Geschwind (1975) ‘Disorders in the execution of learned movements that cannot be accounted for weakness, incoordination, sensory loss, incomprehension, or inattention to commands’. Daily living activities (ADL) of apraxic patients as well as their relations with their surroundings may be affected adversely, depending on the extent to which they show inability in fulfilling verbal or visual instructions (Landry and Spaulding, 1998). It is obvious that the ability of clinicians working with a patient group with stroke to determine apraxia is a very important entity to establish rehabilitation targets. On the basis of this argument, the aim of this study was to investigate the effect of ideomotor apraxia on ADL and to determine if the presence of apraxia interferes with rehabilitation. Methods Patients The study included 47 patients with right hemiplegia caused by a cerebrovascular accident aged between 35 and 65 years, with an average stroke period of 73 days. Level of paresis was determined according to Brunnstrom stages and patients with levels 1 and 2 were included. Apraxia occurs more frequently in patients with right hemiplegia owing to the dominancy of the left hemi- sphere in the motor control planning (De Renzi, 1989; Donkervoort et al., 2000). Although apraxia is also seen in patients with left hemiplegia, patients with left hemi- plegia are not included in the study to eliminate the effects on ADLs of the cognitive deficits accompanying the right hemisphere damage. Inclusion criteria of the study were as follows: ability to cooperate, right hand dominancy, ability to speak Turkish, and at least a 5-year formal education. Exclusion criteria were patients with previous cerebrovascular accident history, with neurological deficits in the form of ataxia on the body parts to be subjected to Ideomotor Apraxia Test (IAT), with vision defects or psychological illness, or with bilateral stroke. Instruments Ideomotor Apraxia Test Patients were assessed for apraxia by IAT. IAT consists of 20 items in four different categories (facial, upper 0342-5282  c 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins