Limbs apraxia is a motor disorder whose characteristic is the inability or difficulty to perform intentional movements of the limbs (gestures), most frequently involving the upper limbs. Recent literature indicated promising effects of transcranial direct current stimulation (tDCS) in the recovery of limbs apraxia, showing that, in stroke patients, excitatory anodal tDCS over left inferior parietal lobe (IPL) may improve limb apraxia. Despite this encouraging evidence, the need for larger well powered and sham-controlled clinical trials has also been identified. For these reasons, the objective of this study is to investigate the effects of tDCS application on the left posterior parietal cortex, associated with the treatment for apraxia made by Smania et al. in 2000, on the recovery of the upper limbs ideomotor apraxia in patients with left brain lesion of vascular origin.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
SUPPORTIVE_CARE
Masking
DOUBLE
Enrollment
20
Direct current transcranial stimulation will be applied for 20 minutes over the left posterior parietal cortex with an intensity set to 2 mA.
The same positioning of electrodes as the stimulation condition will be used, but the current will be applied for 30 seconds and then progressively reduced.
Treatment for upper limbs ideomotor apraxia (Smania et al., 2000)
CLINICA DI RIABILITAZIONE TOSCANA Spa
Montevarchi, Arezzo, Italy
RECRUITINGChanges from baseline Ideomotor apraxia test
It consists of 24 imitation tests carried out with the fingers, the hand and the limb homolateral to the lesion. Each gesture is presented up to three times if the production is incorrect, and receives a score of 3 to 0 depending on whether the copy is correct the first, the second, the third time, or never. The test includes 24 gestures, 12 symbolic and 12 non-symbolic, for a total score of 72. Application of the test to over 200 normal subjects showed that the diagnosis of apraxia can be made reliably when the score drops below 53, it's probable, but not certain, for a score between 53 and 62, and it's excluded when the score is greater than 62.
Time frame: The first day of treatment; End of 2nd week; End of 3rd week
Changes from baseline Standardized test for the diagnosis of a selective ideomotor apraxia deficit on the basis of gesture and effector types
Test for ideomotor apraxia assessment which allows to highlight: 1) the selective deficits for the type of gesture to be imitated and, therefore, specific damage to the two processes underlying the imitation (direct route and semantic pathways) presenting known and new gestures in separate blocks; and 2) deficits of the distal or proximal component of the movements.
Time frame: The first day of treatment; End of 2nd week; End of 3rd week
Changes from baseline Ideational apraxia test
By placing in front of the patient one object at a time, he is asked to perform the pantomime of use of the object without touching or holding the object itself, but only by looking at it (visual mode). The examiner will assign 2 points if the execution is correct, 1 point if the execution is correct after repetition of the command and 0 points for always incorrect execution. The objects used are: glass, screwdriver, comb, gun, fork, key, rubber, saw, hammer, fan.
Time frame: The first day of treatment; End of 2nd week; End of 3rd week
Changes from baseline Oral apraxia test
The examiner mimics the 10 bucco-facial movements required by the protocol, and asks the patient to imitate them. If the subject does not perform the task or does not perform it correctly, the therapist repeats the gesture a second time. If, again, the patient does not perform or makes a mistake, the next stimulus is taken. Maximum time for each stimulus is 30 seconds. The gestures to imitate are: show your tongue, whistle, yawn, try to lick your nose, make a partridge, give a kiss, show how your teeth shake when it's cold, snap your tongue making the sound of a galloping horse, blow and scratch your throat. The score is 2 if the execution is accurate on the first attempt, 1 if it is correct on the second attempt and 0 if the gesture is not executed or is not reproduced correctly.
Time frame: The first day of treatment; End of 2nd week; End of 3rd week
Changes from baseline Jebsen-Taylor Hand Functional Assessment Scale
It is a scale that allows to assess the level of hand function during daily activities. It consists of 7 subtests: writing, turning a page, lifting small objects, pantomime of eating, stacking objects, lifting large and light objects and large and heavy objects. The non-dominant hand will be tested first and then the dominant one. The time for each item will be timed: the final score (total time) will be given by the sum of all the part times: the lower the score, the better the level of hand function.
Time frame: The first day of treatment; End of 2nd week; End of 3rd week
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