Does therapy of apraxia generalize to daily living?
Prof Georg GOLDENBERGa
a Technical University Munich
Successful therapy beyond the effects of spontaneous recovery has been demonstrated for two domains of action affected by apraxia: Defective use of tools and object and production of communicative gestures for compensation of severe aphasia. However, significant improvements were mainly confined to items that had been directly trained during the therapy sessions. There was at best very limited improvement of untrained items. Published studies did not systematically assess the transfer of improvements into daily living outside the therapeutic context, but anecdotal observations and clinical experience suggest that this is limited too.
I will discuss the consequences of limited generalization for the choice of therapeutic approaches. Specifically, I will distinguish between “bottom up” and “top - down” therapy programs and argue that top down approaches tend to believe in the efficacy of generalisation whereas bottom up approaches rather favour items specific improvements. Based on results from a therapy study for gestural communication I will then discuss the possibility that a same therapy program may be bottom up for one aspect and top down for another and that there may be generalization for single aspects of the trained skills.
Keywords : Apraxia, Use of Tool, therapy