A new bedside test of gestures in stroke: The apraxia screen of TULIA (AST)

Apraxia in stroke patients may be overlooked in busy hospital settings as dexterous difficulties and impaired gestural communication are often attributed to the frequently coexisting sensorimotor deficits and aphasia. Early and valid detection of apraxia by a bedside test may be relevant for functional outcome in stroke patients. The present study aimed to develop in 2 phases a new screening test for apraxia, called the Apraxia Screen of TULIA (AST), based on the comprehensive standardized test for upper limb apraxia (TULIA). In Phase I an item reduction analysis of the TULIA (48 gestures) following the methods of classical test theory was performed based on a large population of stroke patients (n = 133) and healthy subjects (n = 50). Furthermore, the 6-point scoring method of TULIA was dichotomized to the score levels pass and fail. In Phase II validity of the resulting new scale AST was prospectively assessed in a new cohort of stroke patients (n = 31) by using Pearson’s correlation analysis and binary classification display (apraxia yes, apraxia no) with the TULIA. Stepwise removal of items resulted in the final scale of 12 gestures still demonstrating high internal consistency (Cronbach’s alpha = 0.92). Validation of the 12-item AST with the TULIA showed a remarkable diagnostic accuracy with high specificity, sensitivity and positive predictive value, both for the presence of apraxia and its severity. In conclusion, AST offered a reliable and valid bedside test in stroke patients allowing a straightforward assessment of apraxia within a few minutes.status: publishe