Action Disorganization Syndrome Research Articles

The efficacy of a task model approach to ADL rehabilitation in stroke apraxia and action disorganisation syndrome: A randomised controlled trial.

BackgroundApraxia and action disorganization syndrome (AADS) after stroke can disrupt activities of daily living (ADL). Occupational therapy has been effective in improving ADL performance, however, inclusion of multiple tasks means it is unclear which therapy elements contribute to improvement. We evaluated the efficacy of a task model approach to ADL rehabilitation, comparing training in making a cup of tea with a stepping training control condition.MethodsOf the 29 stroke survivors with AADS who participated in this cross-over randomized controlled feasibility trial, 25 were included in analysis [44% females; mean(SD) age = 71.1(7.8) years; years post-stroke = 4.6(3.3)]. Participants attended five 1-hour weekly tea making training sessions in which progress was monitored and feedback given using a computer-based system which implemented a Markov Decision Process (MDP) task model. In a control condition, participants received five 1-hour weekly stepping sessions.ResultsCompared to stepping training, tea making training reduced errors across 4 different tea types. The time taken to make a cup of tea was reduced so the improvement in accuracy was not due to a speed-accuracy trade-off. No improvement linked to tea making training was evident in a complex tea preparation task (making two different cups of tea simultaneously), indicating a lack of generalisation in the training.ConclusionsThe clearly specified but flexible training protocol, together with information on the distribution of errors, provide pointers for further refinement of task model approaches to ADL rehabilitation. It is recommended that the approach be tested under errorless learning conditions with more impaired patients in future research.Trial registrationRetrospectively registered at ClinicalTrials.gov on 5th August 2019 [NCT04044911] https://clinicaltrials.gov/ct2/show/NCT04044911?term=Cogwatch&rank=1

Step by Step: Kinematics of the Reciprocal Trail Making Task Predict Slowness of Activities of Daily Living Performance in Alzheimer's Disease.

Dementia impairs the ability to perform everyday activities. Reduced motor capacity and executive functions as well as loss of memory function and forms of apraxia and action disorganization syndrome can be reasons for such impairments. In this study, an analysis of the hand trajectories during the sequential movements in an adapted version of the trail making task, the reciprocal trail making task (RTMT), was used to predict performance in activities of daily living (ADL) of patients suffering from mild cognitive impairment and dementia. 1 patient with dementia of the Alzheimer’s type and 15 healthy, age-matched adults were tested in the standardized ADL of tea making and document filing. The characteristics of the kinematic performance in the RTMT were assessed, and models of multiple linear regression were computed to predict the durations of the ADL. Patients showed increased trial durations (TDs) in the ADL (Cohen’s d: tea making 1.64, document filing 1.25). Parameters and explained variability differed across patients and control as well as between different activities. The models for the patient sample were stronger and particularly high for the document filing task for which kinematics explained 71% of the variance (: tea making 0.62, document filing 0.71; both tasks combined patients 0.55, controls 0.25). The most relevant factors for the models were the TD and a parameter characterizing movement fluency and variability (“movement harmonicity”) in the RTMT. The models of multiple linear regression suggested that the patients’ activity of daily living performance was limited by cognitive demands, namely, identifying the varying targets during sequencing and the healthy controls’ performance by their motor capacity. Such models could be used to estimate the severity of ADL impairments in patients.

Preliminary evaluation of a personal healthcare system prototype for cognitive eRehabilitation in a living assistance domain.

The integration of rehabilitation systems in an ambient assisted living environment can provide a powerful and versatile tool for long-term stroke rehabilitation goals. This paper introduces a novel concept of a personalized cognitive rehabilitation system in a naturalistic setting. The proposed platform was developed within the CogWatch project, with the intent of fostering independence in activities of daily living in patients with apraxia and action disorganization syndrome. Technical usability was evaluated in a series of pilot experiments, which illustrate how this approach may help to retrain patients in activities of daily living. The first system prototype has been tested with 36 participants divided into three groups, providing an exploratory evaluation of the usability of this solution and its acceptability. The technical solutions used within the CogWatch project are targeted to meet both the end users' needs from the interaction and usability point of views and the clinical requirements associated with the use of such systems. The challenges behind the development of ambient assisted living systems for cognitive rehabilitation are discussed.

The tool in the brain: apraxia in ADL. Behavioral and neurological correlates of apraxia in daily living.

Humans differ from other animals in the way they can skilfully and precisely operate or invent tools to facilitate their everyday life. Tools have dominated our home, travel and work environment, becoming an integral step for our motor skills development. What happens when the part of the brain responsible for tool use is damaged in our adult life due to a cerebrovascular accident? How does daily life change when we lose the previously mastered ability to make use of the objects around us? How do patients suffering from compromised tool use cope with food preparation, personal hygiene, grooming, housework, or use of home appliances? In this literature review we present a state of the art for single and multiple tool use research, with a focus on the impact that apraxia (impaired ability to perform tool-based actions) and action disorganization syndrome (ADS; impaired ability to carry out multi-step actions) have on activities of daily living (ADL). Firstly, we summarize the behavioral studies investigating the impact of apraxia and other comorbidity syndromes, such as neglect or visual extinction, on ADL. We discuss the hallmarks of the compromised tool use in terms of the sequencing of action steps, conceptual errors committed, spatial motor control, and temporal organization of the movement. In addition, we present an up-to-date overview of the neuroimaging and lesion analyses studies that provide an insight into neural correlates of tool use in the human brain and functional changes in the neural organization following a stroke, in the context of ADL. Finally we discuss the current practice in neurorehabilitation of ADL in apraxia and ADS aiming at increasing patients’ independence.

What neuropsychology tells us about human tool use? The four constraints theory (4CT): mechanics, space, time, and effort.

Our understanding of human tool use comes mainly from neuropsychology, particularly from patients with apraxia or action disorganization syndrome. However, there is no integrative, theoretical framework explaining what these neuropsychological syndromes tell us about the cognitive/neural bases of human tool use. The goal of the present article is to fill this gap, by providing a theoretical framework for the study of human tool use: The Four Constraints Theory (4CT). This theory rests on two basic assumptions. First, everyday tool use activities can be formalized as multiple problem situations consisted of four distinct constraints (mechanics, space, time, and effort). Second, each of these constraints can be solved by the means of a specific process (technical reasoning, semantic reasoning, working memory, and simulation-based decision-making, respectively). Besides presenting neuropsychological evidence for 4CT, this article shall address epistemological, theoretical and methodological issues I will attempt to resolve. This article will discuss how 4CT diverges from current cognitive models about several widespread hypotheses (e.g., notion of routine, direct and automatic activation of tool knowledge, simulation-based tool knowledge).

Assistive system for people with Apraxia using a Markov decision process.

CogWatch is an assistive system to re-train stroke survivors suffering from Apraxia or Action Disorganization Syndrome (AADS) to complete activities of daily living (ADLs). This paper describes the approach to real-time planning based on a Markov Decision Process (MDP), and demonstrates its ability to improve task's performance via user simulation. The paper concludes with a discussion of the remaining challenges and future enhancements.

Handmade Task Tracking Applied to Cognitive Rehabilitation

This article presents research focused on tracking manual tasks that are applied in cognitive rehabilitation so as to analyze the movements of patients who suffer from Apraxia and Action Disorganization Syndrome (AADS). This kind of patients find executing Activities of Daily Living (ADL) too difficult due to the loss of memory and capacity to carry out sequential tasks or the impossibility of associating different objects with their functions. This contribution is developed from the work of Universidad Politécnica de Madrid and Technical University of Munich in collaboration with The University of Birmingham. The Kinect™ for Windows© device is used for this purpose. The data collected is compared to an ultrasonic motion capture system. The results indicate a moderate to strong correlation between signals. They also verify that Kinect™ is very suitable and inexpensive. Moreover, it turns out to be a motion-capture system quite easy to implement for kinematics analysis in ADL.

Multiple task demands in action disorganization syndrome

We present novel evidence for specific, disruptive effects of multi-step task demands on the production of everyday life tasks in two patients with Action Disorganization Syndrome (ADS). Experiment 1 demonstrated that the patients were impaired at carrying out everyday life tasks but improved when they instructed the examiner to perform the tasks. Experiments 2 and 3 showed that the patients improved in their own performance when the demands were reduced – by eliminating the need to use their own task schema (Experiment 2) and by reducing the need for error monitoring (Experiment 3). Experiment 4 reduced sequential effects in task performance further by having patients perform the same individual actions as before but now out of the task context. The data indicate that ADS patients are vulnerable to multiple demands made during the performance of everyday life tasks and show abnormal, disruptive effects of three specific factors: (i) using a self-driven schema, (ii) error monitoring and (iii) the activation of prior actions from the same task. The implications for understanding ADS are discussed.

Eye movements in action disorganization syndrome: A single case analysis

This study examines eye movements made by a patient with action disorganization syndrome (ADS) as everyday tasks are performed. Relative to both normal participants and control patients, the ADS patient showed normal time-locking of eye movements to the subsequent use of objects. However, there were proportionately more unrelated fixations, and more fixations concerned with locating objects irrelevant to the immediate action, compared with control participants. The data suggest a dissociation between normal eye movement patterns for control of visually guided actions such as reaching and grasping, and abnormal eye movements between object-related fixations. The implications for understanding ADS are discussed.

Action disorganization syndrome (ADS) を呈した脳梁離断症候群の一例

Action disorganization syndrome (以下ADS) を呈した脳梁離断症候群の一例を経験し，ADS の出現機序と関連領域について検討した。ADS は日常的生活の順序を多く含む動作において，使用対象の誤り，順序過程の誤り，省略，質的誤り，空間的誤りを示し目的行為が障害される。ADS は目的行為の概念は保たれるが contention scheduling system におけるスキーマの表象が誤ったり省略されたりし，さらにその誤って表象されたスキーマを supervisory attention system によって訂正できない結果，そのまま誤って表象された行為が出現する。本症例は脳梁膝から，左上・中前頭回にかけて損傷されており，過去の報告例では左右どちらか一方，または両側の上・中前頭回が損傷されていた。ADS は左右両側の広範な前頭葉領域内の損傷によって生じる可能性が考えられ，左右の上・中前頭回を結ぶ交連線維の損傷により，脳内における情報の統合障害や錯綜，注意機能や抑制機能の低下が加わることで生じると考えられた。

Disinhibition of sequential actions following right frontal lobe damage

Action disorganization syndrome (ADS) is a frontal lobe neuropsychological syndrome characterized by deficits in the performance of familiar sequential tasks such as making a cup of tea. In this study, we examined the performance of familiar sequential tasks by 3 patients with right frontal brain tumours and no other areas of brain damage. When task-irrelevant objects were presented as distractors in addition to the target objects, all patients used the distractors in accordance with the target task. These patients showed few of the sequential and omission errors that had been previously reported in patients with ADS. Although normal participants could suppress the activation of task-irrelevant objects, these patients had difficulty with this process, which would normally be carried out by the right frontal lobe to determine the most suitable action behaviour. The intact left frontal lobe may receive bottom-up activation from the distractors and modify this schema to match the behavioural context. Our findings suggest that patients with only right frontal lobe damage may be characterized more by action disinhibition than by disorganization.

Comparing action disorganization syndrome and dual-task load on normal performance in everyday action tasks

The term ‘action disorganization syndrome’ has been used to describe patients with selective impairments in carrying out multi-step everyday tasks, which are not linked to motor deficits. We used a range of everyday life tasks to examine the effects on a patient with ADS of having related distractors present during task performance. The presence of related distractors increased omission errors in the patient. In a second experiment we assessed whether we could mimic this pattern of deficit when normal participants carried out the everyday tasks and a secondary task was imposed to place demands on executive processes. Secondary task load produced a general increase in errors in the controls and reduced the number of self-correcting responses, but there were no proportional increases in omission errors. Control participants and patients with ADS may suffer from demands on different processes involved in the performance of everyday actions. We discuss the implications for understanding everyday actions.

Dissociations in Routine Behaviour across Patients and Everyday Tasks

We present a single case study of a patient, FK, who was severely impaired on routine, everyday tasks, such as preparing a cup of tea. We used the action coding system developed by Schwartz et al to provide quantitative and qualitative measures of his performance in a number of experimental manipulations. In section A, we established FK’s baseline performance on a range of tasks with (a) task-congruent objects only and (b) task-congruent objects and semantic distracters. In section B, we aimed to facilitate FK’s performance by (a) giving him a pictorial representation of the goal, (b) giving him a set of written commands to follow, (c) giving him one command at a time, (d) demonstrating how the task should be performed and (e) dividing the task into smaller subgoals. We compared FK’s performance with another patient, HG, to establish if there are qualitative differences between patients with ‘action disorganization syndrome’. In section C, we aimed to hinder FK’s performance by interrupting his execution of routine tasks. By comparing the factors that facilitated and impaired FK’s performance in sections B and C, we hoped to isolate the key cognitive processes required to generate and control routine behaviour. In section D, we investigated how task demands impact on our ability to complete different everyday activities. The results of these experiments have important clinical implications for rehabilitation programmes for patients with action disorganization syndrome and can also help to distinguish between contemporary theoretical accounts of routine behaviour. In particular, we propose that patients who can be classified under the umbrella term of ‘action disorganization syndrome’ do not all have a reduction to ‘non-specific cognitive resources’ but can have qualitatively different impairments to a specialized action production system.

Action-based Memory in Alzheimer’s Disease: a Longitudinal Look at Tea Making

In this paper we report the results of a longitudinal study which examined memory for a single routine activity of daily living in people with dementia of the Alzheimer type. We assessed memory in a natural setting, visiting volunteers in their homes. We video-taped performance on the selected task and analysed the record for the presence or absence of each of its component actions over a period of 6 years. In this way, we obtained longitudinal data for a small group of people moving from the mild-moderate stages of dementia through to severe dysfunction. In the first section of paper we examine the nature of the errors which are made in recall of a routine activity by volunteers with dementia of the Alzheimer type and what happens to that routine as the dementia erodes memory. In the second section we examine the consequence of moving the routine from a familiar setting to a novel setting. We observed large differences in the rate of decline of our volunteers, with substantial preservation of performed recall of the everyday task, even in the more severe phases of the disease. The pattern of decline suggests a benign degradation of the memory trace, with omissions comprising the most common category of errors, and this result is contrasted with the more dramatic action disorganization syndrome associated with frontal injury. The results have implications both for theoretical models of action-based memory and intervention programmes aimed at maintaining functional independence for people with dementia.

Dissociations in Routine Behaviour across Patients and Everyday Tasks

We present a single case study of a patient, FK, who was severely impaired on routine, everyday tasks, such as preparing a cup of tea. We used the action coding system developed by Schwartz et al to provide quantitative and qualitative measures of his performance in a number of experimental manipulations. In section A, we established FK’s baseline performance on a range of tasks with (a) task-congruent objects only and (b) task-congruent objects and semantic distracters. In section B, we aimed to facilitate FK’s performance by (a) giving him a pictorial representation of the goal, (b) giving him a set of written commands to follow, (c) giving him one command at a time, (d) demonstrating how the task should be performed and (e) dividing the task into smaller subgoals. We compared FK’s performance with another patient, HG, to establish if there are qualitative differences between patients with ‘action disorganization syndrome’. In section C, we aimed to hinder FK’s performance by interrupting his execution of routine tasks. By comparing the factors that facilitated and impaired FK’s performance in sections B and C, we hoped to isolate the key cognitive processes required to generate and control routine behaviour. In section D, we investigated how task demands impact on our ability to complete different everyday activities. The results of these experiments have important clinical implications for rehabilitation programmes for patients with action disorganization syndrome and can also help to distinguish between contemporary theoretical accounts of routine behaviour. In particular, we propose that patients who can be classified under the umbrella term of ‘action disorganization syndrome’ do not all have a reduction to ‘non-specific cognitive resources’ but can have qualitatively different impairments to a specialized action production system.