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

Jo Howe*, Winnie Chua*, Emily Sumner, Bogna Drozdowska, Rosanna Laverick, Rachel L. Bevins, Emilie Jean-Baptiste, Martin Russell, Pia Rotshtein, Alan M. Wing

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Background: Apraxia 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. Methods: Of 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 computerbased system which implemented a Markov Decision Process (MDP) task model. In a control condition, participants received five 1-hour weekly stepping sessions. Results: Compared 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. Conclusions: The 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.

Original languageEnglish
Article numbere0264678
Number of pages20
JournalPLoS ONE
Issue number3
Publication statusPublished - 3 Mar 2022

Bibliographical note

© 2022 Howe et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Funding: Funding: The work presented in this manuscript was supported by the European Commission under grant FP7-ICT-2011-288912 (CogWatch) and
BBSRC BB/R003971/1 to AW. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the


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