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Shortened neuropsychological assessment (cognitive screening) is usually conducted in order to gain insight into the cognitive functioning of stroke patients quickly and globally in order to identify in an early stage factors which can facilitate or hamper the rehabilitation process, to formulate recommendations concerning extensive neuropsychological assessment and to enable recommendations concerning treatment and consultation. Ideally every stroke patient should receive neuropsychological testing during the first few weeks after admission to a rehabilitation setting. Cognitive screening is an efficient way to assess all patients for the psychologist as well as the rest of the rehabilitation team, and is less distressing for the patients than extensive neuropsychological testing. For standard use of cognitive screening, normative data are a useful tool; however, for some well known and frequently used neuropsychological tests there are no normative data for Dutch stroke patients available. In this paper we therefore present the results of a standardized cognitive screening which is used in the Hoensbroeck Rehabilitation Centre since 1996. The results are based on a stroke population of 275 persons, being tested during the first two months after suffering from a first stroke. In addition, a group of forty healthy partners of the stroke patients were assessed with the same battery of tests, in order to generate norms for healthy matched persons. The results of the two groups can be used as norms in comparable clinical settings.

In 1999, a Task Force was set up under the auspices of the European Federation of Neurological Societies with the aim to evaluate the existing evidence for the clinical effectiveness of cognitive rehabilitation. This review led to the development of a set of guidelines to be used in the management of adult patients with cognitive disorders due to acquired focal neurological damage.

The internal consistency and the diagnostic value of a test for apraxia in patients having had a stroke are presented. Results indicate that the items of the test form a strong and consistent scale: Cronbach's alpha as well as the results of a Mokken scale analysis present good reliability and good scalability. The diagnostic value of the test was determined by comparison of test results in three groups of patients: 44 stroke patients with apraxia (patients), 35 stroke patients without apraxia (patient controls), and 50 healthy nursing home residents with no history of stroke (normal controls). The diagnostic value is expressed by means of the sensitivity and specificity and the predictive value of the test. In addition, Receiver Operator Characteristics (ROC) curves are presented. The sensitivity and specificity of the apraxia test appear to be good: all values are higher than 80%. The test also has high predictive value. The ROC curves illustrate that the test is sufficiently discriminative to allow a differentiation between persons with apraxia and persons without apraxia.

Objective: Evaluation of a therapy programme for stroke patients with apraxia. The programme is based on teaching patients strategies to compensate for the presence of apraxia. This programme was designed for assessment and treatment by occupational therapists., Design: The outcome was studied in a pre-post test design. Measurements were conducted at baseline and 12 weeks later., Subjects: Thirty-three stroke patients with apraxia were treated at occupational therapy departments n general hospitals, rehabilitation centres and nursing homes., Main Outcome Measures: The following measurements were conducted: an apraxia test, a motor functioning test, observation of activities of daily living (ADL), Barthel Index, and an ADL questionnaire for the therapist and the patient., Results: The patients showed large improvements in ADL functioning on all measures and small improvements on the apraxia test and the motor functioning test. The effect sizes for the disabilities, ranging from 0.92 to 1.06, were large compared to the effect sizes for apraxia (0.34) and motor functioning (0.19). The significant effect of treatment is also seen when individual improvement and subjective improvement are considered. Measured with the Barthel Index for instance, 71% of the patients improved., Conclusions: These results suggest that the programme seems to be successful in teaching patients compensatory strategies that enable them to function more independently, despite the lasting presence of apraxia.

Consistent preferences for particular types of movement suggest criteria for movement selection. These can be important when, as is usually the case, infinitely many movements allow a task to be achieved. The experiments reported here were designed to identify the source of a strong preference observed in earlier object-manipulation studies. In those earlier studies, subjects usually grabbed objects to be moved from one location to another in a way that afforded a comfortable final posture rather than a comfortable initial posture (the end-state comfort effect). The comfortable final state usually allowed the forearm to be at or near the middle of its range of motion on the pronation-supination dimension. The hypothesis tested here was that the end-state comfort effect stemmed from an expectation that movements can be made more quickly in the middle of the pronation-supination range than at either extreme. To test this hypothesis, we asked subjects, in the first experiment, to perform a handle rotation task that demanded little or no precision and so no need to make rapid to-and-fro homing-in movements near the end of the rotation. Half the subjects did not show the end-state comfort effect, in contrast to all previous studies, where all subjects showed the effect. An incidental finding of the first experiment was that handle rotations that ended at or near the end of the range of motion took longer than handle rotations that ended at or near the middle of the range of motion. To test the latter result more carefully, we asked subjects, in Experiments 2 and 3, to oscillate the forearm as quickly as possible, either in the supination part of the forearm rotation range, in the middle part of the range, or in the pronation part of the range. As predicted, oscillation frequencies were highest in midrange, and this was true for both hands. The results as a whole have implications for the relation between cognitive psychology and biomechanics, and for human factors.