J Neurol Neurosurg Psychiatry 83:513-521 doi:10.1136/jnnp-2011-300968
  • Cognitive neurology
  • Research paper

Systematic assessment of apraxia and functional predictions from the Birmingham Cognitive Screen

  1. Glyn W Humphreys1
  1. 1School of Psychology, University of Birmingham, Birmingham, UK
  2. 2Psychological Sciences Research Institute, Université Catholique de Louvain, Louvain-La-Neuve, Belgium
  1. Correspondence to Dr W-L Bickerton, School of Psychology, Hills Building, University of Birmingham, Birmingham B15 2TT, UK; w.bickerton{at}
  1. Contributors W-LB: designed the data collection tools, coordinated and monitored data collection for the whole trial, planned the statistical analysis, cleaned and analysed the data, and drafted and revised the paper. She is the guarantor. MJR: initiated the project, designed the data collection tools, supervised the development of the validation studies and revised the draft paper. DS: initiated the project, designed the data collection tools and revised the draft paper. ABB: data collection, data entry and monitoring, and revised the draft paper. BM: data checking and cleaning, conducted part of the statistical analysis and reviewed the draft paper. GWH: initiated the project, designed the data collection, implemented the trial, analysed the data and revised the draft paper. Nele Demeyere: coordinated the data collection, implemented the data collection and data monitoring. Lara Harris, Jon Williamson, Gemma Gray: data collection and data monitoring. Johnny King Lau: data entry and data cleaning. WMSRN facilitators: data collection.

  • Received 14 July 2011
  • Revised 5 January 2012
  • Accepted 25 January 2012
  • Published Online First 1 March 2012


Objective The validity and functional predictive values of the apraxia tests in the Birmingham Cognitive Screen (BCoS) were evaluated. BCoS was developed to identify patients with different forms of praxic deficit using procedures designed to be inclusive for patients with aphasia and/or spatial neglect.

Method Observational studies were conducted from a university neuropsychological assessment centre and from acute and rehabilitation stroke care hospitals throughout an English region. Volunteers from referred patients with chronic acquired brain injuries, a consecutive hospital sample of patients within 3 months of stroke (n=635) and a population based healthy control sample (n=100) were recruited. The main outcome measures used were the Barthel Index, the Nottingham Extended Activities of Daily Living Scale as well as recovery from apraxia.

Results There were high inter-rater reliabilities and correlations between the BCoS apraxia tasks and counterpart tests from the literature. The vast majority (88.3%) of the stroke survivors were able to complete the screen. Pantomime and gesture recognition tasks were more sensitive in differentiating between individuals with left hemisphere damage and right hemisphere damage whereas the Multistep Object Use test and the imitation task had higher functional correlates over and above effects of hemiplegia. Together, the initial scores of the four tasks enabled predictions with 75% accuracy, the recovery of apraxia and independence level at 9 months.

Conclusions As a model based assessment, BCoS offers a quick and valid way to detect apraxia and predict functional recovery. It enables early and informative assessment of most stroke patients for rehabilitation planning.


  • Funding This study was funded by the Stroke Association, UK, and the West Midlands Stroke Research Network.

  • Competing interests None.

  • Ethics approval The study was approved by the UK National Research Ethics Committee (Essex 1).

  • Provenance and peer review Not commissioned; externally peer reviewed.

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