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Research paper
Systematic assessment of apraxia and functional predictions from the Birmingham Cognitive Screen
  1. Wai-Ling Bickerton1,
  2. M Jane Riddoch1,
  3. Dana Samson2,
  4. Alex Bahrami Balani1,
  5. Bejal Mistry1,
  6. 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}


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.

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  • 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.