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. 2022;81(4):311-321.
doi: 10.1159/000523778. Epub 2022 Apr 1.

Validation of the Apraxia Screen TULIA (AST) in Schizophrenia

Hanta Bachofner  1 , Konstantin A Scherer  1 , Tim Vanbellingen  2 , Stephan Bohlhalter  2   3 , Katharina Stegmayer  1 , Sebastian Walther  1
Affiliations

Validation of the Apraxia Screen TULIA (AST) in Schizophrenia

Hanta Bachofner et al. Neuropsychobiology. 2022.

Abstract

Introduction: Deficits in social interaction and community functioning, including impaired use, performance, and perception of hand gestures, are key features in schizophrenia. A well-established tool to assess gesture deficits is the test of upper limb apraxia (TULIA). However, given its time-consuming application based on video analyses, research has proposed the bedside apraxia screen of TULIA (AST). This study aims to test the validity and reliability of the AST to detect gesture abnormalities at bedside in a sample of 27 patients diagnosed with schizophrenia, schizotypal disorder, acute and transient psychotic disorders, or schizoaffective disorder.

Methods: Patients completed the 48-item TULIA and the 12-item AST. Two different raters assessed the AST: one at bedside (online) and the other based on the video recordings.

Results: The total AST scores demonstrated a high parallel reliability, moderate inter-rater reliability on a single-item level, and good construct validities.

Conclusions: The psychometric properties of the AST suggest it can well be used for the clinical assessment of gesture deficits in schizophrenia. However, when detailed information is required, the AST rated from video or conducting the full TULIA is recommended. The findings call for refining the selection of the TULIA items for a psychosis-AST bedside test to increase specificity.

Keywords: AST; Hand gestures; Nonverbal communication; Schizophrenia spectrum disorders; TULIA.

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Conflict of interest statement

The authors have no conflicts of interest to declare.

Figures

Fig. 1
Fig. 1
Procedure of statistical tests.
Fig. 2
Fig. 2
Scatter plot showing the correlation between the full TULIA and the AST.
Fig. 3
Fig. 3
Scatter plot showing the construct validity.
Fig. 4
Fig. 4
Boxplot with the scores (0–5) for the 48 TULIA items of all 27 patients. Imi, Imitation, Pan, Pantomime. The red bars represent the 12 AST items, starting with no. 1 at the bottom of the boxplot. Note that AST item nos. 1, 2, and 4 form a ceiling effect, which is why only the numbers are marked with a red star and no bars are visible. The 13 TULIA items with sufficient variance are listed in bold black font, while red indicates the 4 items, which are included in the current AST.
See this image and copyright information in PMC

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