Advertisement

Survivors of Chronic Stroke Experience Continued Impairment of Dexterity But Not Strength in the Nonparetic Upper Limb

Published:February 27, 2020DOI:https://doi.org/10.1016/j.apmr.2020.01.018

      Abstract

      Objective

      To investigate the performance of the less affected upper limb in people with stroke compared with normative values. To examine less affected upper limb function in those whose prestroke dominant limb became paretic and those whose prestroke nondominant limb became paretic.

      Design

      Cohort study of survivors of chronic stroke (7.2±6.7y post incident).

      Setting

      The study was performed at a freestanding academic rehabilitation hospital.

      Participants

      Survivors of chronic stroke (N=40) with severe hand impairment (Chedoke-McMaster Stroke Assessment rating of 2-3 on Stage of Hand) participated in the study. In 20 participants the prestroke dominant hand (DH) was tested (nondominant hand [NH] affected by stroke), and in 20 participants the prestroke NH was tested (DH affected by stroke).

      Interventions

      Not applicable.

      Main Outcome Measure

      Jebsen-Taylor Hand Function Test. Data from survivors of stroke were compared with normative age- and sex-matched data from neurologically intact individuals.

      Results

      When combined, DH and NH groups performed significantly worse on fine motor tasks with their nonparetic hand relative to normative data (P<.007 for all measures). Even the participants who continued to use their prestroke DH as their primary hand after the stroke demonstrated reduced fine motor skills compared with normative data. In contrast, grip strength was not significantly affected in either group of survivors of stroke (P>.140).

      Conclusions

      Survivors of stroke with severe impairment of the paretic limb continue to present significant upper extremity impairment in their nominally nonparetic limb even years after stroke. This phenomenon was observed regardless of whether the DH or NH hand was primarily affected. Because this group of survivors of stroke is especially dependent on the nonparetic limb for performing functional tasks, our results suggest that the nonparetic upper limb should be targeted for rehabilitation.

      Keywords

      List of abbreviations:

      BBT (box and blocks test), DH (dominant hand), FMUE (Fugl-Meyer Assessment of the Upper Extremity), GS (grip strength), JTHFT (Jebsen-Taylor Hand Function Test), LPS (lateral pinch strength), NH (nondominant hand), 9HPT (9-hole peg test), PPS (palmar pinch strength)
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Archives of Physical Medicine and Rehabilitation
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Bejot Y.
        • Daubail B.
        • Giroud M.
        Epidemiology of stroke and transient ischemic attacks: current knowledge and perspectives.
        Rev Neurol (Paris). 2016; 172: 59-68
        • Feigin V.L.
        • Lawes C.M.
        • Bennett D.A.
        • Barker-Collo S.L.
        • Parag V.
        Worldwide stroke incidence and early case fatality reported in 56 population-based studies: a systematic review.
        Lancet Neurol. 2009; 8: 355-369
        • Bejot Y.
        • Daubail B.
        • Jacquin A.
        • et al.
        Trends in the incidence of ischaemic stroke in young adults between 1985 and 2011: the Dijon Stroke Registry.
        J Neurol Neurosurg Psychiatry. 2014; 85: 509-513
        • Tong X.
        • Kuklina E.V.
        • Gillespie C.
        • George M.G.
        Medical complications among hospitalizations for ischemic stroke in the United States from 1998 to 2007.
        Stroke. 2010; 41: 980-986
        • Dobkin B.H.
        Functional MRI: a potential physiologic indicator for stroke rehabilitation interventions.
        Stroke. 2003; 34: e23-e28
        • Dobkin B.H.
        Clinical practice. Rehabilitation after stroke.
        N Engl J Med. 2005; 352: 1677-1684
        • Trombly S.T.
        Professional liability: spotlight on ambulatory care.
        J Ambul Care Manage. 1989; 12: 40-49
        • de Groot-Driessen D.
        • van de Sande P.
        • van Heugten C.
        Speed of finger tapping as a predictor of functional outcome after unilateral stroke.
        Arch Phys Med Rehabil. 2006; 87: 40-44
        • Sunderland A.
        • Bowers M.P.
        • Sluman S.M.
        • Wilcock D.J.
        • Ardron M.E.
        Impaired dexterity of the ipsilateral hand after stroke and the relationship to cognitive deficit.
        Stroke. 1999; 30: 949-955
        • Jebsen R.H.
        • Taylor N.
        • Trieschmann R.B.
        • Trotter M.J.
        • Howard L.A.
        An objective and standardized test of hand function.
        Arch Phys Med Rehabil. 1969; 50: 311-319
        • Noskin O.
        • Krakauer J.W.
        • Lazar R.M.
        • et al.
        Ipsilateral motor dysfunction from unilateral stroke: implications for the functional neuroanatomy of hemiparesis.
        J Neurol Neurosurg Psychiatry. 2008; 79: 401-406
        • Spaulding S.J.
        • McPherson J.J.
        • Strachota E.
        • Kuphal M.
        • Ramponi M.
        Jebsen Hand Function Test: performance of the uninvolved hand in hemiplegia and of right-handed, right and left hemiplegic persons.
        Arch Phys Med Rehabil. 1988; 69: 419-422
        • Wetter S.
        • Poole J.L.
        • Haaland K.Y.
        Functional implications of ipsilesional motor deficits after unilateral stroke.
        Arch Phys Med Rehabil. 2004; 86: 776-781
        • Yelnik A.
        • Bonan I.
        • Debray M.
        • Lo E.
        • Gelbert F.
        • Bussel B.
        Changes in the execution of a complex manual task after ipsilateral ischemic cerebral hemispheric stroke.
        Arch Phys Med Rehabil. 1996; 77: 806-810
        • Kwon Y.H.
        • Kim C.S.
        • Jang S.H.
        Ipsi-lesional motor deficits in hemiparetic patients with stroke.
        NeuroRehabilitation. 2007; 22: 279-286
        • Ottenbacher K.J.
        • Smith P.M.
        • Illig S.B.
        • Linn R.T.
        • Ostir G.V.
        • Granger C.V.
        Trends in length of stay, living setting, functional outcome, and mortality following medical rehabilitation.
        JAMA. 2004; 292: 1687-1695
        • Kitsos G.H.
        • Hubbard I.J.
        • Kitsos A.R.
        • Parsons M.W.
        The ipsilesional upper limb can be affected following stroke.
        ScientificWorldJournal. 2013; 2013: 684860
        • Brasil-Neto J.P.
        • de Lima A.C.
        Sensory deficits in the unaffected hand of hemiparetic stroke patients.
        Cogn Behav Neurol. 2008; 21: 202-205
        • Chestnut C.
        • Haaland K.Y.
        Functional significance of ipsilesional motor deficits after unilateral stroke.
        Arch Phys Med Rehabil. 2008; 89: 62-68
        • Desrosiers J.
        • Bourbonnais D.
        • Bravo G.
        • Roy P.M.
        • Guay M.
        Performance of the 'unaffected' upper extremity of elderly stroke patients.
        Stroke. 1996; 27: 1564-1570
        • Sainburg R.L.
        • Maenza C.
        • Winstein C.
        • Good D.
        Motor lateralization provides a foundation for predicting and treating non-paretic arm motor deficits in stroke.
        Adv Exp Med Biol. 2016; 957: 257-272
        • Haaland K.Y.
        • Schaefer S.Y.
        • Knight R.T.
        • et al.
        Ipsilesional trajectory control is related to contralesional arm paralysis after left hemisphere damage.
        Exp Brain Res. 2009; 196: 195-204
        • Schaefer S.Y.
        • Haaland K.Y.
        • Sainburg R.L.
        Hemispheric specialization and functional impact of ipsilesional deficits in movement coordination and accuracy.
        Neuropsychologia. 2009; 47: 2953-2966
        • Yadav G.
        • Haaland K.Y.
        • Mutha P.K.
        Laterality of damage influences the relationship between impairment and arm use after stroke.
        J Int Neuropsychol Soc. 2019; 25: 470-478
        • Downey J.E.
        • Quick K.M.
        • Schwed N.
        • et al.
        Primary motor cortex has independent representations for psilateral and contralateral arm movements but correlated representations for grasping.
        medRxiv. 2019;
        • Verstynen T.
        • Diedrichsen J.
        • Albert N.
        • Aparicio P.
        • Ivry R.B.
        Ipsilateral motor cortex activity during unimanual hand movements relates to task complexity.
        J Neurophysiol. 2005; 93: 1209-1222
        • Verstynen T.
        • Ivry R.B.
        Network dynamics mediating ipsilateral motor cortex activity during unimanual actions.
        J Cogn Neurosci. 2011; 23: 2468-2480
        • Willett F.R.
        • Deo D.R.
        • Avansino D.T.
        • et al.
        Hand knob area of motor cortex in people with tetraplegia represents the whole body in a modular way.
        bioRxiv. 2019;
        • Gowland C.
        • Stratford P.
        • Ward M.
        • et al.
        Measuring physical impairment and disability with the Chedoke-McMaster Stroke Assessment.
        Stroke. 1993; 24: 58-63
        • Mathiowetz V.
        • Weber K.
        • Kashman N.
        • Volland G.
        Adult norms for the nine hole peg test of finger dexterity.
        Occup Ther J Res. 1985; 5: 24-38
        • Mathiowetz V.
        • Volland G.
        • Kashman N.
        • Weber K.
        Adult norms for the box and block test of manual dexterity.
        Am J Occup Ther. 1985; 39: 386-391
        • Hackel M.E.
        • Wolfe G.A.
        • Bang S.M.
        • Canfield J.S.
        Changes in hand function in the aging adult as determined by the Jebsen Test of Hand Function.
        Phys Ther. 1992; 72: 373-377
        • Oxford Grice K.
        • Vogel K.A.
        • Le V.
        • Mitchell A.
        • Muniz S.
        • Vollmer M.A.
        Adult norms for a commercially available nine hole peg test for finger dexterity.
        Am J Occup Ther. 2003; 57: 570-573
        • Mathiowetz V.
        • Kashman N.
        • Volland G.
        • Weber K.
        • Dowe M.
        • Rogers S.
        Grip and pinch strength: normative data for adults.
        Arch Phys Med Rehabil. 1985; 66: 69-74
        • Fugl-Meyer A.R.
        • Jaasko L.
        • Leyman I.
        • Olsson S.
        • Steglind S.
        The post-stroke hemiplegic patient. 1. a method for evaluation of physical performance.
        Scand J Rehabil Med. 1975; 7: 13-31
        • Morris J.H.
        • Van Wijck F.
        Responses of the less affected arm to bilateral upper limb task training in early rehabilitation after stroke: a randomized controlled trial.
        Arch Phys Med Rehabil. 2012; 93: 1129-1137
        • Jones R.D.
        • Donaldson I.M.
        • Parkin P.J.
        Impairment and recovery of ipsilateral sensory-motor function following unilateral cerebral infarction.
        Brain. 1989; 112: 113-132
        • McCrea P.H.
        • Eng J.J.
        • Hodgson A.J.
        Time and magnitude of torque generation is impaired in both arms following stroke.
        Muscle Nerve. 2003; 28: 46-53
        • Xu J.
        • Haith A.M.
        • Krakauer J.W.
        Motor control of the hand before and after stroke.
        in: Clinical systems neuroscience. Springer, Tokyo2014
        • Gomes-Osman J.
        • Tibbett J.A.
        • Poe B.P.
        • Field-Fote E.C.
        Priming for improved hand strength in persons with chronic tetraplegia: a comparison of priming-augmented functional task practice, priming alone, and conventional exercise training.
        Front Neurol. 2016; 7: 242
        • Cunha B.P.
        • de Freitas S.
        • de Freitas P.B.
        Assessment of the ipsilesional hand function in stroke survivors: the effect of lesion side.
        J Stroke Cerebrovasc Dis. 2017; 26: 1615-1621
        • Semrau J.A.
        • Herter T.M.
        • Kenzie J.M.
        • Findlater S.E.
        • Scott S.H.
        • Dukelow S.P.
        Robotic characterization of ipsilesional motor function in subacute stroke.
        Neurorehabil Neural Repair. 2017; 31: 571-582
        • Mooney R.A.
        • Ackerley S.J.
        • Rajeswaran D.K.
        • et al.
        The influence of primary motor cortex inhibition on upper limb impairment and function in chronic stroke: a multimodal study.
        Neurorehabil Neural Repair. 2019; 33: 130-140
        • van Dokkum L.E.H.
        • le Bars E.
        • Mottet D.
        • Bonafe A.
        • Menjot de Champfleur N.
        • Laffont I.
        Modified brain activations of the nondamaged hemisphere during ipsilesional upper-limb movement in persons with initial severe motor deficits poststroke.
        Neurorehabil Neural Repair. 2018; 32: 34-45
        • Quaney B.M.
        • He J.
        • Timberlake G.
        • Dodd K.
        • Carr C.
        Visuomotor training improves stroke-related ipsilesional upper extremity impairments.
        Neurorehabil Neural Repair. 2010; 24: 52-61