Abstract
Objective
To identify how individuals respond to unilateral upper extremity peripheral nerve
injury via compensation (increased use of the nondominant hand). We hypothesized that
injury to the dominant hand would have a greater effect on hand use (left vs right
choices). We also hypothesized that compensation would not depend on current (postinjury)
nondominant hand performance because many patients undergo rehabilitation that is
not designed to alter hand use.
Design
Observational survey, single-arm.
Settings
Academic research institution and referral center.
Participants
A total of 48 adults (N=48) with unilateral upper extremity peripheral nerve injury.
Another 14 declined participation. Referred sample, including all eligible patients
from 16 months at 1 nerve injury clinic and 1 hand therapy clinic.
Interventions
Not applicable.
Main Outcome Measures
Hand use (% of actions with each hand) via Block Building Task. Dexterity via Jebsen-Taylor
Hand Function.
Results
Participants preferred their dominant hand regardless of whether it was injured: hand
usage (dominant/nondominant) did not differ from typical adults, regardless of injured
side (P>.07), even though most participants (77%) were more dexterous with their uninjured
nondominant hand (mean asymmetry index, −0.16±0.25). The Block Building Task was sensitive
to hand dominance (P=2 × 10−4) and moderately correlated with Motor Activity Log amount scores (r2=0.33, P<.0001). Compensation was associated only with dominant hand dexterity (P=3.9 × 10−3), not on nondominant hand dexterity, rehabilitation, or other patient and/or injury
factors (P>.1).
Conclusions
Patients with peripheral nerve injury with dominant hand injury do not compensate
with their unaffected nondominant hand, even if it is more dexterous. For the subset
of patients unlikely to recover function with the injured hand, they could benefit
from rehabilitation that encourages compensation with the nondominant hand.
Keywords
List of abbreviations:
ANOVA (analysis of variance), DH (dominant hand), JTHF (Jebsen-Taylor Hand Function Test), MAL (Motor Activity Log), NDH (nondominant hand), PNI (peripheral nerve injury)To read this article in full you will need to make a payment
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References
- Impact of handedness on disability after unilateral upper-extremity peripheral nerve disorder.HAND (N Y). 2020; 15: 327-334
- The impact of hand dominance and ulnar and median nerve impairment on strength and basic daily activities.J Hand Ther. 2005; 18: 40-45
- Self-reported disability following distal radius fractures: the influence of hand dominance.J Hand Surg. 2000; 25: 476-482
- Left handedness does not extend to visually guided precision grasping.Exp Brain Res. 2007; 182: 275-279
- The assessment and analysis of handedness: the Edinburgh Inventory.Neuropsychologia. 1971; 9: 97-113
- Evidence for a dynamic-dominance hypothesis of handedness.Exp Brain Res. 2002; 142: 241-258
Brattain K. Analysis of the peripheral nerve repair market in the United States. Minneapolis: Magellan Medical Technology Consultants Inc; 2013.
- Peripheral nerve injuries: a retrospective survey of 1124 cases.Neurol India. 2017; 65: 551
- The incidence of peripheral nerve injury in extremity trauma.Am J Phys Med Rehabil. 2008; 87: 381-385
- Handedness has a narrow impact on disability after unilateral peripheral nerve disorder.American Society for Neurorehabilitation, Baltimore2017
- History of standard scoring, notation, and summation of neuromuscular signs. A current survey and recommendation.J Peripher Nerv Syst. 2005; 10: 158-173
Medical Research Council. Aids to the investigation of the peripheral nervous system. London: Her Majesty's Stationary Office; 1943.
- Factors predicting sensory and motor recovery after the repair of upper limb peripheral nerve injuries.Neural Regen Res. 2014; 9: 661-672
- Hemispheric specialization for the visual control of action is independent of handedness.J Neurophysiol. 2006; 95: 3496-3501
- Hand use for grasping in a bimanual task: evidence for different roles?.Exp Brain Res. 2013; 224: 455-467
- A biologically plausible computational theory for value integration and action selection in decisions with competing alternatives.PLoS Comput Biol. 2015; 11e1004104
- The neural basis of hand choice: an fMRI investigation of the posterior parietal interhemispheric competition model.NeuroImage. 2019; 185: 208-221
- The Motor Activity Log-28 assessing daily use of the hemiparetic arm after stroke.Neurology. 2006; 67: 1189-1194
- Seven-day activity and self-report compared to a direct measure of physical activity.Am J Epidemiol. 1984; 120: 818-824
- The accuracy of self-reports of physical activity.Med Sci Sports Exerc. 1990; 22: 690-697
- Research Electronic Data Capture (REDCap)—a metadata-driven methodology and workflow process for providing translational research informatics support.J Biomed Inform. 2009; 42: 377-381
- Development of the QuickDASH: comparison of three item-reduction approaches.J Bone Joint Surg Am. 2005; 87: 1038-1046
- Minimal clinically important difference of the Disabilities of the Arm, Shoulder and Hand outcome measure (DASH) and its shortened version (QuickDASH).J Orthop Sports Phys Ther. 2014; 44: 30-39
- The shortened Disabilities of the Arm, Shoulder and Hand questionnaire (QuickDASH): validity and reliability based on responses within the full-length DASH.BMC Musculoskelet Disord. 2006; 7: 44
- BORIS: a free, versatile open-source event-logging software for video/audio coding and live observations.Methods Ecol Evol. 2016; 7: 1325-1330
- Manual preferences for visually- and haptically-guided grasping.Acta Psychol (Amst). 2015; 160: 1-10
- An objective and standardized test of hand function.Arch Phys Med Rehabil. 1969; 50: 311-319
- Hand function evaluation: a factor analysis study.Am J Occup Ther. 1993; 47: 439-443
U.S. Department of Labor. O*NET OnLine. Available at: https://www.onetonline.org/. Accessed March 6, 2017.
- Investigation of reliability, validity, and cutoff value of the Jebsen-Taylor Hand Function Test.J Hand Ther. 2021; 34: 396-403
- Pain assessment using the NIH Toolbox.Neurology. 2013; 80 (11 Suppl): S49-S53
- Predictive value of the DASH tool for predicting return to work of injured workers with musculoskeletal disorders of the upper extremity.Occup Environ Med. 2016; 73: 807-815
- Dose response of task-specific upper limb training in people at least 6 months poststroke: a phase II, single-blind, randomized, controlled trial.Ann Neurol. 2016; 80: 342-354
- Does task-specific training improve upper limb performance in daily life poststroke?.Neurorehabil Neural Repair. 2017; 31: 290-300
- Can left-handedness be switched? Insights from an early switch of handwriting.J Neurosci. 2007; 27: 7847-7853
- Somatosensory deafferentation research with monkeys: implications for rehabilitation medicine.(editor)in: Ince L Behavioral psychology and rehabilitation medicine. Williams & Wilkins, Baltimore1980
- Forced use of hemiplegic upper extremities to reverse the effect of learned nonuse among chronic stroke and head-injured patients.Exp Neurol. 1989; 104: 125-132
- Neural substrates for the effects of rehabilitative training on motor recovery after ischemic infarct.Science. 1996; 272: 1791-1794
- Efficacy of Handwriting for Heroes, a novel hand dominance transfer intervention.Hand Therapy. 2012; 17: 15-24
- Non-dominant arm training improves functional performance and modifies spontaneous arm selection.Pennsylvania State University, University Park, PA2017
- Managing the upper extremity amputee: a protocol for success.J Hand Ther. 2008; 21: 160-176
- Wait wait, don't tell me: handedness questionnaires do not predict hand preference for grasping.Laterality. 2019; 24: 176-196
- Treatment for the service member: a description of innovative interventions.J Hand Ther. 2008; 21 ([quiz: 195]): 189-194
- Motor learning concepts applied to activity-based intervention with adults with hemiplegia.Am J Occup Ther. 1991; 45: 523-530
- Stability of handwriting performance following injury-induced hand-dominance transfer in adults: a pilot study.J Rehabil Res Dev. 2011; 48: 59-68
Article Info
Publication History
Published online: October 30, 2021
Accepted:
October 5,
2021
Received in revised form:
September 2,
2021
Received:
February 8,
2021
Footnotes
Presented as a poster summary of some of this research to the American Society for Neurorehabilitation, October 17, 2019, Chicago, IL.
Funded by Young Investigator Pilot Award 93230A from the Program in Occupational Therapy, Washington University School of Medicine. Research reported in this publication was supported by the Washington University Institute of Clinical and Translational Sciences grant UL1 TR000448 from the National Center for Advancing Translational Sciences (NCATS) of the National Institutes of Health (NIH). The content is solely the responsibility of the authors and does not necessarily represent the official view of the NIH.
Disclosures: none
Identification
Copyright
© 2021 by the American Congress of Rehabilitation Medicine.
