Category: Stroke; Clinical Practice (assessment, diagnosis, treatment, knowledge translation/EBP, implementation science, program development)
Objective :
Impairment of the paretic hand following stroke places greater functional demands on the ipsilesional “nonparetic” hand. Dexterity of the nonparetic upper-limb, may also be compromised, although the extent is largely unquantified. This study examines the effects of stroke on strength and dexterity of the nonparetic hand in stroke survivors with chronic impairment.
Design :
A cohort of forty individuals with upper-extremity impairment after stroke participated in one evaluation session. Each participant performed assessments with their nonparetic upper-limb: Jebsen-Taylor Hand Function Test (JTHFT), 9-Hole Peg Test (9HPT), Box and Blocks Test (BBT), and maximum grip and pinch. Data were compared to age- and gender-matched normative values.
Setting :
The study took place at The Shirley Ryan AbilityLab (Chicago, IL), a freestanding rehabilitation hospital.
Participants (or Animals, Specimens, Cadavers) :
Forty stroke survivors with severe, chronic hand impairment (Chedoke-McMaster Stroke Assessment rating of 2-3 on Stage of Hand) participated. Participants were grouped by pre-stroke dominance of the nonparetic hand (n=20 pre-stroke Dominant Hand tested - DH, n=20 pre-stroke Non-dominant Hand tested - NH).
Interventions : Not applicable.
Main Outcome Measure(s) :
The primary outcome measure in this study was the JTHFT score of the nonparetic upper limb.
Results : Both the DH and NH groups performed significantly worse than normative data for the JTHFT, 9HPT, and BBT (p
Conclusions :
Even stroke survivors who primarily use their dominant hand after stroke exhibited significant deficits relative to normative data. Those forced to use their pre-stroke nondominant hand, exhibited substantial deficits relative to normative data for the dominant hand. Targeting the nonparetic upper-limb for therapy should be considered.
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Alexander Barry
– Biomedical Research Engineer I, Shirley Ryan AbilityLab, Chicago, Illinois
Elliot Roth
– Professor and Chair, Department of Physical Medicine and Rehabilitation, Northwestern University and Shirley Ryan Ability Lab, Chicago, IllinoisKristen Triandafilou
– Biomedical Engineer III, Shirley Ryan AbilityLab, Oak Park, IllinoisNaveen Bansal
– Professor, Marquette University, Milwaukee, WisconsinMary Ellen Stoykov
– Research Scientist/Research Associate Professor, Shirley Ryan Ability Lab/Northwestern University, Chicago, IllinoisDerek Kamper
– Associate Professor, UNC/NCSU Joint Department of Biomedical Engineering; Associate Director, Closed-Loop Engineering for Advanced Rehabilitation, North Carolina State University, University of North Carolina at Chapel Hill, Raleigh, North Carolina