Functional Deficits in the Less-Impaired Arm of Stroke Survivors Depend on Hemisphere of Damage and Extent of Paretic Arm Impairment.
Candice Maenza, David C Good, Carolee J Winstein and 2 others
PMID 31538852WHAT IT FOUND
Chronic stroke survivors' less-affected arm was slower and less effective on hand tasks, especially when the paretic arm was severely impaired.
Left hemisphere damage slowed writing and feeding. This does not show training helps.
Key findings
01Stroke survivors' less-affected arm took longer on the Jebsen-Taylor Hand Function Test than matched controls, and the severe paretic-impairment group was the slowest.
02After left hemisphere damage, the less-affected arm was slower on writing and simulated feeding than after right hemisphere damage or controls.
03Severe paretic-arm impairment was associated with weaker grip and slower pegboard performance in the less-affected arm, regardless of hemisphere.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTs
Read the rest of this summary
You get three full summaries a month, free, and we do not ask for a card. Search, the TL;DRs and your library stay unlimited either way.
What it does not show
This was an observational assessment, not a treatment study, so it cannot show that any intervention improves the less-affected arm. Cognitive status was not quantitatively assessed, although participants demonstrated understanding of tasks. Aphasia and visual neglect were reported but not used as covariates because they were not represented across impairment groups. Apraxia was treated as present or absent, not as a continuous severity score, and only 20 of 110 stroke participants were identified as apraxic. Removing apraxic participants reduced the ability to detect an effect, so the loss of the severity-by-hand interaction after removal is uncertain. Group sizes were unequal: the moderate group had 14 participants, the mild group had 58, and the severe group had 38. The sample came from a medical center and was limited by participant availability during recruitment. Only right-handed stroke survivors with chronic unilateral middle cerebral artery stroke were studied, so results may not apply to left-handed stroke survivors or other lesion types.
Declared interests
The authors declared no conflict of interest. The article is tagged as supported by NIH extramural and non-U.S. government research funds.
The easy way to misread this
Do not use this paper to conclude that training the less-affected arm will improve function. It measured deficits in stroke survivors and controls, and no rehabilitation intervention was tested.