Arm Use After Left or Right Hemiparesis Is Influenced by Hand Preference

Abstract

Background and Purpose-Despite strong evidence for hand preference and its impact on motor performance, its influence on stroke rehabilitation has not been routinely considered. Previous research demonstrates that patients with hemiparetic stroke use their ipsilesional, nonparetic arm 5 to 6 times more frequently than their paretic arm, but it is unknown if such use varies with laterality of hemiparesis. The purpose of our study was to determine if the right arm is used more frequently in right-handed patients with stroke. Methods-We assessed relative use of the right, left, and both arms with wrist accelerometers on patients with unilateral, paretic stroke matched for degree of paresis (12 with right hemisphere damage, 17 with left hemisphere damage) and 25 neurologically intact control participants as they performed the Arm Motor Ability Test. Results-We showed: (1) ipsilesional arm use was greater after right hemisphere damage than left hemisphere damage; (2) the left hemisphere damage group used both arms together more often than the right hemisphere damage group but less often than the control group; and (3) both stroke groups used their contralesional, paretic arm to the same degree. Conclusions-These findings emphasize the influence of hand preference on arm use after stroke for the ipsilesional but not the contralesional arm. Although both stroke groups used their ipsilesional more than their contralesional arm, the difference was greater for the right hemisphere damage group who used their ipsilesional arm 4 times more frequently than their contralesional arm, whereas the left hemisphere damage group used their ipsilesional arm 2 times more frequently than their contralesional arm.

Deficits in upper limbs after stroke

“…These findings are in conformity with relate the deficits of ipsilateral dexterity to different reasons, where they observed that the lesions on the left hemisphere cause apraxia of the member, and the lesions on the right hemisphere cause spatial disturbances 22 . The patients with lesions on the right hemisphere use the ipsilateral upper limb four times more than the patients with lesions on the left hemisphere 23 . This can be explained due to the majority are handed people, so, the spontaneous use can contribute decisively to this behavior.…”

“…This is easily understandable, as the influence of the cortical-spinal tract is predominantly crossed 25 . Reinforcing these aspects these patients used 5 to 6 times more their ipsilateral members comparing to the contralateral members 23 .…”

“…Some studies have demonstrated that alterations occur in both upper limbs after a unilateral stroke affecting the frontal and/or parietal lobes of brain 22,23 . Undoubtedly, the greatest focus is given to the contralateral alterations due to the severity of the deficits that cause important functional impacts.…”

“…Considering that all the patients were handed people, it was observed a better performance in right hemiparetic patients. Besides the spontaneous use of the dominant limb (preferred) to execute the most Rev Neurocienc 2015;23(2):260-266 complex component of the task, it was already observed that those patients with lesion on the left hemisphere use twice more the upper limbs bilaterally, what could contributed to a better performance in this dexterity test 23 .…”

Arm Selection Behavior of Stroke Patients in Reaching: a Preliminary Study

“…Harris and Eng 15) showed that arm use was affected less in patients who had the dominant arm affected than in patients who had the non-dominant arm affected. A recent study showed that ipsilesional arm use was greater after right-side stroke, while patients with left-side stroke used both arms together more often than patients with the right-side stroke 16) . However, the above-mentioned studies focused on the tendency of arm selection after a stroke.…”