Dexterity is impaired at both hands following unilateral subcortical middle cerebral artery stroke

Abstract

Dexterity was investigated in right-handed subjects in the subacute phase of a first unilateral subcortical middle cerebral artery stroke affecting the left or right hemisphere and right-handed healthy subjects. Dexterity was quantified at both hands by kinematic recordings of finger and hand tapping, a reach-to-grasp movement, quantitative analysis of grip forces in a grasp-lift task and clinical rating scales. Stroke subjects exhibited significant deficits in timing and coordination of tapping movements at both the contralesional and ipsilesional hands, irrespective of the hemisphere affected. Likely for the reach-to-grasp and grasp-lift movements a bilateral impairment was found in stroke subjects. In particular, slowing of hand transport towards the object, deficient timing and scaling of grasp formation, discoordination between grip and lift forces and inefficient scaling of grip forces were observed. The severity of impairment was independent of the hemisphere affected and evident for both the reach (involving more proximal muscles of the arm) and grasp (involving more distal muscles of the arm and hand) components of the task. Strong correlations were found between clinical scores of hand function and loss of sensibility with the deficits in timing, coordination and efficiency of movement of the contralesional and ipsilesional hand. These data provide evidence that dexterity is impaired at both hands after subcortical middle cerebral artery stroke.

Deficits in upper limbs after stroke

“…However, the ipsilateral alterations are usually neglected by clinicians also need detailed investigation, so they can represent important dysfunctions that reflect on the functional performance of daily activities, which are most of the time bimanual [5][6][7][8][9] . So, identifying these deficits and understand which influence of the hemispheric asymmetries can contribute to the appropriate and realistic planning of these patients' rehabilitation.…”

“…Although the contralateral and ipsilateral alterations of the upper limbs of hemiparetic patients have been well documented in the literature [5][6][7][8][9][10] it is important to investigate which dominant (preference) manual influences over the motor, sensory and functional aspects of these patients. The objective of this study was to verify if the functional hemispheric asymmetry play an influence over the deficits of upper limbs of hemiparetic stroke patients, as well as if these possible alterations are different between men and women.…”

Understanding and supporting occupational therapists clinical decision-making for the management of upper limb post stoke sensory impairment

“…Given that ULPSSI significantly impact not only upper limb functional use (Nowak et al, 2007; Rand et al, 2001) but also outcomes (e.g. independence in self-care, mobility, or participation) for stroke survivors (Desrosiers et al, 2003; Rand et al, 2001; 37 Tyson et al, 2008) it would appear that ULPSSI management would be an important component of occupational therapy practice.…”

“…Subsequent studies and their implication are reported in the latter sections of the thesis. (Dannenbaum & Jones, 1993;Nowak et al, 2007; Rand, Gottlieb & Weiss, 2001;van der Lee et al, 1999;Yekutiel, 2000), decreased fine motor control, object manipulation, and grasp force (Aruin, 2005;Blennerhassett, Matyas, & Carey, 2007;Carey, 1995;Nowak et al, 2007;Robertson & Jones, 1994;Welmer, Holmqvist, & Sommerfeld, 2008;Yekutiel, 2000). Sensory impairments are also associated with increased length of hospitalisation; decreased numbers discharged home, lower functional levels at discharge, decreased long term participation, and increased mortality rates (Carey, 1995; Rand et al, 2001;Tyson, Hanley, Chillala, Selley, & Tallis, 2008;Yekutiel, 2000).…”

“…The quality of upper limb movements is also impaired in the presence of sensory impairments (Nowak et al, 2007; Rand et al, 2001). Stroke survivors were found to have impairments in force control, fine motor manipulation of objects, sensory ataxia, decreased grasp, and changes in prehension patterns, all of which have been found to be associated with sensory impairment (Aruin, 2005;Blennerhassett et al, 2007;Carey, 1995;Nowak et al, 2007;Robertson & Jones, 1994;Welmer et al, 2008;Yekutiel, 2000).Sensory deficits have been shown to predict poor functional outcome after stroke, including increased length of hospitalisation, lower levels of discharge home, lower numbers of home discharges, and increased mortality rates (Carey, 1995; Rand et al., 2001;Yekutiel, 2000). Tyson et al found that impairment of sensation was significantly associated with mobility, independence in activities of daily living and recovery (Tyson et al, 2008) while Desrosiers et al (2006) found a significant association with long-term participation.…”