Abstract
A goal of rehabilitation after stroke is to promote pre-stroke levels of arm use for every day, frequently bimanual, functional activities. We reasoned that, after a stroke, the choice to use one or both hands for bimanual tasks might depend not only on residual motor capacity, but also the specialized demands imposed by the task on the paretic hand. To capture spontaneous, task-specific choices, we covertly observed 50 pre-stroke right-handed chronic stroke survivors (25 each of left, LHD, and right-hemisphere damage, RHD) and 11 age-similar control adults and recorded their hand use strategies for two pairs of bimanual tasks with distinct demands: one with greater precision requirements (photo-album tasks), and another with greater stabilization requirements (letter-envelope tasks). The primary outcome was the choice to use one or both hands. Logistic regression was used to test the two hypotheses that the probability of choosing a bimanual strategy would be greater in those with less severe motor impairment and also in those with LHD. When collapsed across the four tasks, we found support for these hypotheses. Notably, however, the influence of these factors on bimanual choice varied based on task demands. For the photo–album pair, the probability of a bimanual strategy was greater for those with LHD compared to RHD, regardless of the degree of motor impairment. For the letter–envelope pair, we found a significant interaction between impairment and side of lesion in determining the likelihood of choosing both hands. Therefore, the manner in which side of lesion moderates the effect of impairment on hand use depends on the task.
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Notes
We thank an anonymous reviewer for suggesting the addition of this analysis.
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Acknowledgements
Dr. Laurel Buxbaum (Moss Rehabilitation Research Institute) for contributing their dataset to this analysis. Drs. James Gordon (USC) and Robert Sainburg (Pennsylvania State University) for helpful discussions. Cassandra Castillo and Antonio Raymundo, students of the Engineering for Health Academy program, Francisco Bravo Medical Magnet High School, LAUSD, for coding the video data.
Funding
This research study is supported by the Eunice Kennedy Shriver NICHD National Center for Medical Rehabilitation Research of the National Institutes of Health under award numbers: F31HD098796 to RV and R01HD065438 to NS and CW.
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The data table and code for analysis are available on the first author’s OSF repository: https://doi.org/10.17605/osf.io/uh574.
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Communicated by Winston D Byblow.
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Varghese, R., Kutch, J.J., Schweighofer, N. et al. The probability of choosing both hands depends on an interaction between motor capacity and limb-specific control in chronic stroke. Exp Brain Res 238, 2569–2579 (2020). https://doi.org/10.1007/s00221-020-05909-5
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DOI: https://doi.org/10.1007/s00221-020-05909-5