CHANGES IN THE EXECUTION OF A COMPLEX MANUAL TASK AFTER IPSILATERAL ISCHEMIC CEREBRAL HEMISPHERIC STROKE

Objective: To analyze behavioral adaptation of hemiplegic patients per forming a complex manual task without time constraint. It was postulat ed that ipsilateral motor disturbance could not be observed after a he mispheric stroke. Design: Two manual tasks were used: (1) a new one, ' 'PigTail,'' required the patients to run a 3-cm-diameter copper ring i n a wooden handle along a wavy copper wire without any time constraint ; (2) the second task was the Nine-Hole Peg Test (NHPT). Setting: A ho spital department of rehabilitation. Patients: A consecutive sample of 36 patients, who had all suffered an ischemic stroke in the middle ce rebral artery territory, 18 with left hemisphere damage (LHD) and 18 w ith right (RHD), and who had similar ages (mean 54+/-13), stroke sever ity, time since stroke (mean 60 days), and functional independence acc ording to the FIM. Main Outcome Measure: Main data were number of faul ts, time in seconds, and difference of time for two trials. Analysis c ompared the results with the same hand for patients and 86 healthy sub jects. Results: Patients scores for NHPT were worse than controls, wha tever the side of the lesion (p <.05). For Pig-Tail, the number of fau lts by patients was greater than by controls (p < .05); time was highe r for LHD, but not significantly, and was similar to controls for RHD. All patients and controls speeded up between the two trials. Although the RHD were clumsy, they were always faster than LHD patients. Concl usion: There are ipsilateral motor disturbances in a complex manual ta sk after hemispheric stoke, even without a speed constraint, and regar dless of the hemisphere damaged. Further studies are needed to examine speed control that seemed impaired by right hemisphere damage and cou ld explain clumsiness in these patients. (C) 1996 by the American Cong ress of Rehabilitation Medicine and the American Academy of Physical M edicine and Rehabilitation.