Hand dominance and side of stroke affect rehabilitation in chronic stroke

OBJECTIVE: To examine the difference between upper extremity deficits in subjects with left versus right hemispheric lesions at baseline and after bilateral arm training. DESIGN: A one-way ANOVA was used to detect group differences and a least square means analysis used to determine significance in pre-to-post scores for each group. SETTING: Testing was in the Physical Therapy and Rehabilitation Science Department Research Laboratory, University of Maryland, Baltimore. Training was at the Senior Exercise Rehabilitation Center in the Veterans Administration Hospital, Baltimore. SUBJECTS: Twenty-two (11 left hemispheric lesion, 11 right hemispheric lesion) right-handed subjects with chronic stroke. INTERVENTIONS: A six-week nonprogressive repetitive bilateral arm training with rhythmic auditory cueing (BATRAC). MAIN MEASURES: Fugl-Meyer Upper Extremity Test, Wolf Motor Arm Test, University of Maryland Arm Questionnaire for Stroke (UMAQS), isometric strength and active and passive range of motion for both sides. RESULTS: No statistical differences were seen at baseline between groups in this sample. Both groups demonstrated improvement after BATRAC in Fugl-Meyer Upper Extremity Test (change scores of those with left lesions = 5.5; right lesions = 3.6) and UMAQS (change scores of those with left lesions = 5 and right lesions = 2.9). Additionally, patients with left hemispheric lesions but not right lesions made improvements in the Wolf Motor Arm Test (time and weight), in strength measures of paretic elbow flexion, shoulder extension, shoulder abduction and nonparetic wrist flexion, wrist extension and shoulder abduction. CONCLUSIONS: There were no baseline motor function differences between those with left and right hemispheric lesions in this sample. There was a clear training response advantage for patients with left hemispheric lesions after completing six weeks of bilateral arm training. As a result, treatment approaches for upper extremity hemiparesis may need to be more specifically selected based on side of stroke.