Recovery of ipsilateral dexterity after stroke

BACKGROUND AND PURPOSE; Previous work indicated that patients within 1 month of parietal or posterior frontal damage are often abnormally slow or clumsy when using the ipsilateral hand for dexterity tasks. This article reports a 6-month follow-up study to assess recovery and the impact on functional outcome.

Twenty-four patients (80%) were available for follow-up. They used the ipsilateral hand on a dexterity test that simulated everyday hand function. Weakness and ideomotor apraxia were also assessed. Performance was compared with that of healthy age-matched control subjects using the same hand. Rating scales for self-care and dexterity in everyday life were completed by patients and carers.

Significant recovery had occurred on all measures, but patients with left hemisphere damage remained impaired on the dexterity test, with 7 patients (58%) scoring below the normal range. Five of these were apraxic. Reports of everyday functioning did not reflect this impairment, but there were inconsistencies in these reports, which raised doubts as to their accuracy.

Ipsilateral dexterity shows recovery during the first 6 months, but there may be persistent impairment related to apraxia after left hemisphere stroke. It appears that the impact of this on functional outcome is typically small compared with the large effect of severity of contralateral paresis. It may be a significant factor in some cases, however, and direct observation of everyday functioning would be needed to clarify more subtle effects on outcome.