Related Experiment Video
Updated: Nov 9, 2025
Author Spotlight: Rehabilitation of Stroke Patients With a Digital Occupational Training System
Published on: December 29, 2023
Cognitive Demands Influence Upper Extremity Motor Performance During Recovery From Acute Stroke
David J Lin1, Kimberly S Erler2, Samuel B Snider2
1From the Center for Neurotechnology and Neurorecovery (D.J.L., J.A.D., N.L., J.R., K.P., A.C., J.F., L.R.H.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston; Division of Neurocritical Care (D.J.L., L.R.H.), Department of Neurology, Stroke Service (D.J.L., S.P.F., L.H.S., L.R.H.), Department of Neurology, J. Philip Kistler Stroke Research Center (A.K.B.), Department of Neurology, Department of Occupational Therapy (J.R.), Department of Physical Therapy (K.P.), and Department of Speech, Language, and Swallowing Disorders (A.C., J.F.), Massachusetts General Hospital, Boston; VA RR&D Center for Neurorestoration and Neurotechnology (D.J.L., L.R.H.), Rehabilitation R&D Service, Department of VA Medical Center, Providence, RI; Department of Occupational Therapy (K.S.E., N.L.), MGH Institute of Health Professions, Boston, MA; Division of Neurocritical Care (S.B.S.), Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; School of Engineering (L.R.H.), Brown University, Providence, RI; Department of Neurology (S.C.C.), University of California, Los Angeles; and California Rehabilitation Hospital (S.C.C.), Los Angeles. dlin7@mgh.harvard.edu.
Objective:
To test the hypothesis that cognitive demands influence motor performance during recovery from acute stroke, we tested patients with acute stroke on 2 motor tasks with different cognitive demands and related task performance to cognitive impairment and neuroanatomic injury.
Methods:
We assessed the contralesional and ipsilesional upper extremities of a cohort of 50 patients with weakness after unilateral acute ischemic stroke at 3 time points with 2 tasks: the Box & Blocks Test, a task with greater cognitive demand, and Grip Strength, a simple and ballistic motor task. We compared performance on the 2 tasks, related motor performance to cognitive dysfunction, and used voxel-based lesion symptom mapping to determine neuroanatomic sites associated with motor performance.
Results:
Consistent across contralesional and ipsilesional upper extremities and most pronounced immediately after stroke, Box & Blocks scores were significantly more impaired than Grip Strength scores. The presence of cognitive dysfunction significantly explained up to 33% of variance in Box & Blocks performance but was not associated with Grip Strength performance. While Grip Strength performance was associated with injury largely restricted to sensorimotor regions, Box & Blocks performance was associated with broad injury outside sensorimotor structures, particularly the dorsal anterior insula, a region known to be important for complex cognitive function.
Conclusions:
Together, these results suggest that cognitive demands influence upper extremity motor performance during recovery from acute stroke. Our findings emphasize the integrated nature of motor and cognitive systems and suggest that it is critical to consider cognitive demands during motor testing and neurorehabilitation after stroke.
More Related Videos
05:28Author Spotlight: Enhancing Upper Limb Rehabilitation in Stroke Patients Through Advanced Robotic and Neuromodulation Technologies
Published on: October 11, 2024
15:00The Impact of Motor Task Conditions on Goal-Directed Arm Reaching Kinematics and Trunk Compensation in Chronic Stroke Survivors
Published on: May 2, 2021