Compromised Motor Dexterity Confounds Processing Speed Task Outcomes in Stroke Patients

Abstract

Most conventional measures of information processing speed require motor responses to facilitate performance. However, although not often addressed clinically, motor impairment, whether due to age or acquired brain injury, would be expected to confound the outcome measure of such tasks. The current study recruited 29 patients (20 stroke and 9 transient ischemic attack) with documented reduction in dexterity of the dominant hand, and 29 controls, to investigate the extent to which 3 commonly used processing speed measures with varying motor demands (a Visuo-Motor Reaction Time task, and the Wechsler Adult Intelligence Scale-IV Symbol Search and Coding subtests) may be measuring motor-related speed more so than cognitive speed. Analyses include correlations between indices of cognitive and motor speed obtained from two other tasks (Inspection Time and Pegboard task, respectively) with the three speed measures, followed by hierarchical regressions to determine the relative contribution of cognitive and motor speed indices toward task performance. Results revealed that speed outcomes on tasks with relatively high motor demands, such as Coding, were largely reflecting motor speed in individuals with reduced dominant hand dexterity. Thus, findings indicate the importance of employing measures with minimal motor requirements, especially when the assessment of speed is aimed at understanding cognitive rather than physical function.

Populations Norms for “SLURP”—An iPad App for Quantification of Visuomotor Coordination Testing

“…Despite the development of good EHC by teen years, peak EHC does not continue through adulthood (Rand and Stelmach, 2011; Engel-Yeger et al, 2012; Ebaid et al, 2017; Low et al, 2017). In the current study, those over the age of 40 increasingly made more errors, took longer, and demonstrated greater variability in performance as the decades progressed.…”

“…In the current study, those over the age of 40 increasingly made more errors, took longer, and demonstrated greater variability in performance as the decades progressed. The deterioration in motor control during adulthood is well-known (Rand and Stelmach, 2011; Engel-Yeger et al, 2012; Ebaid et al, 2017; Low et al, 2017). Adults undertaking the Purdue Pegboard test ( n = 7,834) showed a marked deterioration in dexterity with age (Tiffin and Asher, 1948), with similar outcomes on the more demanding Grooved Pegboard test ( n = 357, 16–70 years) (Ruff, 1993).…”

“…Superimposed upon aging itself, are other neural or physical factors in chronic conditions that are known to affect EHC such as arthritis (Suomi and Collier, 2003) or neurodegenerative diseases such as familial tremor (Trillenberg et al, 2006), Parkinson's disease (Boisseau et al, 2002), glaucoma (Kotecha et al, 2009), and Alzheimer's disease (Verheij et al, 2012). Clearly, acute conditions such as traumatic brain injury, including stroke, might also be expected to have profound effects on EHC (Gao et al, 2010; Rizzo et al, 2017), but the focus on functional assessment has to date been on motor coordination rather than sensory status or visuomotor integration (Ebaid et al, 2017; Low et al, 2017). On the other hand, one study assessing wrist-aiming found that older persons who are physically active do not appear to suffer as great a reduction in EHC performance as would be expected (Van Halewyck et al, 2014).…”

“…As this data also showed that after just one practice item there is no order effect during presentation of the remaining 19 test items, potential existed to select particular items to create two smaller subtests that are objective, much quicker, clinically-useful and equivalent measures to facilitate comparison of developmental or aging milestones or pre/post therapeutic interventions. Areas that may warrant multiple assessment of eye-hand coordination with reference to population norms cover the ophthalmic condition of amblyopia (Suttle et al, 2011), neurological conditions such as stroke (Low et al, 2017), Parkinsons disease (Boisseau et al, 2002), and acquired brain injury (Gao et al, 2010) or the psychological and educational situations of developmental coordination disorder (Bieber et al, 2016), autism spectrum disorder (Anzulewicz et al, 2016), etc.…”

Cognitive and Motor Deficits Contribute to Longer Braking Time in Stroke 

“…Our ndings support that even after su cient strength recovery, braking performance in stroke is impacted by reduced movement precision. (37) and the measurement of motor accuracy can depend on visual information processing (38,39).…”