The Probability of Choosing Both Hands Depends on an Interaction Between Motor Capacity and Limb-Specific Control in Chronic Stroke

Abstract

A goal of rehabilitation after stroke is to promote pre-stroke levels of arm use for everyday, frequently bimanual, functional activities. We reasoned that, after a stroke, the choice to use one or both hands for bimanual tasks might depend not only on residual motor capacity but also the specialized demands imposed by the task on the paretic hand. To capture spontaneous, task-specific choices, we covertly observed 50 pre-stroke right-handed chronic stroke survivors (25 left hemisphere damage, LHD) and recorded their hand use strategies for two pairs of bimanual tasks with distinct demands: one with greater precision requirements (photo-album tasks), and another with greater stabilization requirements (letter-envelope tasks). The primary outcome was the choice to use one or both hands. Logistic regression was used to test the hypothesis that the probability of choosing a bimanual strategy would be greater in those with less severe motor impairment and those with LHD. When collapsed across the four subtasks, we found support for this hypothesis. However, notably, the influence of these factors on bimanual choice varied based on task demands. For the photo-album task, the probability of a bimanual strategy was greater for those with LHD compared to RHD, regardless of the degree of motor impairment. For the letter-envelope task, we found a significant interaction between impairment and side of lesion in determining the likelihood of choosing both hands. Therefore, the manner in which side of lesion moderates the effect of impairment on hand use depends on the task.