The impact of cognitive impairment on upper body dressing difficulties after stroke: a video analysis of patterns of recovery.

OBJECTIVE to study the underlying cognitive deficits influencing a stroke patient's ability to relearn to dress. The aim was to investigate how recovery had occurred and whether the nature of cognitive impairment was the reason for persistent dressing problems. METHODS the dressing performance of 30 stroke patients was compared at the sub-acute stage and three months later. Standardised cognitive and physical tests were carried out, together with a video analysis of patients putting on a polo shirt. RESULTS thirteen patients with preserved power in the upper limb used both arms to put on the shirt. Despite visuospatial impairment or apraxia in some cases, all were successful given sufficient time. Out of 17 patients with arm paresis, 12 were dependent putting on the shirt. Amongst the five who were independent, significantly fewer cases of cognitive impairment were seen on tests for apraxia (p<0.05) and visuospatial perception (p<0.05). Video analysis confirmed the importance of cognitive problems such as neglect or apraxia. Three patients who failed shirt dressing showed neglect or apraxia at follow up and had persistent arm paresis. Test failures also occurred amongst those who were independent. DISCUSSION cognitive impairment affected patients attempting to relearn to dress with one hand, but did not affect patients who used both hands. The three patients who remained impaired on cognitive tests at follow up were unable to adapt or learn any compensatory strategies. The influence of cognition on a person's ability to learn compensatory strategies has implications for the design of rehabilitation therapies.

[1]  G Gainotti,et al.  Patterns of drawing disability in right and left hemispheric patients. , 1970, Neuropsychologia.

[2]  A. Benton,et al.  The visual retention test as a constructional praxis task. , 1962, Confinia neurologica.

[3]  J. Rankin.  Cerebral Vascular Accidents in Patients over the Age of 60: II. Prognosis , 1957, Scottish medical journal.

[4]  J. P. Paul,et al.  The effect of independent practice of motor tasks by stroke patients: a pilot randomized controlled trial , 2002, Clinical rehabilitation.

[5]  D. Wade,et al.  The Barthel ADL Index: a reliability study. , 1988, International disability studies.

[6]  N B Lincoln,et al.  Factors influencing dressing performance after stroke. , 1991, Journal of neurology, neurosurgery, and psychiatry.

[7]  T. Olsen,et al.  Compensation in recovery of upper extremity function after stroke: the Copenhagen Stroke Study. , 1994, Archives of physical medicine and rehabilitation.

[8]  G. Kinsella,et al.  Acute Recovery Patterns in Stroke Patients: Neuropsychological Factors , 1980, The Medical journal of Australia.

[9]  T. Olsen,et al.  Recovery of upper extremity function in stroke patients: the Copenhagen Stroke Study. , 1994, Archives of physical medicine and rehabilitation.

[10]  Bjørneby Er,et al.  Acquiring and maintaining self-care skills after stroke. The predictive value of apraxia , 2018, Journal of Rehabilitation Medicine.

[11]  N. Lincoln,et al.  Evaluation of dressing practice for stroke patients after discharge from hospital: a crossover design study , 1996 .

[12]  Georg Goldenberg Sonja Hagmann,et al.  Therapy of Activities of Daily Living in Patients with Apraxia , 1998 .

[13]  G. Assal,et al.  A comparison of constructive deficits following right and left hemispheric lesions. , 1970, Neuropsychologia.

[14]  Ian H. Robertson,et al.  Rehabilitation of Unilateral Neglect: Improving Function by Contralesional Limb Activation , 1998 .

[15]  D. Kimura,et al.  Motor functions of the left hemisphere. , 1974, Brain : a journal of neurology.

[16]  Benton Al.  The visual retention test as a constructional praxis task. , 1962 .

[17]  W. R. Brain.  VISUAL DISORIENTATION WITH SPECIAL REFERENCE TO LESIONS OF THE RIGHT CEREBRAL HEMISPHERE , 1941 .

[18]  I. Robertson,et al.  Spatiomotor cueing in unilateral left neglect: three case studies of its therapeutic effects. , 1992, Journal of neurology, neurosurgery, and psychiatry.

[19]  M. Annett,et al.  Five Tests of Hand Skill , 1992, Cortex.

[20]  T. Howe,et al.  Visuospatial deficits in stroke patients and their relationship to dressing performance. , 1983, Taiwan yi xue hui za zhi. Journal of the Formosan Medical Association.

[21]  F. Mcdowell,et al.  Improvement in Motor Performance in Paretic and Paralyzed Extremities Following Nonembolic Cerebral Infarction , 1971, Stroke.

[22]  C. V. van Heugten,et al.  Outcome of strategy training in stroke patients with apraxia: a phase II study , 1998, Clinical rehabilitation.

[23]  Nadina B. Lincoln,et al.  The Relation between Perceptual Deficits after Stroke and Independence in Activities of Daily Living , 1990 .

[24]  A. Sunderland.  Recovery of ipsilateral dexterity after stroke. , 2000, Stroke.

[25]  A. Young.  Progress and neglect , 1994 .

[26]  A. Fugl-Meyer,et al.  Motor and perceptual impairments in acute stroke patients: effects on self-care ability. , 1987, Stroke.

[27]  A. Sunderland,et al.  Impaired dexterity of the ipsilateral hand after stroke and the relationship to cognitive deficit. , 1999, Stroke.

[28]  W. Mack,et al.  Correlation of perceptual performance and activities of daily living in stroke patients. , 1991, The American journal of occupational therapy : official publication of the American Occupational Therapy Association.

[29]  L. Rapport,et al.  Validation of the Warrington theory of visual processing and the Visual Object and Space Perception Battery. , 1998, Journal of clinical and experimental neuropsychology.

[30]  I. Reinvang,et al.  Acquiring and maintaining self-care skills after stroke. The predictive value of apraxia. , 1985, Scandinavian journal of rehabilitation medicine.

[31]  D. Wade,et al.  Measurement in neurological rehabilitation. , 1992, Current opinion in neurology and neurosurgery.

[32]  O. L. Zangwill,et al.  VISUAL-CONSTRUCTIVE DISABILITIES ASSOCIATED WITH LESIONS OF THE LEFT CEREBRAL HEMISPHERE , 1960 .

[33]  R. Tallis,et al.  Reasons for variability in the reported rate of occurrence of unilateral spatial neglect after stroke. , 1999, Stroke.

[34]  M. Piercy,et al.  Constructional apraxia associated with unilateral cerebral lesions-left and right sided cases compared. , 1960, Brain : a journal of neurology.

[35]  B. Zoltan.  Vision, perception, and cognition : a manual for the evaluation and treatment of the neurologically impaired adult , 1996 .

[36]  Carlo Umiltà,et al.  A rehabilitation study of hemispatial neglect , 1994 .

[37]  J. Edmans,et al.  The recovery of perceptual problems after stroke and the impact on daily life , 1991 .

[38]  J. Mattingley,et al.  Phasic alerting of neglect patients overcomes their spatial deficit in visual awareness , 1998, Nature.