Influence of hemispheric dominance in upper limb recovery on stroke patients

Resumen

Introduction: The upper limb is widely used in activities of daily living, mainly in bimanual actions. There are indications that after stroke, individuals with dominant upper limb involvement present better recovery, but this is an underexplored aspect of rehabilitation. Objective: To verify whether the manual dominance interferes in upper limb recovery of hemiparetic stroke patients Methodology: This is a cross-sectional study involving 48 patients declared right-handed (24 hemiparetic on the dominant side and 24 on the non-dominant side). Hand Movement Scale (HMS), grip strength (GS), Box and Blocks Test (BBT), and Modified Barthel Index (MBI) were evaluated. Unpaired t-test with Welch's correction was used to compare dominant hemiparesis versus non-dominant hemiparesis groups to parametric variables. The Mann-Whitney U test was used to analyze non-parametric variables. For some variables, such as grip strength and manual dexterity patients were tested bilaterally, thus, these data were analyzed using two-way ANOVA (Tukey's multiple comparisons test). Results: The most important aspects that differed between the groups were about manual function (HMS) and manual dexterity (BBT) for patients with right hemiparesis. And yet, we can consider a minimal clinically important difference favorable to this group for functional independence (MBI). Conclusion: Our results suggest that when there is the involvement of the dominant upper limb, the recovery of manual dexterity, manual function, and functional independence are favored. This better performance may be related to the natural preference of the dominant hand. These findings underscore the importance of tailoring therapy approaches based on hemispheric dominance.

Key words: stroke; upper extremity; functional laterality; rehabilitation.