Ipsilateral Deficits in 1-Handed Shoe Tying After Left or Right Hemisphere Stroke

Objective: To examine 1-handed shoe tying performance and whether cognitive deficits more associated with left or fight hemisphere damage differentially affect it after unilateral stroke. Design: Observational cohort comparing ipsilesional shoe lying, spatial and language skills, and limb praxis. Setting: Primary care Veterans Affairs and private medical center. Interventions: Not applicable. Participants: Volunteer right-handed sample of adults with left or right hemisphere damage and healthy demographically matched adults. Main Outcome Measure: The number of correct trials and the total time to complete 10 trials tying a shoe using the 1-handed method. Results: Both stroke groups had fewer correct trials and were significantly slower tying the shoe than the control group. Spatial skills predicted accuracy and speed after right hemisphere damage. After left hemisphere damage, accuracy was predicted by spatial skills and limb praxis, while speed was predicted by limb praxis only. Conclusions: Ipsilesional shoe tying is similarly impaired after left or fight hemisphere damage, but for different reasons. Spatial deficits had a greater influence after right hemisphere damage, and limb apraxia had a greater influence after left hemisphere damage. Language deficits did not affect performance, indicating that aphasia does not preclude using this therapy approach. These results suggest that rehabilitation professionals should consider assessment of limb apraxia and ipsilesional skill training in the performance of everyday tasks.