Failure to Compensate: Patients With Nerve Injury Use Their Injured Dominant Hand,Even When Their Nondominant Is More Dexterous |
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| Institution: | 1. Program in Occupational Therapy, Washington University School of Medicine, St Louis, Missouri;2. Department of Psychiatry, Washington University School of Medicine, St Louis, Missouri;3. Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, St Louis, Missouri;1. From the Division of Occupational Science and Occupational Therapy, Department of Allied Health Sciences, University of North Carolina-Chapel Hill, Chapel Hill, NC;2. Health Sciences Library, University of North Carolina-Chapel Hill, Chapel Hill, NC;1. UPMC Center for High-Value Health Care, UPMC Health Plan, Pittsburgh, PA;2. Human Engineering Research Laboratories, Veterans Administration Pittsburgh Healthcare System, Pittsburgh, PA;3. Department of Physical Medicine and Rehabilitation, University of Pittsburgh School of Medicine, Pittsburgh, PA;1. Kennedy Krieger Institute, Baltimore, Maryland;2. Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, Maryland;3. Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland;4. Department of Neuropsychology, Kennedy Krieger Institute, Baltimore, Maryland;5. Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland;6. Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom;1. College of Anesthesiology, Xuzhou Medical University, Xuzhou City, Jiangsu Province;2. Department of Pain Treatment, the Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu Province, China;1. Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan;2. Department of Rehabilitation Medicine, Kyorin University School of Medicine, Tokyo, Japan;3. Department of Rehabilitation Medicine, National Hospital Organization Saitama Hospital, Saitama, Japan;4. Brain Attack Center Ota Memorial Hospital, Hiroshima, Japan;5. Department of Rehabilitation Medicine, Kawasaki Municipal Hospital, Kanagawa, Japan;6. Department of Rehabilitation Medicine, Saiseikai Yokohama Tobu Hospital, Kanagawa, Japan;1. Department of Rehabilitation Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand;2. Thai Red Cross Rehabilitation Center, Thai Red Cross Society, Samut Prakan, Thailand;3. Department of Rehabilitation Medicine Ι, School of Medicine, Fujita Health University, Toyoake, Japan |
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| Abstract: | ObjectiveTo identify how individuals respond to unilateral upper extremity peripheral nerve injury via compensation (increased use of the nondominant hand). We hypothesized that injury to the dominant hand would have a greater effect on hand use (left vs right choices). We also hypothesized that compensation would not depend on current (postinjury) nondominant hand performance because many patients undergo rehabilitation that is not designed to alter hand use.DesignObservational survey, single-arm.SettingsAcademic research institution and referral center.ParticipantsA total of 48 adults (N=48) with unilateral upper extremity peripheral nerve injury. Another 14 declined participation. Referred sample, including all eligible patients from 16 months at 1 nerve injury clinic and 1 hand therapy clinic.InterventionsNot applicable.Main Outcome MeasuresHand use (% of actions with each hand) via Block Building Task. Dexterity via Jebsen-Taylor Hand Function.ResultsParticipants preferred their dominant hand regardless of whether it was injured: hand usage (dominant/nondominant) did not differ from typical adults, regardless of injured side (P>.07), even though most participants (77%) were more dexterous with their uninjured nondominant hand (mean asymmetry index, ?0.16±0.25). The Block Building Task was sensitive to hand dominance (P=2 × 10?4) and moderately correlated with Motor Activity Log amount scores (r2=0.33, P<.0001). Compensation was associated only with dominant hand dexterity (P=3.9 × 10?3), not on nondominant hand dexterity, rehabilitation, or other patient and/or injury factors (P>.1).ConclusionsPatients with peripheral nerve injury with dominant hand injury do not compensate with their unaffected nondominant hand, even if it is more dexterous. For the subset of patients unlikely to recover function with the injured hand, they could benefit from rehabilitation that encourages compensation with the nondominant hand. |
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| Keywords: | JTHF"} {"#name":"keyword" "$":{"id":"pc_GOxsLsyMZW"} "$$":[{"#name":"text" "_":"Jebsen-Taylor Hand Function Test |
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