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Logo of jnnpsycJournal of Neurology, Neurosurgery and PsychiatryCurrent TOCInstructions for authors
J Neurol Neurosurg Psychiatry. Jan 2004; 75(1): 43–48.
PMCID: PMC1757467

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.

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Selected References

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  • Titus MN, Gall NG, Yerxa EJ, Roberson TA, Mack W. Correlation of perceptual performance and activities of daily living in stroke patients. Am J Occup Ther. 1991 May;45(5):410–418. [PubMed]
  • Walker MF, Lincoln NB. Factors influencing dressing performance after stroke. J Neurol Neurosurg Psychiatry. 1991 Aug;54(8):699–701. [PMC free article] [PubMed]
  • Bernspång B, Asplund K, Eriksson S, Fugl-Meyer AR. Motor and perceptual impairments in acute stroke patients: effects on self-care ability. Stroke. 1987 Nov-Dec;18(6):1081–1086. [PubMed]
  • Bjørneby ER, Reinvang IR. Acquiring and maintaining self-care skills after stroke. The predictive value of apraxia. Scand J Rehabil Med. 1985;17(2):75–80. [PubMed]
  • van Heugten CM, Dekker J, Deelman BG, van Dijk AJ, Stehmann-Saris JC, Kinebanian A. Outcome of strategy training in stroke patients with apraxia: a phase II study. Clin Rehabil. 1998 Aug;12(4):294–303. [PubMed]
  • PIERCY M, HECAEN H, de AJURIAGUERRA Constructional apraxia associated with unilateral cerebral lesions-left and right sided cases compared. Brain. 1960;83:225–242. [PubMed]
  • BENTON AL. The visual retention test as a constructional praxis task. Confin Neurol. 1962;22:141–155. [PubMed]
  • Hécaen H, Assal G. A comparison of constructive deficits following right and left hemispheric lesions. Neuropsychologia. 1970 Jul;8(3):289–303. [PubMed]
  • Sunderland A, Bowers MP, Sluman SM, Wilcock DJ, Ardron ME. Impaired dexterity of the ipsilateral hand after stroke and the relationship to cognitive deficit. Stroke. 1999 May;30(5):949–955. [PubMed]
  • Sunderland A. Recovery of ipsilateral dexterity after stroke. Stroke. 2000 Feb;31(2):430–433. [PubMed]
  • RANKIN J. Cerebral vascular accidents in patients over the age of 60. II. Prognosis. Scott Med J. 1957 May;2(5):200–215. [PubMed]
  • Kimura D, Archibald Y. Motor functions of the left hemisphere. Brain. 1974 Jun;97(2):337–350. [PubMed]
  • Annett M. Five tests of hand skill. Cortex. 1992 Dec;28(4):583–600. [PubMed]
  • Pollock Alexandra S, Durward Brian R, Rowe Philip J, Paul John P. The effect of independent practice of motor tasks by stroke patients: a pilot randomized controlled trial. Clin Rehabil. 2002 Aug;16(5):473–480. [PubMed]
  • Robertson IH, North NT, Geggie C. Spatiomotor cueing in unilateral left neglect: three case studies of its therapeutic effects. J Neurol Neurosurg Psychiatry. 1992 Sep;55(9):799–805. [PMC free article] [PubMed]
  • Robertson IH, Mattingley JB, Rorden C, Driver J. Phasic alerting of neglect patients overcomes their spatial deficit in visual awareness. Nature. 1998 Sep 10;395(6698):169–172. [PubMed]
  • Bowen A, McKenna K, Tallis RC. Reasons for variability in the reported rate of occurrence of unilateral spatial neglect after stroke. Stroke. 1999 Jun;30(6):1196–1202. [PubMed]
  • Kinsella G, Ford B. Acute recovery from patterns in stroke patients: neuropsychological factors. Med J Aust. 1980 Dec 13;2(12):663–666. [PubMed]
  • Robertson IH, Mattingley JB, Rorden C, Driver J. Phasic alerting of neglect patients overcomes their spatial deficit in visual awareness. Nature. 1998 Sep 10;395(6698):169–172. [PubMed]
  • McDowell F, Louis S. Improvement in motor performance in paretic and paralyzed extremities following nonembolic cerebral infarction. Stroke. 1971 Jul-Aug;2(4):395–399. [PubMed]

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