[ES-1-1] The use of paretic hand has an effect of delay on cognitive process in performing Trail making Test
Introduction
The trail making test (TMT) is a psychological test widely used to evaluate the deficits in attention or executive function after stroke. Performing the TMT requires a sequential process of sensory-motorcognitive function; 1) visually perceiving the target, 2) determining whether the target is correct or not, and 3) drawing a line. Although it is known that the completion time is increased when the paretic hand is used, which process of the sensory-motor-cognitive function is affected by the use of paretic hand is unclear. The aim of this study was to investigate the effects of using paretic hand after stroke in performing the TMT.
Methods
Nine patients with stroke (8 males and 1 female, 66.0 ± 13. years, 7 ischemic and 2 hemorrhagic, mean UE-FMA 62.0 ± 5.4 points) participated in this study. The study was approved by the Ethical Review Board of the hospital, and informed consent was obtained from all patients. A glasses-type eye tracker (Tobii pro Glass 2, Tobii Technology Co., Ltd.) and an electronic TMT (electronic peg board K3000, Work joy Co., Ltd.) were used. The subjects wore the eye tracker and performed the electronic TMT - >A and -B two times; the testing order for the paretic and non-paretic hands was randomized. They were
asked to touch numbers/Hiragana on the screen as quickly as possible, based on the rule of TMT with
a touch pen dedicated to the task. Three visual parameters were used to quantitatively assess the TMT
process; 1) Visual search (time spent searching for the target, msec), 2) Fixation (gaze point retention
time on the target, msec) and 3) Visuomotor coordination (time spent touching the target on the screen, msec). Wilcoxon signed-rank test was used to compare the visual parameters between the paretic and non-paretic hands. Values of p < 0.05 were considered significant.
Results
Mean value of the visual parameters was as follows; Visual search on TMT-A (paretic: 1029 ± 410(ms), nonparetic: 846 ± 292 (ms)) and TMT-B (paretic: 1774 ± 1048 (ms), nonparetic: 1830 ± 1205 (ms)), Fixation on TMT-A (paretic: 842 ± 212 (ms), nonparetic: 659 ± 108 (ms)) and TMT-B (paretic:1080 ± 272 (ms), nonparetic: 862 ± 157 (ms)) and Visuomotor coordination on TMT-A (paretic: 930 ± 181 (ms), nonparetic: 759 ± 125 (ms)) and TMT-B (paretic: 1061 ± 247 (ms), nonparetic: 847 ± 136 (ms)). There were significant differences between hands in Visual search on TMT-A (p = 0.02), Fixation
on TMT-A (p = 0.02) and -B (p = 0.01) and Visuomotor coordination on TMT-A (p = 0.02) and -B (p = 0.01).
Discussion
The visual parameters were significantly increased when using the paretic hand. The results suggest that the use of the paretic hand has an effect of delay not only on the motor process, but also the cognitive process during the TMT. Our findings may provide useful information in explaining the poor TMTperformance in the paretic hand in patients with stroke.
The trail making test (TMT) is a psychological test widely used to evaluate the deficits in attention or executive function after stroke. Performing the TMT requires a sequential process of sensory-motorcognitive function; 1) visually perceiving the target, 2) determining whether the target is correct or not, and 3) drawing a line. Although it is known that the completion time is increased when the paretic hand is used, which process of the sensory-motor-cognitive function is affected by the use of paretic hand is unclear. The aim of this study was to investigate the effects of using paretic hand after stroke in performing the TMT.
Methods
Nine patients with stroke (8 males and 1 female, 66.0 ± 13. years, 7 ischemic and 2 hemorrhagic, mean UE-FMA 62.0 ± 5.4 points) participated in this study. The study was approved by the Ethical Review Board of the hospital, and informed consent was obtained from all patients. A glasses-type eye tracker (Tobii pro Glass 2, Tobii Technology Co., Ltd.) and an electronic TMT (electronic peg board K3000, Work joy Co., Ltd.) were used. The subjects wore the eye tracker and performed the electronic TMT - >A and -B two times; the testing order for the paretic and non-paretic hands was randomized. They were
asked to touch numbers/Hiragana on the screen as quickly as possible, based on the rule of TMT with
a touch pen dedicated to the task. Three visual parameters were used to quantitatively assess the TMT
process; 1) Visual search (time spent searching for the target, msec), 2) Fixation (gaze point retention
time on the target, msec) and 3) Visuomotor coordination (time spent touching the target on the screen, msec). Wilcoxon signed-rank test was used to compare the visual parameters between the paretic and non-paretic hands. Values of p < 0.05 were considered significant.
Results
Mean value of the visual parameters was as follows; Visual search on TMT-A (paretic: 1029 ± 410(ms), nonparetic: 846 ± 292 (ms)) and TMT-B (paretic: 1774 ± 1048 (ms), nonparetic: 1830 ± 1205 (ms)), Fixation on TMT-A (paretic: 842 ± 212 (ms), nonparetic: 659 ± 108 (ms)) and TMT-B (paretic:1080 ± 272 (ms), nonparetic: 862 ± 157 (ms)) and Visuomotor coordination on TMT-A (paretic: 930 ± 181 (ms), nonparetic: 759 ± 125 (ms)) and TMT-B (paretic: 1061 ± 247 (ms), nonparetic: 847 ± 136 (ms)). There were significant differences between hands in Visual search on TMT-A (p = 0.02), Fixation
on TMT-A (p = 0.02) and -B (p = 0.01) and Visuomotor coordination on TMT-A (p = 0.02) and -B (p = 0.01).
Discussion
The visual parameters were significantly increased when using the paretic hand. The results suggest that the use of the paretic hand has an effect of delay not only on the motor process, but also the cognitive process during the TMT. Our findings may provide useful information in explaining the poor TMTperformance in the paretic hand in patients with stroke.