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J Phys Ther. 2012; 5(1): 14-29

Examining visuospatial/visuomotor performance in chronic stroke patients with right fronto-parietal damage: Can greater functional recovery be expected as time goes by?

William J Tippett, PhD.a,b,c,g,*, Lisa D Alexander, MPT.a,b,c, Mireille N Rizkalla, BSc.g, Lauren E Sergio, PhD.d,e, Sandra E Black, MD.a,b,c,f..

Background: There is a paucity of information regarding visuospatial (VS) and visuomotor (VM) task performance in patients with chronic right fronto-parietal lobe stroke, as the majority of knowledge to date in this realm has been gleaned from acute stroke patients.
Aim: To determine how VS and VM performance in chronic stroke patients compare to the performance of healthy participants.
Methods: Nine patients with stroke involving the right fronto-parietal region were evaluated against match controls on neuropsychological tests and a computerized visuomotor assessment task.
Results: Initial evaluation indicated that performance between participant groups were relatively similar on both Neuropsychology measures and on our novel computerized VM task. However, an in-depth analysis of variability revealed observable differences participant groups. In addition, large effect size values were also observed lending support to the theory that using only conventional examination (e.g. p-values) measures may result in miss-identifying crucial stroke-related differences in behaviour.
Conclusion: Through conventional evaluation methods it would appear that the chronic stroke participants had made significant functional gains over time. However, it was shown that the type of evaluation used was essential to identifying group differences, particularly when faced with a limited number of patients or when clinicians are seeking insight into functional deficits on a patient by patient basis. Thus, supplementary methods of evaluation are required to unmask true functional changes, and to determine if true gains occurred over time.

Key words: visuospatial; visuomotor; chronic stroke; fronto-parietal lesions; neuropsychological rehabilitation.

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