Impairments in Cognitive Control Using a Reverse Visually Guided Reaching Task Following Stroke

Background Cognitive and motor function must work together quickly and seamlessly to allow us to interact with a complex world, but their integration is difficult to assess directly. Interactive technology provides opportunities to assess motor actions requiring cognitive control. Objective To adapt a reverse reaching task to an interactive robotic platform to quantify impairments in cognitive-motor integration following stroke. Methods Participants with subacute stroke (N=59) performed two tasks using the Kinarm: Reverse Visually Guided Reaching (RVGR) and Visually Guided Reaching (VGR). Tasks required subjects move a cursor "quickly and accurately" to virtual targets. In RVGR, cursor motion was reversed compared to finger motion (i.e., hand moves left, cursor moves right). Task parameters and Task Scores were calculated based on models developed from healthy controls, and accounted for the influence of age, sex, and handedness. Results Many stroke participants (86%) were impaired in RVGR with their affected arm (Task Score > 95% of controls). The most common impairment was increased movement time. Seventy-three percent were also impaired with their less affected arm. The most common impairment was larger initial direction angles of reach. Impairments in RVGR improved over time, but 71% of participants tested longitudinally were still impaired with the affected arm similar to 6 months post-stroke. Importantly, although 57% were impaired with the less affected arm at 6 months, these individuals were not impaired in VGR. Conclusions Individuals with stroke were impaired in a reverse reaching task but many did not show similar impairments in a standard reaching task, highlighting selective impairment in cognitive-motor integration.