The Japanese journal of neuropsychology

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ArticleTitle	Impaired visuo-motor skills in unaffected lower limbs of stroke patients with Lt-hemiplegica and constructional disturbance: studies using a Computerized Leg Exercise Assisting Machine (C-LEAM)
Language	J
AuthorList	Kazumi Kawahira¹⁾, Shu-ji Matsumoto¹⁾, Megumi Shimodouzono¹⁾, Nobuyuki Tanaka¹⁾, Showzou Tsujio²⁾
Affiliation	1) Department of Rehabilitation and Physical Medicine, Faculty of Medicine, Kagoshima University, Kagoshima, Japan 2) Department of Mechanical Engineering, Faculty of Engineering, Kagoshima University, Kagoshima, Japan
Publication	Japanese Journal of Neuropsychology: 18 (2), 129-135, 2002
Received	Oct 31, 2001
Accepted	Mar 14, 2002
Abstract	Objects: The purpose of this study was to determine the relation between constructional disturbances in the right hand and visuo-motor skills of lower limbs in figure tracking. Subjects: Subjects were 40 individuals consisting of 25 stroke patients with Lt.-hemiplegia (62.7± 9.5 yrs) and 15 normal controls (57.5± 7.3 yrs). Methods: Visuo-motor skills of unaffected lower limbs were evaluated with a Computerized Leg Exercise Assisting Machine (C-LEAM) testing the accuracy of trajectory tracking. In addition to normal figure tracking, mirror image figure tracking in which the foot marker was displayed at the mirror-image positioning was also performed. Drawing disability was evaluated with copy drawing of a cube. Visuo-special hemineglect was evaluated with line bisection and cancellation tests and by copy drawing. Results: The patients with Lt. lemiplegia were divided into two groups according to copy drawing disability. Trajectory errors in the tracking of unaffected lower limbs were compared among 10 patients with constructional disturbances (64.4± 9.6 yrs), 15 patients without constructional disturbances (61.6± 9.7 yrs) and normal controls. Visuo-spatial hemineglect was found in 8 of 10 patients with constructional disturbances. Physical abilities, including vibratory sensation and standing balance of the unaffected lower limbs, tapping of unaffected hands and severity of hemiplegic lower limbs, of patients with constructional disturbances were lower than those of normal controls. Patients with constructional disturbances showed significantly greater tracking errors in normal figure tracking than did the normal controls. In the mirror image task, patients with constructional disturbances showed significantly greater tracking errors than either patients without constructional disturbances or the normal controls did. The ratios of mirror image trajectory errors/normal image trajectory among the patients with constructional disturbance and the other two groups increased. Discussion: Impaired visuo-motor skills in a mirror imaged tracking task of patients with constructional disturbances suggested a dysfunction of the association cortex of the parietal and/or frontal lobes. Conclusion: Our results using a C-LEAM demonstrated impaired visuo-motor skills, especially in mirror imaged visuo-motor tasks, of unaffected lower limbs of stroke patients with constructional disturbances.
Keywords	constructional disturbance, left visuo-spatial agnosia, unaffected lower limb, visuo-motor task