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Body schema as assessed by upper limb left right judgement tasks is altered in stroke. Implications for motor imagery training.pdf (454.96 kB)

Body Schema as Assessed by Upper Limb Left/Right Judgment Tasks Is Altered in Stroke: Implications for Motor Imagery Training

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posted on 2024-02-26, 05:14 authored by Brendon HaslamBrendon Haslam, David ButlerDavid Butler, TS Cocks, AS Kim, Leeanne CareyLeeanne Carey
Background and Purpose: Individuals with stroke often experience significant impairment of the upper limb. Rehabilitation interventions targeting the upper limb are typically associated with only small to moderate gains. The knowledge that body schema can be altered in other upper limb conditions has contributed to the development of tailored rehabilitation approaches. This study investigated whether individuals with stroke experienced alterations in body schema of the upper limb. If so, this knowledge may have implications for rehabilitation approaches such as motor imagery. Methods: An observational study performed online consisting of left/right judgment tasks assessed by response time and accuracy of: (i) left/right direction recognition; (ii) left/right shoulder laterality recognition; (iii) left/right hand laterality recognition; (iv) mental rotation of nonembodied objects. Comparisons were made between individuals with and without stroke. Secondary comparisons were made in the stroke population according to side of stroke and side of pain if experienced. Results: A total of 895 individuals (445 with stroke) participated. Individuals with stroke took longer for all tasks compared to those without stroke, and were less accurate in correctly identifying the laterality of shoulder (P < 0.001) and hand (P < 0.001) images, and the orientation of nonembodied objects (P < 0.001). Moreover, the differences observed in the hand and shoulder tasks were greater than what was observed for the control tasks of directional recognition and nonembodied mental rotation. No significant differences were found between left/right judgments of individuals with stroke according to stroke-affected side or side of pain. Discussion and Conclusions: Left/right judgments of upper limb are frequently impaired after stroke, providing evidence of alterations in body schema. The knowledge that body schemas are altered in individuals with longstanding stroke may assist in the development of optimal, well-accepted motor imagery programs for the upper limb.


Funding for software development and website hosting for the study was provided by the Neuro Orthopaedic Institute. We acknowledge support from the National Health andMedical Research Council (NHMRC) of Australia Partnership grant (GNT1134495); NHMRC Project grant (GNT1022694); NHMRC Ideas grant (GNT2004443); James S McDonnell Foundation 21st Century Science Initiative in Cognitive Rehabilitation-Collaborative Award (#220020413); a Florey Institute of Neuroscience and Mental Health top-up scholarship awarded to B.S.H.; and the Victorian Government's Operational Infrastructure Support Program. This research is supported by an Australian Government Research Training Scholarship.


Publication Date



Journal of Neurologic Physical Therapy






29p. (p. 26-34)


Wolters Kluwer Health



Rights Statement

© 2022 The Authors. This is a pre-copyedited, author-produced version of an article accepted for publication in Journal of Neurologic Physical Therapy. The published version of record Haslam, Brendon S. MPT (Neurological); Butler, David S. DEd; Cocks, Timothy S. BAppSc (Physiotherapy); Kim, Anthony S. MD; Carey, Leeanne M. PhD. Body Schema as Assessed by Upper Limb Left/Right Judgment Tasks Is Altered in Stroke: Implications for Motor Imagery Training. Journal of Neurologic Physical Therapy 47(1):p 26-34, January 2023 is available online at: This manuscript version is made available under the Creative Commons Attribution (CC BY) license:

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