Hand preferences in preschool children: Reaching, pointing and symbolic gestures

Upper extremity asymmetry due to nerve injuries or central neurologic conditions: a scoping review

BACKGROUND

Peripheral nerve injuries and central neurologic conditions can result in extensive disabilities. In cases with unilateral impairment, assessing the asymmetry between the upper extremity has been used to assess outcomes of treatment and severity of injury. A wide variety of validated and novel tests and sensors have been utilized to determine the upper extremity asymmetry. The purpose of this article is to review the literature and define the current state of the art for describing upper extremity asymmetry in patients with peripheral nerve injuries or central neurologic conditions.

METHOD

An electronic literature search of PubMed, Scopus, Web of Science, OVID was performed for publications between 2000 to 2022. Eligibility criteria were subjects with neurological conditions/injuries who were analyzed for dissimilarities in use between the upper extremities. Data related to study population, target condition/injury, types of tests performed, sensors used, real-world data collection, outcome measures of interest, and results of the study were extracted. Sackett's Level of Evidence was used to judge the quality of the articles.

RESULTS

Of the 7281 unique articles, 112 articles met the inclusion criteria for the review. Eight target conditions/injuries were identified (Brachial Plexus Injury, Cerebral Palsy, Multiple Sclerosis, Parkinson's Disease, Peripheral Nerve Injury, Spinal Cord Injury, Schizophrenia, and stroke). The tests performed were classified into thirteen categories based on the nature of the test and data collected. The general results related to upper extremity asymmetry were listed for all the reviewed articles. Stroke was the most studied condition, followed by cerebral palsy, with kinematics and strength measurement tests being the most frequently used tests. Studies with a level of evidence level II and III increased between 2000 and 2021. The use of real-world evidence-based data, and objective data collection tests also increased in the same period.

CONCLUSION

Adequately powered randomized controlled trials should be used to study upper extremity asymmetry. Neurological conditions other than stroke should be studied further. Upper extremity asymmetry should be measured using objective outcome measures like motion tracking and activity monitoring in the patient's daily living environment.

The Handedness Index Practical Task (HI20): An economic behavioural measure for assessing manual preference

ABSTRACTBecause self-report hand preference measures are limited to investigating cognitive aspects of manual laterality, valid, easy-to-administer and economic behavioural methods are needed for capturing the motoric component of handedness. Therefore, this study introduces the Handedness Index Practical Task (HI₂₀) and tests it in a sample of 206 students (M_age = 23.79 years, SD_age = 3.01 years), half of whom were self-specified left-handers. After confirming good reliabilities at the subscale and total scale levels, k-means cluster analysis allowed an empirically based partitioning of test subjects into left- (n = 72), mixed- (n = 23) and right-handers (n = 111). To validate this categorization and the HI₂₀ index, data were compared with the Edinburgh Handedness Inventory (EHI), EHI-short, HI₂₂ and hand grip strength. The congruency between the HI₂₀ clusters and alternative categorizations ranged from 95.6% to 84.0%, while the clusters explained large portions of variance in grip strength differences. The HI₂₀ sub- and total scores showed strong correlations with other measures of lateral preference. Altogether, the freely available HI₂₀ emerges as a reliable and valid alternative for behavioural handedness assessment, whose power lies in explaining differential hand use patterns and enabling fine-grained examinations of handedness.

Hand Movements in Communicative and Noncommunicative Situations in Very Young Infants: A Preliminary Study

As a step toward understanding the developmental relationship between handedness and language lateralization, this longitudinal study investigated how infants (N = 21) move their hands in noncommunicative and communicative situations at 2 weeks and at 3 months of age. The authors looked at whether left-right asymmetry in hand movements and in duration of self-touch appeared across conditions and whether the direction of asymmetry depended on the communicative nature of the situation. The authors found that asymmetries appeared less consistently than suggested in literature and did not only depend on the communicative nature of the situation. Instead, hand activity and self-touch patterns depended on age, the presence of the mother, the degree of novelty of the situation, and the presence of an object. The results partly support previous studies that pointed out an early differentiation of communicative hand movements versus noncommunicative ones in infants. It is in terms of the amount of global hand activity, rather than in those of the laterality of hand movements that this differentiation emerged in this study. At 3 months, infants moved their hands more in the communicative conditions than in the noncommunicative conditions and this difference appeared as a tendency already at 2 weeks of age.

Hand preference in referential gestures: Relationships to accessing words for speaking in monolingual and bilingual children

INTRODUCTION

Infants' right-hand preference for pointing is associated with higher vocabulary. It is not clear whether the link between right-hand preference for gesturing and language persists into the preschool years. The primary purpose of the present study was to test whether preschool children's hand preference for referential gestures was associated with their language abilities. Secondarily, we predicted that the children's right-hand preference would be negatively associated with their visuospatial abilities. We also predicted that monolingual children would show a strong right-hand preference while bilinguals might show a reduced right-hand preference.

METHODS

Monolingual and bilingual children between the ages of four and six years did a storytelling task. Their referential gestures were coded for hand use (right, left, both). We measured language skills (receptive vocabulary, semantic fluency).

RESULTS

We found no difference between bilinguals and monolinguals on hand preference. Semantic fluency was a positive predictor and vocabulary a negative predictor of right-hand preference. Children's visuospatial abilities were not a predictor of right-hand preference.

CONCLUSION

These results suggest that right-hand preference may help children select semantically appropriate words out of their existing vocabulary. In other words, this preference may be related to children's construction of the message that they would like to produce. The association between hand preference and language skills persists into the preschool years.

Nine-month old infants' hand preference shows no link to concurrent or later vocabulary

Previous studies have shown a link between language abilities and right hand preference (RHP) for both object manipulation and pointing between 10 and 18 months of age. For infants, RHP can still be unstable. The purpose of the present study was to test whether the link between vocabulary and RHP exists among 9-month-old infants. The study included 88 infants who were observed in videotaped free-play interactions with their mothers at 9 months of age. The infants' hand preference was coded for touching objects and pointing. The children's vocabulary was measured at 9, 12, and 18 months of age. The results showed a small and significant RHP for touching objects and no significant RHP for pointing. The degree of RHP was not correlated with vocabulary scores at any age. One interpretation of these results is that, for the infants in this study, the lateralization for motor abilities was still stabilizing and therefore showed no relationship with their vocabulary. If so, this result is consistent with the argument that language lateralization builds on the lateralization for skilled and/or communicative movement.

Which hand knows the "right" word? What hand selection reveals about vocabulary in pre-and school-aged children

Research has shown that infants with increased right-hand selection for their first gestures perform better at an array of language tasks when they are tested later as toddlers. There is a smaller body of literature which focuses on preschoolers and how their right-handed movements relate to their speech and vocabulary development. Some research has established a connection between right-hand preference for grasping and speech production ability in preschool children, but the link to gestures is relatively unexplored in this age group. We investigated if lateralized gestures (pointing) are related to measures of language development (vocabulary) in a preschool-age sample. Specifically, typically developing children (aged 3-6) completed the Peabody Picture Vocabulary Test (PPVT) to assess receptive language. We recorded their hand preference for pointing during the PPVT and the incidence of mistakes (pointing to the wrong picture). Despite the length of the test, children were more likely to select a correct response with their right hand. This result suggests a relationship between lateralized communicative gestures (pointing) and receptive language. This study provides evidence for an intimate relationship between right-handed manual movement and language development. Implications of this finding include developing simple fine-motor tasks to detect and/or ameliorate delayed language development.

The home handedness questionnaire: pilot data from preschoolers

While handedness questionnaires are widely used in adults, there is no comparable measure designed specifically for children. The current study developed the Home Handedness Questionnaire (HHQ), a new measure for preschoolers administered by parents using common household items. The HHQ has two scales that distinguish action types typically combined on other measures: actions performed with only the right or left hand (i.e., unimanual, such as holding a toothbrush), and actions performed with one hand holding the object for the other hand's action (i.e., role-differentiated bimanual manipulation or RDBM, such as unscrewing a lid from a jar). The HHQ was able to detect right preference, left preference, and no preference for unimanual and RDBM actions in a proof of concept study in 3-year-olds (N = 64). The HHQ identified a majority of children as right-handed, but was also sensitive to variability in direction across skill types. Approximately one-quarter of children in the sample had mixed preferences for the two types of manual skills, suggesting that for a subgroup of children, hand use patterns may still be undergoing change. Suggestions for refining the HHQ are discussed. Overall, the HHQ is a promising multidimensional parent-led tool for assessing preschool handedness.