{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,27]],"date-time":"2026-05-27T14:04:31Z","timestamp":1779890671506,"version":"3.53.1"},"reference-count":47,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2026,5,27]],"date-time":"2026-05-27T00:00:00Z","timestamp":1779840000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Brain Sciences"],"abstract":"<jats:p>Background: Spinal cord injury (SCI) impairs sensorimotor function below the lesion and reshapes supralesional circuits, potentially influencing motor control above the injury. Although upper extremity strength and sensation are clinically normal in paraplegia, it is not known whether supralesional reorganization may produce subclinical alterations in the fine motor skills of the upper extremities. The aim of the study was to compare manual dexterity evaluated through the Purdue Pegboard Test between patients with SCI (PwSCI) and healthy subjects (HS). Methods: We recruited 18 PwSCI with complete paraplegia and 18 age- and sex-matched HS. Participants completed the four subtests of the Purdue Pegboard Test: dominant hand (1), non-dominant hand (2), bimanual (3), and assembly (4). For the first three subtests, a mixed 3 \u00d7 2 ANOVA (3 subtests \u00d7 2 groups) was performed, whereas for the fourth subtest, an independent samples t-test was performed. Spearman\u2019s rho quantified correlations among subtests and with clinical findings. Results: PwSCI showed full upper extremity muscle strength and sensation. The mean scores of the four subtests were significantly lower in PwSCI than in HS. Unilateral and bimanual subtests correlated with each other in both groups; however, the bimanual subtest was not as well predicted by dominant hand alone, as PwSCI depended more on non-dominant ability. In PwSCI, the assembly subtest strongly depended on dominant, non-dominant, and bimanual scores, whereas this dependency was weaker in HS. The subtests were influenced by ageing in PwSCI. Conclusions: Despite upper extremity muscle strength and sensation being clinically normal, PwSCI showed impaired manual dexterity. This may reflect diminished ascending somatosensory input to supraspinal centres and plastic changes in supralesional motor pathways. These preliminary results open new rehabilitation perspectives for PwSCI.<\/jats:p>","DOI":"10.3390\/brainsci16060566","type":"journal-article","created":{"date-parts":[[2026,5,27]],"date-time":"2026-05-27T12:31:56Z","timestamp":1779885116000},"page":"566","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Manual Dexterity Impairment in Patients with Complete Paraplegia: An Exploratory Study"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2061-0346","authenticated-orcid":false,"given":"Chiara","family":"Pavese","sequence":"first","affiliation":[{"name":"Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, 27100 Pavia, Italy"},{"name":"Istituti Clinici Scientifici Maugeri IRCCS, Centro Studi Attivit\u00e0 Motorie (CSAM) and Neurorehabilitation and Spinal Units of Pavia Institute, 27100 Pavia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marta","family":"Mirando","sequence":"additional","affiliation":[{"name":"Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, 27100 Pavia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benedetta","family":"Cazzulani","sequence":"additional","affiliation":[{"name":"Istituti Clinici Scientifici Maugeri IRCCS, Centro Studi Attivit\u00e0 Motorie (CSAM) and Neurorehabilitation and Spinal Units of Pavia Institute, 27100 Pavia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9376-4699","authenticated-orcid":false,"given":"Valeria","family":"Pingue","sequence":"additional","affiliation":[{"name":"Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, 27100 Pavia, Italy"},{"name":"Istituti Clinici Scientifici Maugeri IRCCS, Centro Studi Attivit\u00e0 Motorie (CSAM) and Neurorehabilitation and Spinal Units of Pavia Institute, 27100 Pavia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonio","family":"Nardone","sequence":"additional","affiliation":[{"name":"Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, 27100 Pavia, Italy"},{"name":"Istituti Clinici Scientifici Maugeri IRCCS, Centro Studi Attivit\u00e0 Motorie (CSAM) and Neurorehabilitation and Spinal Units of Pavia Institute, 27100 Pavia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,5,27]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"17018","DOI":"10.1038\/nrdp.2017.18","article-title":"Traumatic spinal cord injury","volume":"3","author":"Ahuja","year":"2017","journal-title":"Nat. Rev. Dis. Prim."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"699","DOI":"10.1123\/jsr.2018-0104","article-title":"Differences of Relative and Absolute Strength of Individuals with Spinal Cord Injury From Able-Bodied Subjects: A Discriminant Analysis","volume":"28","author":"Tanhoffer","year":"2019","journal-title":"J. Sport. Rehabil."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1","DOI":"10.46292\/sci2702-1","article-title":"International Standards for Neurological Classification of Spinal Cord Injury: Revised 2019","volume":"27","author":"Rupp","year":"2021","journal-title":"Top. Spinal Cord. Inj. Rehabil."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1038\/s41393-021-00675-9","article-title":"Reliability and validity of the international standards for neurological classification of spinal cord injury in patients with non-traumatic spinal cord lesions","volume":"60","author":"Lena","year":"2022","journal-title":"Spinal Cord."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"e347","DOI":"10.1212\/WNL.0000000000207417","article-title":"Distinguishing Distinct Neural Systems for Proximal vs Distal Upper Extremity Motor Control After Acute Stroke","volume":"101","author":"Lin","year":"2023","journal-title":"Neurology"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"667","DOI":"10.1523\/JNEUROSCI.11-03-00667.1991","article-title":"The origin of corticospinal projections from the premotor areas in the frontal lobe","volume":"11","author":"Dum","year":"1991","journal-title":"J. Neurosci."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"825","DOI":"10.1006\/nimg.2000.0739","article-title":"Different ipsilateral representations for distal and proximal movements in the sensorimotor cortex: Activation and deactivation patterns","volume":"13","author":"Nirkko","year":"2001","journal-title":"Neuroimage"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"195","DOI":"10.1146\/annurev.neuro.31.060407.125547","article-title":"Descending pathways in motor control","volume":"31","author":"Lemon","year":"2008","journal-title":"Annu. Rev. Neurosci."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"7341","DOI":"10.1523\/JNEUROSCI.0390-14.2014","article-title":"Subcortical control of precision grip after human spinal cord injury","volume":"34","author":"Bunday","year":"2014","journal-title":"J. Neurosci."},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Laliberte, A.M., Goltash, S., Lalonde, N.R., and Bui, T.V. (2019). Propriospinal Neurons: Essential Elements of Locomotor Control in the Intact and Possibly the Injured Spinal Cord. Front. Cell. Neurosci., 13.","DOI":"10.3389\/fncel.2019.00512"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"3918","DOI":"10.1046\/j.1460-9568.1998.00454.x","article-title":"How does the human brain deal with a spinal cord injury?","volume":"10","author":"Bruehlmeier","year":"1998","journal-title":"Eur. J. Neurosci."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"494","DOI":"10.1016\/j.nicl.2017.05.026","article-title":"Relationship between brainstem neurodegeneration and clinical impairment in traumatic spinal cord injury","volume":"15","author":"Grabher","year":"2017","journal-title":"Neuroimage Clin."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"103339","DOI":"10.1016\/j.nicl.2023.103339","article-title":"Dynamics of progressive degeneration of major spinal pathways following spinal cord injury: A longitudinal study","volume":"37","author":"Schading","year":"2023","journal-title":"Neuroimage Clin."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"2567","DOI":"10.1093\/brain\/awf250","article-title":"Changes of non-affected upper limb cortical representation in paraplegic patients as assessed by fMRI","volume":"125","author":"Curt","year":"2002","journal-title":"Brain"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"944","DOI":"10.1126\/science.2000496","article-title":"Reshaping the cortical motor map by unmasking latent intracortical connections","volume":"251","author":"Jacobs","year":"1991","journal-title":"Science"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"e30657","DOI":"10.1097\/MD.0000000000030657","article-title":"Effect of compressive therapy on sensorimotor function of the more affected upper extremity in chronic stroke patients: A randomized clinical trial","volume":"101","author":"Alwhaibi","year":"2022","journal-title":"Medicine"},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Hartelt, E., Scherbaum, R., Kinkel, M., Gold, R., Muhlack, S., and T\u00f6nges, L. (2020). Parkinson\u2019s Disease Multimodal Complex Treatment (PD-MCT): Analysis of Therapeutic Effects and Predictors for Improvement. J. Clin. Med., 9.","DOI":"10.3390\/jcm9061874"},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Yeo, S.S., Nam, S.M., and Cho, I.H. (2023). Injury of the Vestibulocerebellar Tract and Signs of Ataxia in Patients with Cerebellar Stroke. J. Clin. Med., 12.","DOI":"10.3390\/jcm12216877"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"234","DOI":"10.1037\/h0061266","article-title":"The Purdue pegboard; norms and studies of reliability and validity","volume":"32","author":"Tiffin","year":"1948","journal-title":"J. Appl. Psychol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"555","DOI":"10.5014\/ajot.54.5.555","article-title":"Test-retest reliability of the Purdue Pegboard Test","volume":"54","author":"Buddenberg","year":"2000","journal-title":"Am. J. Occup. Ther."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"217","DOI":"10.3109\/09638289509166638","article-title":"The Purdue Pegboard Test: Normative data for people aged 60 and over","volume":"17","author":"Desrosiers","year":"1995","journal-title":"Disabil. Rehabil."},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Capozio, A., Chowdhury, S.T., Chakrabarty, S., Delis, I., Horne, M., Sivan, M., Gad, P., Holt, R., Ichiyama, R., and Astill, S.L. (2025). Bimanual upper limb task practice and Transcutaneous electrical stimulation enhance spinal plasticity and hand function after chronic cervical spinal cord injury. medRxiv.","DOI":"10.1101\/2025.01.06.24319679"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"160","DOI":"10.1016\/j.clinph.2025.03.047","article-title":"A single session of motor imagery paired with spinal stimulation improves manual dexterity and increases cortical excitability after spinal cord injury","volume":"174","author":"Capozio","year":"2025","journal-title":"Clin. Neurophysiol."},{"key":"ref_24","first-page":"211","article-title":"Upper limb function in persons with long term paraplegia and implications for independence: Part I","volume":"32","author":"Pentland","year":"1994","journal-title":"Paraplegia"},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Bloch, A., Tamir, D., Vakil, E., and Zeilig, G. (2016). Specific Deficit in Implicit Motor Sequence Learning following Spinal Cord Injury. PLoS ONE, 11.","DOI":"10.1371\/journal.pone.0158396"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1089\/089771502753460222","article-title":"Differential effect of spinal cord injury and functional impairment on human brain activation","volume":"19","author":"Curt","year":"2002","journal-title":"J. Neurotrauma"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"588","DOI":"10.1002\/hbm.23868","article-title":"New evidence for preserved somatosensory pathways in complete spinal cord injury: A fMRI study","volume":"39","author":"Wrigley","year":"2018","journal-title":"Hum. Brain Mapp."},{"key":"ref_28","first-page":"304","article-title":"Coordinated network functioning in the spinal cord: An evolutionary perspective","volume":"100","author":"Falgairolle","year":"2006","journal-title":"J. Physiol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1906","DOI":"10.1046\/j.0953-816x.2001.01813.x","article-title":"Neuronal coordination of arm and leg movements during human locomotion","volume":"14","author":"Dietz","year":"2001","journal-title":"Eur. J. Neurosci."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1186\/1743-0003-10-5","article-title":"The physiological basis of neurorehabilitation\u2014Locomotor training after spinal cord injury","volume":"10","author":"Hubli","year":"2013","journal-title":"J. Neuroeng. Rehabil."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"129","DOI":"10.1177\/17589983251387718","article-title":"Investigation of the relationship between dominant hand abilities and hemispheric dominance","volume":"31","author":"Sohrabi","year":"2025","journal-title":"Hand Ther."},{"key":"ref_32","unstructured":"Marvin, K. (2026, May 20). Purdue Pegboard Test (PPT). Available online: https:\/\/strokengine.ca\/en\/assessments\/purdue-pegboard-test-ppt."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"873","DOI":"10.1016\/S1474-4422(13)70146-7","article-title":"MRI investigation of the sensorimotor cortex and the corticospinal tract after acute spinal cord injury: A prospective longitudinal study","volume":"12","author":"Freund","year":"2013","journal-title":"Lancet Neurol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"356","DOI":"10.1093\/brain\/awh355","article-title":"Sequential loss of myelin proteins during Wallerian degeneration in the human spinal cord","volume":"128","author":"Buss","year":"2005","journal-title":"Brain"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"1024","DOI":"10.1016\/j.neuroimage.2010.11.089","article-title":"Demyelination and degeneration in the injured human spinal cord detected with diffusion and magnetization transfer MRI","volume":"55","author":"Pradat","year":"2011","journal-title":"Neuroimage"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"1839","DOI":"10.1111\/j.1460-9568.2011.07895.x","article-title":"Corticomotor representation to a human forearm muscle changes following cervical spinal cord injury","volume":"34","author":"Freund","year":"2011","journal-title":"Eur. J. Neurosci."},{"key":"ref_37","doi-asserted-by":"crossref","unstructured":"Leemhuis, E., Giuffrida, V., De Martino, M.L., Forte, G., Pecchinenda, A., De Gennaro, L., Giannini, A.M., and Pazzaglia, M. (2022). Rethinking the body in the brain after spinal cord injury. J. Clin. Med., 11.","DOI":"10.3390\/jcm11020388"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"e214516","DOI":"10.1212\/WNL.0000000000214516","article-title":"The Relationship Between Age and Recovery After Spinal Cord Injury: A Longitudinal Cohort Study","volume":"106","author":"Pavese","year":"2026","journal-title":"Neurology"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"87","DOI":"10.1037\/0021-9010.75.1.87","article-title":"Marked sex differences on a fine motor skill task disappear when finger size is used as covariate","volume":"75","author":"Peters","year":"1990","journal-title":"J. Appl. Psychol."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"7703205030","DOI":"10.5014\/ajot.2023.050023","article-title":"The Purdue Pegboard Test: Normative Data From 1,355 Healthy People From Austria","volume":"77","author":"Stijic","year":"2023","journal-title":"Am. J. Occup. Ther."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"878","DOI":"10.1016\/j.jht.2025.02.012","article-title":"Purdue manual dexterity testing: Normative data from young people from Turkey","volume":"38","author":"Irmak","year":"2025","journal-title":"J. Hand Ther."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"116","DOI":"10.1016\/j.jht.2019.12.006","article-title":"Purdue manual dexterity testing: A cohort study of community-dwelling elderly","volume":"34","author":"Rule","year":"2021","journal-title":"J. Hand Ther."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1038\/sj.sc.3102053","article-title":"Clinical correlates of fatigue in spinal cord injury","volume":"46","author":"Wheeler","year":"2008","journal-title":"Spinal Cord."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1007\/s40122-015-0033-y","article-title":"Management of Neuropathic Pain Associated with Spinal Cord Injury","volume":"4","author":"Hagen","year":"2015","journal-title":"Pain. Ther."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"68","DOI":"10.46292\/sci20-00061","article-title":"Upper Extremity Overuse Injuries and Obesity After Spinal Cord Injury","volume":"27","author":"Felix","year":"2021","journal-title":"Top. Spinal Cord. Inj. Rehabil."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"620","DOI":"10.1179\/2045772314Y.0000000284","article-title":"Prevalence of depression, fatigue, and sleep disturbances in patients with myelopathy: Their relation with functional and neurological recovery","volume":"39","author":"Menon","year":"2016","journal-title":"J. Spinal Cord. Med."},{"key":"ref_47","first-page":"980","article-title":"Unveiling the mosaic: Comparing demographics and outcomes in traumatic vs. non-traumatic spinal cord injuries","volume":"60","author":"Emanuela","year":"2024","journal-title":"Eur. J. Phys. Rehabil. Med."}],"container-title":["Brain Sciences"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2076-3425\/16\/6\/566\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,27]],"date-time":"2026-05-27T13:16:28Z","timestamp":1779887788000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2076-3425\/16\/6\/566"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,27]]},"references-count":47,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2026,6]]}},"alternative-id":["brainsci16060566"],"URL":"https:\/\/doi.org\/10.3390\/brainsci16060566","relation":{},"ISSN":["2076-3425"],"issn-type":[{"value":"2076-3425","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,27]]}}}