Abstract

Intermanual differences in performing the Rey–Osterrieth Complex Figure Test (ROCFT) were experimentally investigated. Undergraduate participants (n = 120; 60 men, 60 women) were randomly assigned to one of four groups based on the hand used in a copy trial and a recall test. Hand use had a minimal effect on performance in the copy trial. However, recall accuracy was lower when the non-dominant left hand was used in the copy trial than when the dominant right hand was used, regardless of the hand used in the recall test. These findings are important from a clinical perspective, especially in cases in which patients use the non-dominant hand due to hemiplegia of the dominant hand when conducting the ROCFT.

Introduction

The Rey–Osterrieth Complex Figure Test (ROCFT) is one of the most commonly used neuropsychological tests for assessing visuospatial construction ability and visual memory (Osterrieth, 1944; Rey, 1941). This test involves copying a complex geometric figure and then reproducing it from memory, either immediately or after a delay. Although there are several variants of the scoring method, the 36-point scoring system is most often used (Lezak, 1995; Meyers & Meyers, 1995; Spreen & Strauss, 1998).

Although the ROCFT is generally performed with the dominant hand, some people with hemiplegia of the dominant hand due to brain injury perform the test with the non-dominant hand. Few studies, however, have investigated whether there are performance differences between the dominant and non-dominant hands.

Zacharias and Kirk (1998) asked 30 elderly subjects without a history of neurological disease to draw, from memory, seven geometric figures and objects using the right and left hands. Right- and left-hand drawings were compared using a standardized scoring system utilized in several previous studies of drawing in focal and diffuse neurological disease. Drawings made using the left hand were found to be significantly simpler, more tremulous, and of poorer overall quality than those made by the same subjects using the right hand. Yamashita (2002) found similar results in Japanese university student sample. It has been suggested that such common features of left-hand drawings might be misattributed to constructional impairment due to left-hemisphere injury.

Recently, Budd, Houtz, and Lambert (2008) used a counterbalanced, within-subjects design to assess the copy accuracy on the ROCFT in 154 undergraduates using both right and left hands. Performance differences were statistically, but not clinically, significant. Non-dominant- and dominant-hand performances did not differ from normative data (Meyers & Meyers, 1995). They concluded that performance on the ROCFT using the non-dominant hand could produce scores within the normative range and would not falsely suggest neuropsychological impairment. However, perhaps due to constraints on within-subjects design (e.g., learning effect, intentional learning effect on second trial), their study did not examined the recall performance. In addition to visuospatial construction ability and visual memory, many different cognitive abilities are needed for a correct performance of the ROCFT (e.g., concentration, attention, motor planning, motor control, working memory, and executive functions). The lack of difference between dominant and non-dominant hand in the copy performances, however, does not necessarily imply equivalence in the recall performance.

To the best of author's knowledge, there is no little data available concerning the non-dominant-hand performance of the recall part of the ROCFT. Therefore, in this study, intermanual differences in the copy and recall (reproduction) performance on the ROCFT were investigated in individuals without brain injuries.

Materials and Methods

Participants

The participants were 120 right-handed Japanese university students (60 men and 60 women: Mean age 21.5 ± 1.5 years; range 18–24). Right handedness was determined using the H. N. Handedness Inventory (HNI). HNI, which has been widely used in Japanese handedness-related studies, consisted of 10 items regarding hand preference for daily activities (Hatta & Nakatsuka, 1975; Hatta & Hotta, 2008). HNI gives plus one point when the right hand is used, minus one point when the left hand is used and 0 points when either hand is used in largely equal proportion. Therefore, the handedness score of HNI (LS-HN) ranges from −10 to +10. The criterion of right handedness is used when the score is >+8. The participants excluded from the present study if they had: (a) a history of neurologic illness or injury, (b) severe sensory or motor impairment that might interfere with the study procedures. Participants were randomly assigned to one of four group conditions within gender, each with 15 men and 15 women, based on the hand used in the copy and recall trials. Those assigned to the RR (Mean age = 19.2 years, SD = 2.7) and LL (Mean age = 18.8 years, SD = 1.1) groups used their right and left hands on both trials, respectively. The participants assigned to the RL (Mean age = 19.3 years, SD = 3.2) used their right hand in the copy trial and their left hand in the recall trial, and vice versa for the LR (Mean age = 19.2 years, SD = 1.7) group. There was no statistically significant differences in age between the four groups, F(3,116) = 0.23, p = .87, partial η2 = .006.

All the procedures conformed to code of ethics and conduct of the Japanese Psychological Association and to the Helsinki Declaration. All the participants gave informed written consent for participation in this study.

Instrument and Procedure

Participants were tested individually with an experimenter present. After signing the informed consent form, they filled out the 10 questions in the HNI. Next, the participants were assigned to one of the four groups and were told that they would be shown a figure (the ROCFT) on a piece of paper (the stimulus card) and that they were to copy the figure on another sheet of blank paper (18.2 cm × 25.7 cm), using the pencil that was provided. Participants in the RR and RL conditions copied the figure using the right hand and participants in the LR and LL conditions copied the figure using the left hand. There was not a time limit, though there were a few people who spent more than 5 min copying the figure. When the drawing is finished, the experimenter removed the drawing and the stimulus card from sight.

After a 3-min delay, the experimenter gave each participant a new sheet of blank paper (18.2 cm × 25.7 cm) and asked the participant to draw the figure from memory (recall test). The participants in RR and LR groups used the right hand and those in RL and LL groups used the left hand.

Test Scoring

The ROCFT was scored using the standard 36-point scoring system (Lezak, 1995; Meyers & Meyers, 1995; Spreen & Strauss 1998), in which the figure is broken down into 18 scoring units. A score of 0, 0.5, 1, or 2 was assigned to each unit of the figure based on presence and accuracy. To examine the inter-rater reliability, two scorers (the author and a speech therapist who was blind to the purpose of the study) independently evaluated the figures drawn by each participant.

Data Analysis

Inter-scorer reliabilities for the total scores of the ROCFT are examined using both Pearson's r and the intraclass correlation coefficient (ICC) using a two-way random-effects model. Pearson's r describes the relative consistency in the way the two scorers assigned scores to the same figure. The ICC provides a measure of inter-scorer reliability agreement (rather than consistency) when the scores from a single (rather than averaged) score will be used for subsequent analysis (Hubley & Jassal, 2006). The scores of copy performance and the scores of recall performance were analyzed by a mixed-model ANOVA. Statistical significance level was set at p < .05. Data analyses were performed using SPSS-15J for Windows statistical package.

Results

Because the Pearson r and the ICC of the recall test scores were sufficiently high (for the right hand: Pearson's r = .98 and ICC = .98. for the left hand: Pearson's r = .99 and ICC = .91), protocols scored by the author were used in the following data analysis.

On qualitative review, there was a tendency for the left-hand drawing to be slightly less accurate on the copy trial and the recall test. Left-hand drawings were more tremulous than the left hand. These features are not reflected in the scoring system.

The mean performance scores for the copy trial and the recall test are presented in Table 1. A two-way mixed-model ANOVA (group × trial) indicated significant main effects of group—F(3,116) = 4.34, p < .01, partial η2 = .101; F(1,116) = 470.36, p < .001, partial η2 = .802—and interaction, F(3,116) = 3.61, p < .05, partial η2 = .085.

Table 1.

Copy and 3-min recall performance scores (mean, SD, and range) for each groups (maximum possible score is 36)

Trial Groups
 
 RR (n = 30)
 
RL (n = 30)
 
LR (n = 30)
 
LL (n = 30)
 
 Mean (SDRange Mean (SDRange Mean (SDRange Mean (SDRange 
Copy 35.9 (0.4) 34.0–36.0 35.7 (0.6) 34.0–36.0 35.6 (0.6) 34.0–36.0 35.7 (0.7) 34.0–36.0 
Recall (3 min) 27.6 (4.3) 17.0–35.0 26.1 (6.5) 13.5–35.0 24.2 (4.6) 14.5–32.0 23.4 (5.4) 15.0–34.0 
Trial Groups
 
 RR (n = 30)
 
RL (n = 30)
 
LR (n = 30)
 
LL (n = 30)
 
 Mean (SDRange Mean (SDRange Mean (SDRange Mean (SDRange 
Copy 35.9 (0.4) 34.0–36.0 35.7 (0.6) 34.0–36.0 35.6 (0.6) 34.0–36.0 35.7 (0.7) 34.0–36.0 
Recall (3 min) 27.6 (4.3) 17.0–35.0 26.1 (6.5) 13.5–35.0 24.2 (4.6) 14.5–32.0 23.4 (5.4) 15.0–34.0 

Notes: RR = right hand copy and right hand recall; RL = right hand copy and left hand recall; LR = left hand copy and right hand recall; LL = left hand copy and left hand recall.

A separate ANOVA on the mean performance scores for the copy trial indicated non-significant group main effect, F(3,116) = 0.91, p = .44, partial η2 = .023. In contrast, main effect of group was significant on the mean performance scores for the recall test, F(3,116) = 4.13, p < .01, partial η2 = .094. The subsequent pair-wise post hoc test using Tukey's HSD test showed a significant difference between groups RR and LL (p < .01), and a marginal difference between RR and LR (p = .06).

Discussion

The present study assessed whether the non-dominant (left)-hand performance of the ROCFT was different from that of the dominant-hand performance. An important result of the study was that the hand used had a minimal effect on the copy performance in the ROCFT. This finding supported previous work showing that the non-dominant hand can produce a clinically accurate copy of the ROCFT (Budd et al., 2008).

Another important finding was that using the dominant or the non-dominant hand influenced the performance on the recall test. The groups that used the left hand for the copy trial had lower performance scores than the groups that used the right hand. In contrast, the difference in the hand used in the recall test did not influence the test results.

One explanation of this discrepant pattern of results may be found in attention allocation in the dual-task paradigm. The copy trial of the ROCFT can be thought of as a dual-task situation consisting of a sensomotor task (hand control) and a cognitive task (information processing of the figure). There is much evidence of interference in sensomotor and cognitive dual tasks (Lindenberger, Marsiske, & Baltes, 2000; Lövdén, Schaefer, Pohlmeyer, & Lindenberger, 2008; McCulloch, 2007; Voelcker-Rehage, Stronge, & Alberts, 2006). This dual-task interference effect may reflect the disruption to a central attention processor that deploys limited resources to subordinate processing mechanisms for executing a task (Baddeley, 2001; Voelcker-Rehage et al., 2006).

Drawing with the unaccustomed left hand may require greater attentional demands from the central attention processor, compared with drawing with the right hand. Strenge and Niederberger (2008) studied the interference effect between the Grooved Pegboard task with either hand and the executive task of cued verbal random-number generation using normal right-handed subjects. In their study, concurrent performance with non-dominant hand but not the dominant hand of random-number generation performance became continuously slower. These results suggested that the non-dominant hand on the pegboard and random-number tasks draw from the same attentional processing resources. In the present study, given that the right hemisphere controls the left hand, drawing with the left hand might increase attentional demands on the right hemisphere that may lead to a reduction in resources to visuospatial information processing and to memory.

One limitation of this study may be the demographic composition of the participants, who were younger and had a higher level of education than many patients in rehabilitation for hemiparesis. Therefore, it is suggested that further studies with samples of older adults and people with brain injuries should be conducted to substantiate the findings of this study. Moreover, it seems likely that the study for the left-handed individuals may bring valuable information.

Despite the limitations of this study and the need for further investigations, this is the first research to clarify intermanual differences in the performance of the ROCFT. Although the non-dominant-hand performance in the copy trial did not differ significantly from that of the dominant hand, the use of the non-dominant hand in the copy trial reduced the accuracy of the recall performance. These results are important from a clinical perspective, especially if patients use the non-dominant hand due to hemiplegia of the dominant one, in which case the ROCFT may underestimate the memory ability to be lower than is actually the case.

Funding

This research was supported by a Grant-in-Aid for Scientific Research (C) from JPSP to HY (21530731).

Conflict of Interest

None declared.

References

Baddeley
A. D.
Is working memory still working?
American Psychologist
 , 
2001
, vol. 
56
 (pg. 
851
-
864
)
Budd
M. A.
Houtz
A.
Lambert
P.
Comparison of nondominant- and dominant-hand performances on the Copy portion of the Rey Complex Figure Test (RCFT)
Journal of Clinical and Experimental Neuropsychology
 , 
2008
, vol. 
30
 (pg. 
380
-
386
)
Hatta
T.
Hotta
C.
Which inventory should be used to assess Japanese handedness?: Comparison between Edinburgh and H. N. handedness inventories
Journal of Human Environmental Studies
 , 
2008
, vol. 
6
 (pg. 
245
-
248
)
Hatta
T.
Nakatsuka
A.
Hatta-Nakatsuka handedness text. In S. Ohno (Ed.)
Festschrift to Prof. Ohnishi K
 , 
1975
 
(pp. 224-247). Osaka: Osaka City University Press
Hubley
A. M.
Jassal
S.
Comparability of the Rey–Osterrieth and Modified Taylor Complex Figures using total scores, completion times, and construct validation
Journal of Clinical and Experimental Neuropsychology
 , 
2006
, vol. 
28
 (pg. 
1482
-
1497
)
Lezak
M. D.
Neuropsychological assessment
 , 
1995
3rd ed.
New York
Oxford University Press
Lindenberger
U.
Marsiske
M.
Baltes
P. B.
Memorizing while walking: Increase in dual-task costs from young adulthood to old age
Psychology and Aging
 , 
2000
, vol. 
15
 (pg. 
417
-
436
)
[PubMed]
Lövdén
M.
Schaefer
S.
Pohlmeyer
A. E.
Lindenberger
U.
Walking variability and working-memory load in aging: A dual-process account relating cognitive control to motor control performance
Journal of Gerontology: Psychological Sciences
 , 
2008
, vol. 
63
 (pg. 
121
-
128
)
[PubMed]
McCulloch
K.
Attention and dual-task conditions: Physical therapy implications for individuals with acquired brain injury
Journal of Neurologic Physical Therapy
 , 
2007
, vol. 
31
 (pg. 
104
-
118
)
[PubMed]
Meyers
J. E.
Meyers
K. R.
Rey Complex Figure Test and Recognition Trial: professional manual.
 , 
1995
Odessa
Psychological Assessment Resources
Osterrieth
P. A.
Le test de copie d'une figure complex: Contributiona l'etude de la perception et de la memoire
Archives de Psychologie
 , 
1944
, vol. 
30
 (pg. 
286
-
356
)
Rey
A.
L'examen psychologique dans les cas d'encephalopathie traumatique
Archives de Psychologie
 , 
1941
, vol. 
28
 (pg. 
286
-
340
)
Spreen
O.
Strauss
E.
A compendium of neuropsychological tests: Administrator, norms, and commentary
 , 
1998
2nd ed.
New York
University Press
Strenge
H.
Niederberger
U.
Unidirectional interference in use of nondominant hand during concurrent Grooved Pegboard and random number generation tasks
Perceptual and Motor Skills
 , 
2008
, vol. 
106
 (pg. 
763
-
774
)
Voelcker-Rehage
C.
Stronge
A. J.
Alberts
J. L.
Age-related differences in working memory and force control under dual-task conditions
Neuropsychology, Development, and Cognition. Section B, Aging, Neuropsychology and Cognition
 , 
2006
, vol. 
13
 (pg. 
366
-
384
)
Yamashita
H.
Drawing abilities of the left hand in normal right-hander: Some implications for the analysis of constructional impairment
Sogo Rihabiriteshon
 , 
2002
, vol. 
30
 (pg. 
173
-
178
)
Zacharias
S.
Kirk
A.
Drawing with the non-dominant hand: Implications for the study of construction
Canadian Journal of Neurological Sciences
 , 
1998
, vol. 
25
 (pg. 
306
-
309
)
[PubMed]