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Archives of Clinical Neuropsychology 25 (2010) 314–317

Right- and Left-hand Performance on the Rey – Osterrieth Complex


Figure: A Preliminary Study in Non-clinical Sample of Right Handed
People
Hikari Yamashita*
Department of Special Education, Ehime University, Matsuyama, Japan
*Corresponding author at: Department of Special Education, Ehime University, Bunkyo-cho 3, Matsuyama 790-8577, Japan. Tel./fax: +81-89-927-9516.
E-mail address: yamabcd@ed.ehime-u.ac.jp (H. Yamashita).
Accepted 18 February 2010

Abstract
Intermanual differences in performing the Rey–Osterrieth Complex Figure Test (ROCFT) were experimentally investigated.
Undergraduate participants (n ¼ 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.

Keywords: Neuropsychological tests; Visuospatial memory; Intermanual differences; Rey –Osterrieth Complex Figure Test

Introduction

The Rey – Osterrieth Complex Figure Test (ROCFT) is one of the most commonly used neuropsychological tests for asses-
sing 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

# The Author 2010. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oxfordjournals.org.
doi:10.1093/arclin/acq019 Advance Access publication on 21 March 2010

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H. Yamashita / Archives of Clinical Neuropsychology 25 (2010) 314–317 315

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 per-
formance of the ROCFT (e.g., concentration, attention, motor planning, motor control, working memory, and executive func-
tions). 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 210 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 ¼ 19.2 years, SD ¼ 2.7) and LL (Mean age ¼ 18.8 years, SD ¼ 1.1) groups used their right and left hands on
both trials, respectively. The participants assigned to the RL (Mean age ¼ 19.3 years, SD ¼ 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 ¼ 19.2 years, SD ¼ 1.7) group.
There was no statistically significant differences in age between the four groups, F(3,116) ¼ 0.23, p ¼ .87, partial h2 ¼ .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 thera-
pist 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

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316 H. Yamashita / Archives of Clinical Neuropsychology 25 (2010) 314–317

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 ¼ .98 and
ICC ¼ .98. for the left hand: Pearson’s r ¼ .99 and ICC ¼ .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) ¼ 4.34, p , .01, partial h2 ¼ .101;
F(1,116) ¼ 470.36, p , .001, partial h2 ¼ .802—and interaction, F(3,116) ¼ 3.61, p , .05, partial h2 ¼ .085.
A separate ANOVA on the mean performance scores for the copy trial indicated non-significant group main effect,
F(3,116) ¼ 0.91, p ¼ .44, partial h2 ¼ .023. In contrast, main effect of group was significant on the mean performance
scores for the recall test, F(3,116) ¼ 4.13, p , .01, partial h2 ¼ .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 ¼ .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 per-
formance 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 cog-
nitive 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

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 ¼ 30) RL (n ¼ 30) LR (n ¼ 30) LL (n ¼ 30)
Mean (SD) Range Mean (SD) Range Mean (SD) Range Mean (SD) Range

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 ¼ right hand copy and right hand recall; RL ¼ right hand copy and left hand recall; LR ¼ left hand copy and right hand recall; LL ¼ left hand copy
and left hand recall.

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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.

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