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Objective: The objectives of this study are to establish frequency, clinical correlates and predictors of upper limb dexterity in patients who have survived 1 year or more after a stroke. Design: Cross-sectional study. Setting: Outpatient clinic of a tertiary rehabilitation centre. Participants: One hundred and forty patients who were more than a year after stroke onset. Interventions: Nil. Main outcome measures: Motor Assessment Scale (MAS) for measurement of upper limb dexterity, Ashworth Scale for spasticity, Upper Extremity Motricity Index (UEMI) and Lower Extremity Motricity Index (LEMI) for motor power and Modified Barthel Index (MBI) for functional status. Spasticity was categorized as absent to moderate and severe. Potential predictors of dextrous function were chosen based on retrospective review of the patientfls medical records during admission for inpatient rehabilitation. Results: The mean age was 61.0 ± 13.3 years and patients were evaluated at 41.7 ± 35.1 months after stroke onset. Upper limb dexterity was present in 40 (28.3%) patients. Sensory impairment, severe spasticity and low scores on the MBI, UEMI and LEMI were significantly correlated to poor dextrous function, with severe spasticity (p < 0.001) and UEMI score (p = 0.025) being the most important. Poor dextrous function was predicted by a severe stroke, neglect, sensory impairment, total/partial anterior circulation stroke and low MBI, UEMI and LEMI scores on rehabilitation admission. The most important predictor of dexterity was UEMI score on admission to rehabilitation (p = 0.005). Conclusion: Upper limb dexterity was present in 28.3% of a cohort of chronic stroke patients. The most important correlates of limb dexterity were upper limb strength and severe spasticity and the most significant predictor of dexterity was the severity of upper limb paresis on admission to rehabilitation.

BACKGROUND: The ability to perform basic activities of daily living (ADL) independently is a marker of functional recovery after a stroke. However, there few studies documenting their long-term recovery. OBJECTIVE: To document temporal recovery of activities of daily living (ADL) and establish predictors of ADL in a cohort of ischemic stroke patients in the first year after stroke. METHODS: Prospective cohort study of 163 patients with first-ever ischemic stroke admitted to a rehabilitation centre. The Modified Barthel Index (MBI) was used to measure the patient's ability to perform the following 10 ADLs: feeding, grooming, dressing, bathing, toileting, bladder and bowel continence, transfers, ambulation and stair climbing. It was assessed on rehabilitation admission, discharge, and at 3, 6 and 12 months after stroke. The Motricity Index was used to measure motor power of the hemiplegic limb. RESULTS: The mean age was 63.8 (10.7) years, with 111 males and 52 females. The mean total MBI scores on rehabilitation admission, rehabilitation discharge, 3, 6 and 12 months after stroke were 41.3 (24.6), 72.9 (20.5), 88.4 (18.6), 90.5 (17.2) and 84.2 (20.4) respectively. Median scores of feeding, grooming, toileting, bladder/bowel continence, transfers and ambulation plateaued by 3 months after stroke. Median scores of dressing and stair climbing plateaued at 6 months and that for bathing, 12 months after stroke. None of the patients were functionally independent (defined as MBI score of 100) on rehabilitation admission, but this improved to 8.6% on discharge, and 32.1%, 41.4% and 50.3% at 3, 6 and 12 months after stroke respectively. The MBI and Motricity scores were strongly correlated at all periods of follow up (r = 0.67 to 0.69, p < 0.0001). Univariate analysis showed that age, neglect, a cortical stroke, admission MBI, NIHSS, Motricity Index and Abbreviated Mental Score scores were predictors of functional independence at 12 months after stroke. On logistic regression, only age remained significant, younger patients being more likely than older patients to be functionally independent. CONCLUSION: Most recovery of ADL occurs by 3 months after stroke. For individual ADLs, dressing, stair climbing and bathing appear to take a longer time to recover. Older age was a negative predictor of functional dependence at 12 months after stroke.

OBJECTIVE: To document temporal recovery of upper extremity dexterity and establish predictors of limb dexterity in a cohort of stroke patients in the first year after stroke. DESIGN: Prospective cohort study. SUBJECTS: One hundred patients with a first-ever ischemic stroke admitted to a rehabilitation centre. METHODS: Assessment of upper extremity dexterity, motor power and selfcare function using the Motor Assessment Scale (MAS), Upper Extremity Motor Index (UEMI) and Modified Barthel Index (MBI) respectively. RESULTS: Eighteen percent, 25.5% and 31.6% of patients recovered limb dexterity at 3, 6 and 12 months after stroke respectively. Patients who recovered dexterity late (≥6 months after stroke) were significantly younger with lower rehabilitation admission UEMI scores than those who recovered dexterity early. The UEMI score was the most significant correlate of limb dexterity at all follow up periods. Recovery of limb dexterity at 12 months was predicted by UEMI (OR1.54, 95% CI 1.13-2.10) and MBI (OR 1.03, 95% CI 1.00-1.07) scores on admission to rehabilitation. CONCLUSIONS: In this study, 31.6% of patients recovered upper extremity dexterity at 12 months after stroke. Although late recovery of dexterity occurs only in a small proportion of patients, this finding is still pertinent given the significant impact of dexterity on upper limb and selfcare function.