Recovery of upper limb dexterity in patients more than 1 year after stroke: Frequency, clinical correlates and predictors

Abstract

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.

Stroke survivors talk while doing: Development of a therapeutic framework for continued rehabilitation of hand function post stroke

“…Studies have shown that while 82% of patients with stroke ambulate independently, 1 only 5% to 34% achieve full upper limb function. 2,3 These differences in recovery of upper and lower limb are thought to be partly due to less time spent in rehabilitating the upper limb 4–6 and decreased spontaneous use of the affected upper limb, both of which contribute to learned non-use. 7 Once discharged from inpatient and outpatient rehabilitation services, the gap between upper and lower limb function often widens because patients’ do not know how to maximize use of their affected hand in their own environment, and options for continued therapy in a formal setting are limited.…”

Precision Grip in Congenital and Acquired Hemiparesis: Similarities in Impairments and Implications for Neurorehabilitation

“…The nature of hand motor impairment and its treatment after stroke has also been reviewed (Raghavan, 2007), as well as treatment’s intensity (Cooke et al, 2010). Whatever the strategy used to re-train precision grip, a large cohort study shows that the likelihood to regain some dexterity is strongly linked to the presence of early voluntary extension of the fingers and abduction of the shoulder (Nijland et al, 2010; Kong et al, 2011). …”

Mental Practice Combined with Physical Practice to Enhance Hand Recovery in Stroke Patients

“…Among these survivors, a large proportion (46% to 95%) remains symptomatic six months after the ischemic stroke event [2]. Loss of arm function adversely affects quality of life [3], and functional motor recovery in affected upper extremities in patients with hemiplegia is the primary goal of physical therapists [4].…”