Upper Extremity Use in People with Hemiparesis in the First Few Weeks After Stroke

Abstract

The purposes of this report were to: 1) determine the amount of upper extremity use in people with hemiparesis post stroke during their inpatient rehabilitation stay, and 2) to examine the relationships between upper extremity use and impairments and activity limitations at this early time point after stroke. We studied 34 subjects with mild-to-moderate acute hemiparesis (mean time since stroke = 9.3 days) and 10 healthy control subjects. Upper extremity use was measured over 24 hours using bilateral wrist accelerometers. Upper extremity impairments and activity limitations were measured using standard clinical techniques and tests. We found that healthy control subjects use their dominant and nondominant upper extremities 8-9 hours per day. Hemiparetic subjects used their affected and unaffected upper extremities substantially less than control subjects, 3.3 and 6.0 hours per day, respectively. Seven of ten impairment level measures and each of the activity level measures were related to affected upper extremity use. The impairment measures that were related to upper extremity use were those measures that assessed the ability to activate muscles (ie active range of motion and force production) and the measurement of shoulder pain. Our data show that affected upper extremity use is minimal during the inpatient rehabilitation stay, especially given that patients in this setting are required to have 3 hours of therapy per day. We speculate that accelerometer measurements of upper extremity use could be used in a variety of settings and that the objective information they provide would be of great value to clinicians as they select treatments and evaluate progress.

Predictive value of upper-limb accelerometry in acute stroke with hemiparesis

“…Our results supplement the information of Lang et al, who investigated upper-limb activity in a rehabilitation center, and Thrane et al, who investigated patients with acute stroke albeit without a control group [24][25]. All studies, current one included, used the protocol presented by Uswatte et al [4][5][6].…”

Investigating Measures of Intensity During a Structured Upper Limb Exercise Program in Stroke Rehabilitation: An Exploratory Study

“…Although repetitions have been used as measures of intensity in animal studies that examine neuroplasticity 20,21 , the use of repetitions is less frequent within rehabilitation research and practice. Lang and colleagues have used repetitions to quantify the intensity of upper limb exercise that occurs during rehabilitation 22 , and during inpatient hospital stays after stroke 23 . However, these observational studies focused on routine therapy sessions where many challenges in categorising the content, and hence intensity of these sessions, have arisen 22,24 .…”

“…The clinical utility of using repetitions to measure intensity of practice during structured exercise programmes has not been investigated. Wrist accelerometers are another alternative method used by researchers attempting to quantify the intensity of upper limb exercise 22,23 and have been used to measure arm-hand usage when a patient is on the stroke rehabilitation unit 27 . This study will use three measures of intensity (i) time, (ii) repetitions and (iii) wrist accelerometers to describe the intensity of exercise carried out during a session using the Graded Repetitive Arm Supplementary Program (GRASP).…”

Exercise and Environmental Enrichment as Enablers of Task-Specific Neuroplasticity and Stroke Recovery

“…For example, following stroke humans spontaneously develop a reliance on their nonparetic limb [65,66], which leads to learned nonuse of the affected limb and persistent compensatory behavior with further reduction in use of the impaired limb [67]. In rats, forced training of the nonimpaired forelimb has a negative effect on the recovery of the impaired limb [68,69].…”