Profile of upper limb recovery and development of secondary impairments in patients after stroke with a disabled upper limb: An observational study

ABSTRACT

Purpose: To investigate, in patients after stroke with a very weak upper limb, the profile of recovery for upper limb activity over the first 12 weeks, and whether early secondary impairments predict later upper limb activity. Method: Forty patients within 2 weeks of stroke with a very weak upper limb (<4/6 Item 6 of Motor Assessment Scale) were observed longitudinally. Upper limb activity (Items 6, 7, and 8 of Motor Assessment Scale), shoulder subluxation (vertical distance), shoulder pain (visual analogue scale), and upper limb range of motion were measured at 2, 6, and 12 weeks poststroke. Results: By Week 12, upper limb activity was 1.0/18 (IQR 3.0). Shoulder subluxation was 42 mm (SD 8), 7 mm > the intact side at 2 weeks. Pain at rest was 0.1/10 (IQR 1.1), and pain during movement was 2.6/10 (IQR 4.5). Passive shoulder external rotation was 23° (SD 34), 30% of the intact side at 2 weeks. Shoulder pain during movement at 2 weeks predicted shoulder pain during movement at 6 and 12 weeks after stroke (p = 0.05). Conclusion: Most patients with a disabled upper limb after stroke have little recovery of activity in the first 12 weeks. Shoulder pain on movement at 2 weeks should be flagged as a predictor of future pain.

KEYWORDS:

• Glenohumeral subluxation
• contracture
• shoulder pain
• stroke
• upper extremity

Acknowledgments

We are grateful to the patients of the Canberra and Manly Hospitals in Australia and Bærum Hospital in Norway who participated in this study and the staff who recruited participants and acted as blind measurers.

Declaration of interest

The authors report no declarations of interest.

Additional information

Funding

This study was supported by the Sydney University Research Grants - Sesqui Research and Development Scheme, Sydney, Australia.