Upper limb use differs among people with varied upper limb impairment levels early post-stroke: a single-site, cross-sectional, observational study

ABSTRACT

Background: There is limited knowledge on the upper limb (UL) use early post-stroke by impairment levels.

Objectives: To 1) To characterize paretic UL use in people with different UL impairment levels early post-stroke during and outside therapy; 2) compare UL use in people early post-stroke to age-matched controls.

Methods: A prospective cross-sectional study of inpatients with first-time stroke ≤4-weeks (n=60, 61±12 years) categorized by Fugl-Meyer UL score for impairment subgroups: mild (51–66), moderate (23–50) and severe (0–22) was conducted. Age-matched, community-dwelling individuals without a history of stroke were recruited (n=30, 60±11 years). Bilateral wrist-worn accelerometers measured the duration of paretic UL use and use the ratio of paretic/non-paretic and non-dominant/dominant UL.

Results: Sixty-three percent of stroke participants with mild impairment used their paretic UL >6 h/day (median (IQR): 6.7(3.3); use ratio 0.9(0.3)). Those with moderate impairment demonstrated wide variation of use; 13.3% achieving >6 h use/day (median (IQR): 4.5(3.8); use ratio 0.5(0.2)). People with severe impairment demonstrated limited use. None achieved >6 h/day of use (median (IQR): 1.7(0.7); use ratio 0.3(0.2)). Paretic UL use and use ratio were greater during therapy compared to outside therapy in moderate and severe groups (p<.002). Age-matched controls used their non-dominant UL for 8.7(3.0) hours, significantly more than all stroke participants (p<.002).

Conclusions: Patterns of UL use differed by severity of impairment. Moderate and severe groups used their paretic UL more during therapy, inferring that it is possible to increase paretic use despite motor impairment. Future research stratifying by impairment across multinational sites is warranted to generalize findings.

KEYWORDS:

• Stroke
• upper extremity
• severity
• accelerometer
• activity monitoring

Acknowledgments

We thank Aloysius Soh, Chin Mei Tan, Cheryl Wong, Jia Wei Loh, Genevieve Loke, Bernadine Teng from Nanyang Polytechnics and Audrey Chai from Tan Tock Seng Rehabilitation Centre for their valuable contribution in data collection. We thank Dion Scott (Principal Scientific Officer, School of Health and Rehabilitation Sciences, The University of Queensland) for his valuable assistance in the processing of the accelerometry data. We would also like to thank Keng He Kong for his valuable advice on research design. LFC is supported by the National Medical Research Council Singapore (MH095:003/008-1031MH). KH was supported by a National Health and Medical Research Council Early Career Fellowship (1088449). The Florey Institute of Neuroscience and Mental Health acknowledge the strong support from the Victorian Government and in particular the funding from the Operational Infrastructure Support Grant. This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

Additional information

Funding

This study is not funded by any agencies or funders.