Changes in Upper Limb Capacity and Performance in the Early and Late Subacute Phase After Stroke

Camilla Biering Lundquist; Binh Tan Nguyen; Thomas Bo Hvidt; Henriette Holm Stabel; Jeanette Reffstrup Christensen; Iris Brunner

doi:10.1016/j.jstrokecerebrovasdis.2022.106590

Changes in Upper Limb Capacity and Performance in the Early and Late Subacute Phase After Stroke

J Stroke Cerebrovasc Dis. 2022 Aug;31(8):106590. doi: 10.1016/j.jstrokecerebrovasdis.2022.106590. Epub 2022 Jun 15.

Authors

Camilla Biering Lundquist¹, Binh Tan Nguyen², Thomas Bo Hvidt², Henriette Holm Stabel¹, Jeanette Reffstrup Christensen³, Iris Brunner⁴

Affiliations

¹ Hammel Neurorehabilitation Centre and University Research Clinic, University of Aarhus, Denmark, Voldbyvej 15, 8450 Hammel, Denmark.
² User perspectives and Community-based Practice, Department of Public Health, University of Southern Denmark, JB Winsløwsvej 9b, 5000 Odense, Denmark.
³ User perspectives and Community-based Practice, Department of Public Health, University of Southern Denmark, JB Winsløwsvej 9b, 5000 Odense, Denmark; The Research Unit of General Practice, Department of Public Health, University of Southern Denmark, JB Winsløwsvej 9b, 5000 Odense, Denmark; The Research Unit of General Practice, Aarhus University, Bartholins Alle 2, 8000 Aarhus C, Denmark.
⁴ Hammel Neurorehabilitation Centre and University Research Clinic, University of Aarhus, Denmark, Voldbyvej 15, 8450 Hammel, Denmark. Electronic address: Iris.Brunner@clin.au.dk.

PMID: 35716523
DOI: 10.1016/j.jstrokecerebrovasdis.2022.106590

Abstract

Background: The course of spontaneous biological recovery indicates that no essential improvements in upper limb (UL) capacity should be expected 3 months after stroke. Likewise, UL performance as assessed with accelerometers does not seem to increase. However, this plateau may not apply to all patients with stroke.

Objectives: This study aimed to investigate the changes in UL capacity and performance from 3 to 6 months post-stroke, and the association between patients' UL capacity and actual UL performance.

Methods: This study was a secondary analysis of a prospective longitudinal cohort study. Patients with UL impairment and first or recurrent stroke were included. Their UL capacity was assessed at 3 and 6 months with the Action Research Arm Test (ARAT) and UL performance was examined with accelerometry and expressed as a use ratio. The association between ARAT and use ratio was examined with multiple regression analyses.

Results: Data from 67 patients were analyzed. It was shown that UL capacity as assessed with ARAT still improved from 3 to 6 months. A clinically meaningful improvement (≥ 6 points on ARAT) was found in 16 (46%) of the 35 patients whose scores allowed for such an increase. Improvements were mainly observed for patients with ARAT scores in the range of 15-51 at 3 months. Conversely, UL performance did not change. Three and 6 months after stroke respectively 69% and 64% of the variation in use ratio was explained by ARAT.

Conclusion: While a substantial part of patients improved their UL capacity, UL performance did not change from 3 to 6 months post-stroke. Strategies to remind patients of including their affected UL may encourage the transfer from better capacity to increased performance.

Keywords: Accelerometry; Neurorehabilitation; Stroke; Upper limb capacity; Upper limb performance.

MeSH terms

Humans
Longitudinal Studies
Prospective Studies
Recovery of Function
Stroke Rehabilitation*
Stroke* / complications
Stroke* / diagnosis
Stroke* / therapy
Upper Extremity