The Recovery of the Less-Affected Upper Extremity (UE) During the First Six Months Poststroke

Abstract

Date Presented 03/26/20

Weakness of the affected UE is common poststroke. However, it is important to be aware that the less-affected UE is also mildly affected poststroke. In this longitudinal study, we revealed that the motor and functional ability of the less-affected UE improved significantly during the first six months poststroke. The impact of this UE on bilateral functioning needs to be further investigated.

Primary Author and Speaker: Samar Hmaied Assadi

Additional Authors and Speakers: Debbie Rand

Contributing Authors: Noa Doron, Shelly Peri, Haim Barel, Israel Dudkiewicz, Gabi Zeilig, Revital Gross-Nevo

Weakness of the affected upper extremity (UE) is common post stroke however, recently, there is more awareness that the upper extremity ipsilateral to the brain lesion is mildly affected following stroke and therefore is termed the less-affected upper extremity (UE). Despite the fact that most functional tasks are performed using both hands in a coordinative manner, very few follow-up studies have been conducted to describe the changes in this upper extremity and to examine its recovery post-stroke.

PURPOSE: To follow-up and to characterize the motor and functional ability of the less-affected UE during the first six months post-stroke.

DESIGN: Multi-center longitudinal study. We included adults who were admitted to four rehabilitation centers following a stroke (determined by CT or MRI), had full hand function before the stroke, could understand simple commands and cooperate, intact or corrected vision and hearing.

METHOD: We administered assessments on rehabilitation admission (T1), six weeks post-stroke (T2) and six months post-stroke (T3), using the following tools; Box and Block Test (BBT) and Functional Dexterity Test (FDT) to assess dexterity, Fugl-Meyer Motor Assessment (FMA) to assess active movement, Jamar dynamometer to assess grip strength and subjective rating of their less-affected UE ability (0-100%).

Statistical analysis included descriptive statistics of the demographic and stroke data and the clinical measures collected on 3-time points. Due to abnormality of the data, Friedman test for repeated measures was used to examine changes over time.

RESULTS: Sixty-seven individuals after first stroke (48 men, mean age (SD) 71.5 (10.6) years) have been recruited. The less-affected UE was the dominant in 60% of the participants.

Significant improvement in dexterity was seen over time [median (IQR) BBT- improved from 40.0 (33.0-50.0) to 44.0 (35.5-53.5) to 50.0 (41.0-56.5) blocks/min, X²(2)= 18.01, p<0.000, median (IQR) FDT decreased from 49.0 (35.5-66.0) to 38.0 (30.0-53.5) to 34.0 (28.3-43.5) seconds, X²(2)= 21.55, p<0.000]. Grip strength also significantly improved from 22.6 (15.5-30.0) to 23.3 (16.2-33.7) to 29.3 (18.8-35.7) kilograms, X²(2)= 10.60, p<0.00. No change in FMA or subjective rating was seen, since it was close to 100% on admission.

CONCLUSION: Although the less affected UE is mildly affected post-stroke, a significant improvement was seen over the six-months follow-up. Interestingly, participants were not really aware of this and rated their ability of the less-affected UE as 100%. Therefore, we recommended to continue investigating the less affected UE and its impact on bilateral function post-stroke.

References

Metrot, J., Froger, J., Hauret, I., Mottet, D., van Dokkum, L., & Laffont, I. (2013). Motor recovery of the ipsilesional upper limb in subacute stroke. Archives of Physical Medicine and Rehabilitation, 94, 2283-2290. doi: 10.1016/j.apmr.2013.05.024

Yarosh, C. A., Hoffman, D. S., & Strick, P. L. (2004). Deficits in movements of the wrist ipsilateral to a stroke in hemiparetic subjects. Journal of Neurophysiology, 92, 3276-3285. doi: 10.1152/jn.00549.2004