Speed of finger tapping as a predictor of functional outcome after unilateral stroke

Abstract

Objectives: To determine (1) if the speed of finger tapping of the hand ipsilateral to the lesion (ie, unaffected hand) remains stable during the first 6 months after stroke and (2) if the speed of finger tapping of the unaffected hand is related to functional outcome after neurorehabilitation, which is of relevance to clinical practice.

Design: Prospective cohort study with measurements at admission to inpatient rehabilitation (t0), 4 weeks after admission (t1), at discharge (t2), and 3 months after discharge (t3).

Setting: Neurorehabilitation unit of a Dutch rehabilitation center.

Participants: Fifty-seven patients with a unilateral first-ever stroke and 42 spouses (controls) of stroke patients without history of neurologic disorders were administered the finger-tapping test to generate normative scores.

Interventions: Not applicable.

Main outcome measures: Finger-tapping speed of the ipsilateral hand from the Amsterdam Neuropsychological Test battery. The Barthel Index, Frenchay Activities Index (FAI), and Sickness Impact Profile-68 (SIP-68) were also used as outcome measures.

Results: The speed of finger tapping of the ipsilateral hand improved significantly from t0 (mean, 44.13) to t1 (mean, 47.30, P=.02) but consecutively remained stable until 3 months after discharge. Four weeks after admission, the speed of finger tapping was comparable to the scores of the controls. The speed of finger tapping at admission was significantly correlated with the Barthel Index score at discharge (r=.39) and the FAI score at discharge (r=.32) and follow-up (r=.37) but not with the SIP-68 score (r=.28). Regression analyses showed that the Barthel Index score at discharge could be predicted by the initial Barthel Index score and finger tapping at admission (R(2)=.49); the variance of FAI score at discharge and follow-up was largely explained by the initial Barthel Index score.

Conclusions: The speed of finger tapping improved over the first 4 weeks postadmission until normative speeds were reached and remained stable during the next 4 months. The speed of finger tapping correlated with functional outcome but not with quality of life; it was a predictor of activity of daily living functioning, although not a strong one. These findings suggest that the speed of finger tapping of the ipsilateral hand is a useful measure of recovery, although other variables such as the initial level of independent functioning are of more importance.