Recovery of upper limb dexterity in patients more than 1 year after stroke: Frequency, clinical correlates and predictors

Abstract

Objective: The objectives of this study are to establish frequency, clinical correlates and predictors of upper limb dexterity in patients who have survived 1 year or more after a stroke.

Design: Cross-sectional study.

Setting: Outpatient clinic of a tertiary rehabilitation centre.

Participants: One hundred and forty patients who were more than a year after stroke onset.

Interventions: Nil.

Main outcome measures: Motor Assessment Scale (MAS) for measurement of upper limb dexterity, Ashworth Scale for spasticity, Upper Extremity Motricity Index (UEMI) and Lower Extremity Motricity Index (LEMI) for motor power and Modified Barthel Index (MBI) for functional status. Spasticity was categorized as absent to moderate and severe. Potential predictors of dextrous function were chosen based on retrospective review of the patient's medical records during admission for inpatient rehabilitation.

Results: The mean age was 61.0 ± 13.3 years and patients were evaluated at 41.7 ± 35.1 months after stroke onset. Upper limb dexterity was present in 40 (28.3% patients. Sensory impairment, severe spasticity and low scores on the MBI, UEMI and LEMI were significantly correlated to poor dextrous function, with severe spasticity (p < 0.001) and UEMI score (p = 0.025) being the most important. Poor dextrous function was predicted by a severe stroke, neglect, sensory impairment, total/partial anterior circulation stroke and low MBI, UEMI and LEMI scores on rehabilitation admission. The most important predictor of dexterity was UEMI score on admission to rehabilitation (p=0.005).

Conclusion: Upper limb dexterity was present in 28.3% of a cohort of chronic stroke patients. The most important correlates of limb dexterity were upper limb strength and severe spasticity and the most significant predictor of dexterity was the severity of upper limb paresis on admission to rehabilitation.