Assessment of upper extremity impairment, function, and activity after stroke: foundations for clinical decision making

Abstract

The purpose of this review is to provide a comprehensive approach for assessing the upper extremity (UE) after stroke. First, common UE impairments and how to assess them are briefly discussed. Although multiple UE impairments are typically present after stroke, the severity of one's impairment, paresis, is the primary determinant of UE functional loss. Second, UE function is operationally defined and a number of clinical measures are discussed. It is important to consider how impairment and loss of function affect UE activity outside of the clinical environment. Thus, this review also identifies accelerometry as an objective method for assessing UE activity in daily life. Finally, the role that each of these levels of assessment should play in clinical decision making is discussed to optimize the provision of stroke rehabilitation services.

Figure 1

Schematic representation of data from multiple studies in our lab ^{, , , -}. In each panel, the large, white circles represent the construct of UE function. The size of the smaller, filled circles represent how much the impairment (A & C, paresis) or joint (B) contributes to UE function. A: At nearly all time points post stroke, the severity of paresis can explain the majority of variance in UE function. B: Loss of UE function stems from paresis across the limb, and not paresis at just a few joints. C: Paresis a few weeks, but not a few days after stroke can predict later UE function. Other impairments tested included muscle tone, fractionation of movement, and somatosensory loss. These other impairments did not add any additional contributions to UE function in the regression models. UE = upper extremity.

Figure 2

Accelerometry can be a useful tool to measure UE use outside of the clinic or laboratory. A: Picture of commercially-available accelerometers worn on the wrists (GT3X+ Activity Monitor, ActiGraph, Pensacola FL). The size of each accelerometer is 4.6 cm x 3.3 cm x 1.5 cm. B: An example of what UE accelerometer data looks like. The date of the recording is provided at the top, and data is shown from 2:30 pm to 4:00 pm. The data line indicates the count or how much the limb was moving during this 1.5 hour period. Moments when the line is equal to zero indicate times when the limb was not moving.