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Carlsson H1, Ekstrand E1, Brogårdh C1
1Lund University, Health Sciences, Lund, Sweden
Background: One of the most common deficits following stroke is upper limb impairments, such as reduced sensorimotor function, spasticity and pain. In the acute phase between 50% and 80% of stroke survivors are affected in their upper limb and approximately 40% have remaining impairments in the chronic phase. The impairments can impede the ability to perform upper limb daily activities and to participate in social activities. To regain upper limb functioning is therefore an important goal in stroke rehabilitation. One central factor for the ability to perform daily activities is dexterity of the hand. However, few studies have evaluated how various demographic and stroke-specific factors are associated with dexterity after stroke. An increased understanding of which factors are associated with dexterity of the affected hand can help the clinicians to better target rehabilitation interventions for the upper limb after stroke.
Purpose: To evaluate how several potential factors (age, gender, affected hand, social situation, vocational situation, grip strength, spasticity, sensory function and pain) are associated with dexterity after stroke.
Methods: Seventy-five participants (54 men) diagnosed with stroke and sensorimotor impairments of the upper limb were recruited. Their mean age was 66 years (SD 8 years) and the time since stroke onset was 33 months (SD 26 months). The following outcome measures were used: the mini Sollerman Hand Function Test to assess dexterity, the Fugl-Meyer Assessment of the Upper Extremity to assess light touch and proprioception; the Shape Texture Identification Test TM to assess active discriminative touch, the Modified Ashworth Scale to assess spasticity, and the Grippit dynamometer to assess grip strength. All assessments were performed at one occasion according to a standardized protocol by an experienced physiotherapist. Data were analyzed using multivariate linear regression models.
Results: Sensory function in terms active discriminate touch had the strongest association with dexterity, explaining 46% of the variance. When spasticity and grip strength were added the explained variance increased to 57% in the final multivariate model.
Conclusion(s): Sensory function in terms of active discriminative touch is a major contributing factor to dexterity after stroke, whereas spasticity and grip strength seem to be of lesser importance.
Implications: To improve dexterity, active discriminative touch should be particularly considered in upper limb rehabilitation after stroke.
Keywords: Stroke, Upper limb, Dexterity
Funding acknowledgements: The study was supported by Skåne county councils, Swedish Stroke Association, Skånes University Hospital and Färs & Frosta Foundation.
Purpose: To evaluate how several potential factors (age, gender, affected hand, social situation, vocational situation, grip strength, spasticity, sensory function and pain) are associated with dexterity after stroke.
Methods: Seventy-five participants (54 men) diagnosed with stroke and sensorimotor impairments of the upper limb were recruited. Their mean age was 66 years (SD 8 years) and the time since stroke onset was 33 months (SD 26 months). The following outcome measures were used: the mini Sollerman Hand Function Test to assess dexterity, the Fugl-Meyer Assessment of the Upper Extremity to assess light touch and proprioception; the Shape Texture Identification Test TM to assess active discriminative touch, the Modified Ashworth Scale to assess spasticity, and the Grippit dynamometer to assess grip strength. All assessments were performed at one occasion according to a standardized protocol by an experienced physiotherapist. Data were analyzed using multivariate linear regression models.
Results: Sensory function in terms active discriminate touch had the strongest association with dexterity, explaining 46% of the variance. When spasticity and grip strength were added the explained variance increased to 57% in the final multivariate model.
Conclusion(s): Sensory function in terms of active discriminative touch is a major contributing factor to dexterity after stroke, whereas spasticity and grip strength seem to be of lesser importance.
Implications: To improve dexterity, active discriminative touch should be particularly considered in upper limb rehabilitation after stroke.
Keywords: Stroke, Upper limb, Dexterity
Funding acknowledgements: The study was supported by Skåne county councils, Swedish Stroke Association, Skånes University Hospital and Färs & Frosta Foundation.
Topic: Neurology: stroke; Disability & rehabilitation; Neurology
Ethics approval required: Yes
Institution: Department of Health Sciences, Lund University, Lund, Sweden
Ethics committee: Regional Ethical Review Board in Lund Sweden
Ethics number: Dnr 2012/591
All authors, affiliations and abstracts have been published as submitted.
