Self-Perceived Utilization of the Paretic Arm in Chronic Stroke Requires High Upper Limb Functional Ability

Abstract

ObjectiveTo explore potential predictors of self-reported paretic arm use at baseline and after task-specific training (TST) in survivors of stroke. DesignData were obtained from a randomized controlled trial of somatosensory stimulation and upper limb TST in chronic stroke. SettingUniversity laboratory. ParticipantsChronic (≥3mo) survivors of stroke (N=33; mean age, 62y; mean stroke duration, 38mo). InterventionsParticipants received 12 sessions of TST preceded by either active (n=16) or sham (n=17) somatosensory stimulation to all 3 peripheral nerves. Main Outcome MeasuresDemographic and clinical characteristics were entered stepwise into multiple linear regression analyses to determine the factors that best predict baseline Motor Activity Log (MAL) amount of use rating and change 3 months after TST. ResultsThe Action Research Arm Test (ARAT) score predicted the amount of use at baseline (R2=.47, P<.001); in using this model, an ARAT score of 54 (maximum of 57) is required to score 2.5 on the MAL (use described as between rarely and sometimes). After TST the change in the ARAT score predicted the change in the amount of use (R2=.31, P=.001). The predictive power of the model for change at 3 months increased if the Fugl-Meyer Assessment wrist component score was added (R2=.41, P=.001). ConclusionsUtilization of the paretic upper limb in activities of daily living requires high functional ability. The increase in self-reported arm use after TST is dependent on the change in functional ability. These results provide further guidance for rehabilitation decisions.