Stroke: After a stroke, the function of the distal upper limbs and functional independence are closely related

Achieving independence in daily life (ADL) is one of the main goals of stroke rehabilitation, and the use of both limbs is essential for many daily activities
.

Because brain lesions contralateral upper extremity (UE) is the inability of brain stroke, a common phenomenon after rehabilitation training will focus on improving the (affected larger) movement and function of the UE

Stroke

Due to the fibers of the ipsilateral corticospinal system, the ipsilateral UE is slightly affected after a stroke, and has little effect on the distal movement of the ipsilateral UE and the instability of the trunk posture (due to hemiplegia), which may also interfere with the effectiveness of the ipsilateral UE Function
.

However, it is not yet known whether the patients themselves are aware of this, and it is also unclear whether they perceive changes in function over time

Less affected UE functional defects have been confirmed as dexterity, motor coordination and grip strength, as well as a small sample of reduced hand function and EMG activity
.

Different stroke-related factors have been shown to affect less affected hand function

Stroke patients, even in the chronic stage, have difficulties with ADL
.

Although the influence of UEs with greater impact on ADL has been studied before, the relationship between UEs with less impact and ADL has hardly been evaluated

Whereby, Samar Hmaied Assadi, etc.
Tel Aviv University in Israel who conducted a longitudinal study: (1) assessment of less affected by the UE of functionality, flexibility, grip strength and feel the change;
(2) the functional, flexible Comparing sex and grip strength with norm data (matching of age, gender and hand advantage); (3) Assess the relationship between two UEs and ADL independence in the first 6 months after stroke
.

They assume that the function, flexibility, and grip strength of the less affected UE will improve over time (however, it is not clear whether it will reach the norm level)
.

In addition, assuming that the hand functions of the two UEs will help explain ADL and Instrumental ADL (IADL)

They evaluated consecutive adults after their first stroke for rehabilitation and admission (T1), 6 weeks (T2) and 6 months (T3) after the onset of the stroke
.

Box and block tests evaluate the functionality of two UEs

They found that participants were evaluated at T1 (N=87), T2 (N=82), and T3 (N=68)
.

In T1, less affected UE defects are obvious (median [interquartile range] box and block test-45 [35-53] blocks, FDT-44.
5 [33.
3-60.

The function of the less affected hands was significantly improved.
In the T2 and T3 stages, 32% and 33% of the people achieved the smallest clinically important difference in the box and block tests, respectively
.

Flexibility was significantly improved between T1 and T2 (P<0.
001, no determined minimum clinically important difference), grip strength was significantly improved between T2 and T3; 3.
4% reached the minimum clinically important difference (P<0.
01)
.

In the T3 stage, most of the participants did not meet the standards (box and building block test-67.
4 blocks, FDT-32.
2 seconds, grip strength-40.
5 kg)
.

After controlling for age, days after onset, stroke type, and cognition, less and more affected UEs can explain a large part of the variation in ADL at all time points

The important significance of this study is that it found that despite some improvements, the less affected UE at 6 months after stroke was still below the standard, explaining the difficulties of ADL and instrumental ADL
.
Needs further research
.

Despite some improvement, the less affected UE at 6 months after stroke is still below the standard, explaining the difficulties of ADL and instrumental ADL
.
Needs further research
.

Original Source:
  Hmaied Assadi S, Barel H, Dudkiewicz I, Gross-Nevo RF, Rand D.
Less-Affected Hand Function Is Associated With Independence in Daily Living: A Longitudinal Study Poststroke.
Stroke.
Published online November 3, 2021:STROKEAHA.
121.
034478.
doi:10.
1161/STROKEAHA.
121.
034478

Less-Affected Hand Function Is Associated With Independence in Daily Living: A Longitudinal Study Poststroke.
Stroke.

 

Leave a message here