Measurement of Upper Limb Motor Recovery Following a Stroke

Normal movement of the upper limb is very complex. Following a stroke a patient can be left with a non-functional arm. The aim of rehabilitation is to minimise impairments and reduce disability and handicap. Outcome measures are required to guide and evaluate rehabilitation. In this study the impairments of spasticity and/or contracture and muscle weakness were assessed. Spasticity and/or contracture were assessed using the Modified Ashworth Scale. Muscle strength was measured by assessing grip strength with the Standard Jamar dynamometer. Upper limb disability was measured with the Nine Hole Peg Test (a test of manual dexterity) and the Action Research Arm Test (a test of upper limb function with the components of reach and grasp or fine manipulation). Twenty-two stroke subjects were assessed on five different occasions post stroke. The initial assessment was carried out 2-4 weeks post stroke and then at 4, 8, 20 and 32 weeks following that assessment. The assessment at week 8 was approximately 3 months post stroke and the assessment at week 32 was approximately 6 months post stroke. The aim of the study was firstly, to look at the validity and reliability of the four tests chosen to measure impairment and disability and secondly, to find out if the four tests were able to detect changes in the hemiplegic upper limb over a 6 month period following acute stroke. All the tests did detect change with most of that change occurring in the first 3 months. The most responsive test to change appeared to be grip strength. This study suggests that the tests are suitable outcome measures to use, to guide and evaluate therapeutic intervention after stroke, although there is a need for standardisation of the methodology, equipment, procedure and the scoring used for these tests