Eliza M. Prager, Catherine E. Lang; Predictive Ability of 2-Day Measurement of Active Range of Motion on 3-Mo Upper-Extremity Motor Function in People With Poststroke Hemiparesis. Am J Occup Ther 2012;66(1):35-41. doi: 10.5014/ajot.2012.002683.
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© 2019 American Occupational Therapy Association
OBJECTIVE. We determined (1) whether active range of motion (AROM) of shoulder flexion and wrist extension measured at the initial therapy evaluation in the acute hospital predicted upper-extremity (UE) motor function 3 mo after stroke and (2) whether the presence of nonmotor impairments influenced this prediction.
METHOD. We collected AROM data from 50 people with stroke during their initial acute hospital therapy evaluation and UE motor function data 3 mo later. Multiple regression techniques determined the predictive ability of initial AROM on later UE motor function.
RESULTS. Initial AROM explained 28% of the variance in UE motor function 3 mo poststroke. Nonmotor deficits did not contribute to the variance.
CONCLUSION. Compared with later AROM measurements, initial values did not adequately predict UE motor function 3 mo after stroke. Clinicians should use caution when informing clients of UE functional prognosis in the early days after stroke.
Adults with clinical diagnosis of ischemic or hemorrhagic stroke meeting International Classification of Diseases, 9th Revision (Centers for Disease Control and Prevention, 1998) criteria
Data from initial physical and occupational therapy assessments ≤7 days after stroke
Unilateral UE paresis, as indicated by a score of 1–4 on the National Institutes of Health Stroke Scale (NIHSS) Arm item
Persistent deficits after stroke, as indicated by a total NIHSS score of ≥2
Ability to follow two-step commands.
Grip strength, assessed with a hand-held dynamometer (Mathiowetz, Kashman, et al., 1985; Schmidt & Toews, 1970) and reported as strength of the affected side as a percentage of the unaffected side
The Nine Hole Peg Test (Mathiowetz, Weber, Kashman, & Volland, 1985), reported as pegs placed or removed per second
The Action Research Arm Test (ARAT; De Weerdt & Harrison, 1985; Hsieh, Hsueh, Chiang, & Lin, 1998; Lang, Edwards, Birkenmeier, & Dromerick, 2008; Lang, Wagner, Dromerick, & Edwards, 2006; Lyle, 1981; van der Lee, Beckerman, Lankhorst, & Bouter, 2001; van der Lee, De Groot, et al., 2001; van der Lee, Roorda, Beckerman, Lankhorst, & Bouter, 2002)
The Stroke Impact Scale, Hand Function subscale (Duncan et al., 1999, 2005; Duncan, Wallace, Studenski, Lai, & Johnson, 2001).
AROM measures, an index of paretic severity, provide good prognostic information about UE function at 3 wk after stroke, but not at 2 to 3 days after stroke.
Stroke-induced deficits of aphasia, neglect, and cognition measured in the first 2 to 3 days after insult did not influence the capacity to use the UE for function 3 mo later.
Clinicians should use caution when informing clients of UE functional prognosis in the early days after stroke.
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