Stroke: Leading Cause Of Disability In Adults

Introduction

Stroke is the leading cause of disability in adults (Morris, van Wijck, Joice, & Donaghy, 2013). A stroke is caused by blood loss to the brain due to a clot or ruptured vessel. Most stroke victims suffer from hemiparesis: partial or full loss of voluntary movement on one side of the body (Pereira et al., 2012). Paresis is the most common motor impairment caused by stroke. Paresis can range from mild to severe and occurs contralateral to the side of the infarct on the brain. Mild paresis results in movements that can appear to be normal or near normal. Severe paresis can result in little to no movement in the affected limb (Lang, Bland, Bailey, Schaefer, & Birkenmeier, 2013).

Due to early detection and improved medical procedures, the number of people surviving from strokes has increased over time (Barker & Brauer, 2005). Despite this increase in survival rate, the recovery rate for upper limb function is poor with many victims disabled years after stroke because of a slow reach or grasp, excessive trunk compensation, or simply decreased finger and hand dexterity (Pereira et al., 2012). Nearly 80% of all stroke survivors suffer

from some type of upper limb disability.

Of this percentage, only 50% of those survivors are expected to regain some upper limb function and only 5%-20% of those survivors will regain full functional recovery (Barker & Brauer, 2005). In general, when beginning the recovery process, stroke patients’ primary

concern is being able to move and coordinate movements of the affected side. This makes performing activities of daily living (ADL) more challenging than before the stroke (Pollock et al., 2014). Improving arm function is the main priority of rehabilitation and over half of stroke patients will continue to have difficulty performing ADL years after being discharged (Pollock et al., 2014). Due to the low number of patients fully recovering after stroke, a great demand has been placed on rehabilitation services to determine which assessment tool is the best fit for the patient and develop intervention strategies to help the patient regain as much upper limb function as possible (Barker & Brauer, 2005).
Movement
A retrospective study conducted by Bohannon and Smith (Bohannon & Smith, 1987) looked at the initial and discharge strengths in stroke patients with hemiparesis. The Chatillon force gauge was used to measure the strength of the following muscle groups: elbow flexors and extensors, wrist extensors, lateral and medial rotators of the shoulder, and shoulder abductors, flexors, and extensors. The patients spent between 10 to 52 days between the initial assessment and discharge assessment receiving rehabilitation services (Bohannon & Smith, 1987). The results showed that 79.8% of the muscle groups tested within the stroke patients had an increase in strength. However, the strength in some of the muscle groups did not significantly improve. Thus, further investigation and research is needed to determine relationships between rehabilitation services and muscle strength. Based on the findings of this study, the researchers concluded that rehabilitation improves strength deficits in stroke patients with hemiparesis (Bohannon & Smith, 1987).
In order to improve strength deficits in the affected upper limb, a study was conducted by Thies and colleagues (Thies et al., 2009) to observe the kinematics of functional tasks. Unilateral drinking from a cup and bilateral moving of a plate were the two functional tasks explored in this study (Thies et al., 2009). An inertial sensor was placed on the arm in order to determine acceleration and timing of completing the functional tasks. In the assessment of unilaterally drinking from a cup, Thies and colleagues (Thies et al., 2009) observed that all of the stroke patients demonstrated a higher variability in timing of the motion compared to the corresponding control subject. In five out of six cases in the cup task, stroke patients also demonstrated higher variability in the accelerometer’s signal magnitude. However, for the plate task, there was not a significant difference in variability between stroke and control patients. The results suggest association with stroke patients’ higher variability in precision and movement control.
There are currently limited tools for quantifying upper limb motion in the clinical atmosphere, especially when it comes to performing functional tasks in the rehabilitation setting. There are many assessments that can be used to measure and track functional use of the upper limb, some of which are standardized and some that are not. Due to the individualized attention, a patient can encounter a nonstandardized assessment. However, it is up to the discretion of the clinician or facility to determine which assessment best suits the patient. Some clinicians may choose tests that are not standardized because of the freedom to individualize the assessment for the patient unlike standardized assessments where a script must be followed. This paper will assess the demographics of patients receiving upper limb assessment tools used in practice for motor recovery after a stroke.