Impairments of the ipsilesional upper-extremity in the first 6-months post-stroke.
Donovan B Smith, Stephen H Scott, Jennifer A Semrau and 1 others
PMID 37580751WHAT IT FOUND
Robot testing found significant arm impairment in nearly half of stroke survivors one week after stroke.
By six months, this dropped to 14%. Standard clinical scales missed many of these deficits, identifying only 16% of patients as impaired. Side of brain injury did not affect impairment severity.
Key findings
01At one week post-stroke, 47.1% of participants showed significant ipsilesional arm impairment on robotic testing, whereas standard clinical scales identified impairment in only 16.0% of arms.
02By six months post-stroke, the proportion of participants with significant ipsilesional arm impairment decreased to 14.2%, while 51.4% still had contralesional arm impairments.
03The side of the brain lesion (left or right hemisphere) had no significant impact on the severity or type of motor impairments observed in either arm.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTs
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What it does not show
The study had few participants with severe stroke and only six left-handed individuals, limiting generalizability to those groups. Missing data occurred in 1.74% of assessments due to dropout or scheduling conflicts. The robotic exoskeleton supported the arms against gravity, which differs from some previous assessment methods and may affect the ecological validity of the findings. The Modified Ashworth Scale was not used to stratify robotic performance, so the interaction between spasticity and subtle motor impairment was not fully explored.
Declared interests
Funded by the Canadian Institutes of Health Research and the Heart and Stroke Foundation of Canada. No commercial conflicts of interest were declared.
The easy way to misread this
Do not assume the ipsilesional arm is fully functional based on standard clinical scores alone. The study showed that robotic assessment identified significant impairments in nearly half of patients at one week, while the CMSA identified them in only 16%. Relying solely on the CMSA may lead to overlooking deficits in the compensatory limb.