Harris JE, Eng JJ; School of Rehabilitation Sciences, University of British Columbia, Vancouver, B.C., Canada and Rehabilitation Research Laboratory, GF Strong Rehab Center, Vancouver, B.C., Canada. jocelyn_ellen@hotmail.com.

PURPOSE: Many persons who have sustained a stroke continue to have upper limb impairment upon discharge, compromising participation in daily activities. The main purpose of this study was to determine how upper extremity deficits affect individuals with chronic stroke, using the ICIDH – 2 model. SUBJECTS: Sixty community-dwelling persons with stroke onset greater than six months and residual unilateral upper extremity impairment, were recruited on a voluntary basis. Each participant participated in a two hour assessment session either in their home or at a tertiary rehabilitation centre. METHODS AND MATERIALS: This study was a prospective cross-sectional design. A registered occupational therapist assessed all participants. Demographic data was collected from all participants and included age, side of stroke, dominant side prior to stroke, sex, and duration of injury. Outcome measures were chosen to reflect the categories illustrated in the ICIDH – 2. 1) Impairment: Modified Ashworth Scale, upper extremity score of the Fugl-Meyer Motor Impairment Scale, isometric muscle strength (hand held dynamometer), grip strength (Jamar dynamometer) and pinch strength (pinch gauge); 2) Activity Limitation: Barthel Index; Motor Activity Log and 3) Participation Restriction: Frenchay Activities Index. ANALYSES: Level of association between impairment, activity and participation was determined using Pearson’s correlation coefficient. Forward stepwise regression models were used to determine the most robust predictors of 1) Activity Limitation and 2) Participation Restriction. RESULTS: Participation Restriction was related to measures of Activity Limitations (r > 0.7). Measures of impairments had low correlations or non-significant relationships with Participation Restriction. The Motor Activity Log was an excellent predictor of Participation Restriction. CONCLUSIONS: The results of this study demonstrate that impairments may not necessarily be a major factor underlying the decreased participation of activities involving the upper extremities. We recommend that clinicians include the assessment and treatment of activity limitations as a major focus of rehabilitation. FUNDING: Supported by the BC Health Research Foundation.

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