Improvements in upper extremity isometric muscle strength, dexterity, and self-care independence during the sub-acute phase of stroke recovery: an observational study on the effects of intensive comprehensive rehabilitation

Řasová K; Martinková P; Vařejková M; Miznerova B; Hlinovská J; Hlinovský D; Iskendri D; Lebdušková L; Vojíková R; Zakouřilová J; Běhounek J; Musil V; Philipp T

doi:10.3389/fneur.2024.1442120

Improvements in upper extremity isometric muscle strength, dexterity, and self-care independence during the sub-acute phase of stroke recovery: an observational study on the effects of intensive comprehensive rehabilitation

Front Neurol. 2024 Oct 23:15:1442120. doi: 10.3389/fneur.2024.1442120. eCollection 2024.

Authors

Řasová K^{1

2}, Martinková P³, Vařejková M³, Miznerova B^{2

4}, Hlinovská J², Hlinovský D⁵, Iskendri D², Lebdušková L², Vojíková R², Zakouřilová J², Běhounek J², Musil V⁶, Philipp T²

Affiliations

¹ Department of Rehabilitation Medicine, Third Faculty of Medicine, Charles University, Prague, Czechia.
² Department of Rheumatology and Physiotherapy, Third Faculty of Medicine, Charles University and Thomayer University Hospital, Prague, Czech Republic.
³ Department of Statistical Modelling, Institute of Computer Science of the Czech Academy of Sciences, Prague, Czechia.
⁴ Department of Rehabilitation and Sports Medicine, Second Medical Faculty, Charles University and University Hospital Motol, Prague, Czech Republic.
⁵ Department of Neurology, Third Faculty of Medicine, Charles University and Thomayer University Hospital, Prague, Czech Republic.
⁶ Center of Scientific Information, Third Faculty of Medicine, Charles University, Prague, Czechia.

Abstract

Background: Stroke often impairs upper extremity motor function, with recovery in the sub-acute phase being crucial for regaining independence. This study examines changes in isometric muscle strength, dexterity, and self-care independence during this period, and evaluates the effects of a comprehensive intensive rehabilitation (COMIRESTROKE).

Methods: Individuals in sub-acute stroke recovery and age- and sex-matched controls were assessed for pre- and post-rehabilitation differences in primary outcomes (grip/pinch strength, Nine Hole Peg Test [NHPT], Action Research Arm Test [ARAT]). COMIRESTROKE's effects on primary and secondary outcomes (National Institute of Health Stroke Scale [NIHSS], Modified Rankin Scale [MRS], Functional Independence Measure [FIM]) were evaluated. Outcomes were analyzed for dominant and non-dominant limbs, both regardless of impairment and with a focus on impaired limbs.

Results: Fifty-two individuals with stroke (NIHSS 7.51 ± 5.71, age 70.25 ± 12.66 years, 21.36 ± 12.06 days post-stroke) and forty-six controls participated. At baseline, individuals with stroke showed significantly lower strength (dominant grip, key pinch, tip-tip pinch, p _adj < 0.05), higher NHPT scores (p _adj < 0.05), and lower ARAT scores (p _adj < 0.001). COMIRESTROKE led to improvements in dominant key pinch, non-dominant tip-tip pinch, NHPT, and both dominant and non-dominant ARAT (p _adj < 0.05). Notably, non-dominant key pinch improved significantly when considering only impaired hands. Pre- and post-test differences between groups were significant only for ARAT (both limbs), even after adjustment (p _adj < 0.05). All secondary outcomes (NIHSS, MRS, FIM) showed significant improvement post-COMIRESTROKE (p _adj < 0.001).

Conclusion: Individuals with stroke exhibit reduced muscle strength and dexterity, impairing independence. However, comprehensive intensive rehabilitation significantly improves these functions. Data are available from the corresponding author upon request and are part of a sub-study of NCT05323916.

Keywords: dexterity; ischemic stroke; isometric grip strength; maximum strength during key, tripod, and tip-tip pinch; physiotherapy; rehabilitation.

Associated data

ClinicalTrials.gov/NCT05323916

Grants and funding

The author(s) declare that financial support was received for the research, authorship, and/or publication of this article. Ministry of Health, Czech Republic – RVO (Thomayer University Hospital – FTN, 00064190) supported the development of the design of the study, including payment of license fees and data recording system. PM and MV were supported by the long-term strategic development financing of the Institute of Computer Science (RVO:67985807) and by the project “Research of Excellence on Digital Technologies and Wellbeing CZ.02.01.01/00/22\_008/0004583” which is co-financed by the European Union. Researchers were also supported by Charles University, programme Cooperatio (Neuroscience) and 260648/SVV/2024. The study was supported by the Charles University, project GA UK No 202322/2022 for technological rehabilitation equipment.