Objectives: Previous studies have shown that recovery of recordable grip strength in acute stroke subjects is one of the most sensitive assessments of initial upper limb recovery and a good prognostic factor for latter recovery. The objectives of this study were to test the reliability of maximal voluntary grip force (MVGF) measures and evaluate the relationship between paretic grip strength deficit and paretic upper extremity function in chronic stroke subjects.
Design: Over a three-week period, bilateral MVGF was assessed three times with a modified strain gauge dynamometer in 15 chronic stroke subjects and 10 control subjects. The paretic MVGF deficit was expressed in relation to the MVGF of the nonaffected hand.
Outcome measures: Upper extremity function in stroke subjects was measured using the Fugl-Meyer, the upper extremity performance test for the elderly (TEMPA), Box and Block and finger-to-nose tests.
Results: MVGF measures in both groups of subjects demonstrated good reliability (intraclass correlation, ICC >0.86) and low standard error measurements (SEM). The paretic MVGF of the stroke subjects was greatly impaired in comparison to the control subjects. Results of linear and quadratic regressions analyses show that this impairment was significantly correlated (p <0.01) with the performance of the stroke subjects on the four upper extremity function tests. The percentages of variances explained by the MVGF deficit on all four upper extremity tests varied from 62% to 78% for the linear regressions and from 72% to 93% for the quadratic regressions.
Conclusions: These results suggest that the paretic maximal grip strength, normalized with the maximal grip strength on the nonaffected side, appears to be a valuable outcome measure of upper extremity function in chronic stroke subjects.
Get full access to this article
View all access options for this article.
References
1.
Bohannon R. Strength associated motor deficits following stroke. Percept Mot Skills1997; 84: 393–394.
2.
Bourbonnais D, Vanden Noven S. Weakness in patients with hemiparesis. Am J Occup Ther1989; 43: 313–319.
3.
Duncan P. Stroke: physical therapy assessment and treatment. In: Contemporary management of motor control problems. Alexandria: Foundation for Physical Therapy, 1991: 209–216.
4.
Bohannon R. Is the measurement of muscle strength appropriate in patients with brain lesions? A special communication. Phys Ther1989; 69: 225–236.
5.
Bohannon R, Walsh S. Nature, reliability, and predictive value of muscles performance measures in patients with hemiparesis following stroke. Arch Phys Med Rehabil1992; 73: 721–725.
6.
Rothstein J, Riddle D, Finucane S. Commentary on the paper ‘Is the measurement of muscle strength appropriate in patients with brain lesions? A special communication’ by R. Bohannon. Phys Ther1990; 70: 330–334.
7.
Bohannon R. Interrelationships of trunk and extremity muscle strengths and body awareness following unilateral brain lesions. Percept Mot Skills1991; 73: 1016–1018.
8.
Bohannon R, Warren M, Cogman K. Motor variables correlated with the hand-to-mouth maneuver in stroke patients. Arch Phys Med Rehabil1991; 72: 682–684.
9.
Hamrin E, Eklund G, Hillgren A, Borges O, Hall J, Hellström O. Muscle strength and balance in post stroke patients. Ups J Med Sci1982; 87: 11–26.
10.
Heller A, Wade D, Wood V, Sunderland A, Hewer R, Ward E. Arm function after stroke: measurement and recovery over the first three months. J Neurol Neurosurg Psychiatry1987; 50: 714–719.
11.
Sunderland A, Tinson D, Bradley L, Hewer R. Arm function after stroke. An evaluation of grip strength as a measure of recovery and a prognostic indicator. J Neurol Neurosurg Psychiatry1989; 52: 1267–1272.
12.
Bohannon RW. Correlations of lower limb strengths and other variables with standing performance in stroke patients. Physiother Canada1989; 41: 198–202.
13.
Bohannon RW. Relevance of muscle strength to gait performance in patients with neurologic disability. J Neurol Rehabil1989; 3: 97–100.
14.
Nakamura R, Hosokawa T, Tsuji I. Relationship of muscle strength for knee extension to walking capacity in patients with spastic hemiparesis. Tohoku J Exp Med1985; 145: 335–340.
15.
Nakamura R, Watanabe S, Handa T, Morohashi I. The relationship between walking speed and muscle strength for knee extension in hemiparetic stroke patients – a follow-up study. Tohoku J Exp Med1988; 143: 111–113.
16.
Bohannon R. Consistency of paretic upper extremity motor performance soon after stroke. J Phys Ther Sci1995; 7: 49–51.
17.
Boissy P, Carlotti M, Bourbonnais D et al. Maximal grip force in chronic stroke subjects and its relationship to global upper extremity function. In: Proceedings of Provincial Rehabilitation Research Network, Quebec. Can J Rehabil1998; 11: 267–268.
18.
Oldfield O. The assessment and analysis of handedness: the Edinburgh Inventory. Neuropsychologica1971; 9: 97–113.
19.
Fugl-Meyer A, Jääskö L, Leyman I, Olsson I, Steglind S. The post-stroke hemiplegic patient: a method for evaluation of physical performance. Scan J Rehabil Med1975; 7: 13–31.
20.
Desrosiers J, Hébert R, Dutil É, Bravo R. Development and reliability of an upper extremity function test for the elderly: the TEMPA. Can J Occup Ther1993; 60: 9–16.
21.
Grinker R, AL S. Neurology, sixth edition. Springfield: Thomas, 1966.
22.
Cromwell FS. Occupational therapists manual for basic skills assessment: Primary prevocational evaluation. New York: John Wiley & Sons, 1965.
23.
Desrosiers J, Hébert J, Dutil É, Bravo G, Mercier L. Validity of a measurement instrument for upper extremity performance: the TEMPA. Occup Ther J Res1994; 14: 267–281.
24.
Desrosiers J, Hébert R, Bravo G, Dutil É. Upper extremity performance test for the elderly (TEMPA): normative data and correlates with sensorimotor parameters. Arch Phys Med Rehabil1995; 76: 1125–1129.
25.
Duncan P, Propst M, Nelson S. Reliability of the Fugl-Meyer assessment of the sensorimotor recovery following cerebrovascular accident. Phys Ther1983; 63: 1606–1610.
26.
Fugl-Meyer A. Post-stroke hemiplegia assessment of physical properties. Scand J Phys Med1982; 20: 85–89.
27.
Mathiowetz V, Volland G, Kashman N, Weber K. Adult norms for the Box and Block test for manual dexterity. Am J Occup Ther1985; 39: 389–391.
28.
Desrosiers J, Bravo G, Hébert R, Dutil É, Mercier L. Validation of the Box and Block test as a measure of dexterity of elderly people: reliability, validity and norm studies. Arch Phys Med Rehabil1994; 76: 751–755.
29.
Swaine B, Sullivan S. Relation between clinical and instrumented measures of motor coordination in traumatically brain injured persons. Arch Phys Med Rehabil1992; 73: 55–59.
30.
Swaine B, Sullivan S. Reliability of the scores for the Finger-to-Nose Test in adults with traumatic brain injury. Phys Ther1993; 73: 71–78.
31.
Fleiss J. The design and analysis of clinical experiment. New York: John Wiley & Sons, 1985.
32.
Winer B. Statistical principles in experimental design, second edition. Toronto: McGraw-Hill, 1971.
33.
Rothstein J, Echternach J. Primer on measurement: an introductory to measurement issues. American Physical Therapy Association, 1993.
34.
Stradford P, Norman G, McIntosh J. Generalizability of grip strength measurements in patients with tennis elbow. Phys Ther1989; 69: 276–281.
35.
Crick J, Brennan R. Manual for Genova: a generalized analysis of variance system. Version 2.1. American College Testing Program, 1983.
36.
Wade D. Measuring arm impairment and disability after stroke. Int Disabil Stud1989; 11: 89–92.
37.
Jones R, Donaldson I, Parkin P. Impairment and recovery of ipsilateral sensory-motor function following unilateral cerebral infarction. Brain1989; 112: 113–132.
38.
Smutok M, Grafman J, Salazar A, Sweeney J, Jonas B, DiRocco P. Effects of unilateral brain damage on contralateral and ipsilateral upper extremity function in hemiplegia. Phys Ther1989; 69: 195–203.
39.
Haaland K, Delaney H. Motor deficit after left or right hemisphere damage due to stroke or tumor. Neuropsychologia1981; 19: 17–27.
40.
Jebsons R, Griffith E, Long E et al. Function of the normal hand in stroke patients. Arch Phys Med Rehabil1971; 52: 170–174.
41.
Kimura D. Acquisition of a motor skill after left hemisphere damage. Brain1977; 100: 527–542.
42.
Robinson LM, Fitts SS, Kraft GH. Laterality of performance in fingertapping rate and grip strength by hemisphere of stroke and gender. Arch Phys Med Rehabil1990; 71: 695–698.
43.
Desrosiers J, Bourbonnais D, Bravo G, Roy P, Guay M. Performance of the ‘unaffected' upper extremity of elderly stroke patients. Stroke1996; 27: 1564–1570.
44.
Riddle D, Finucane S, Rothstein J, Walker M. Intrasession and intersession reliability of hand held dynamometer measurements taken on brain damaged patients. Phys Ther1989; 69: 182–189.
45.
Desrosiers J, Hebert R, Bravo G, Dutil E. Upper extremity performance test for the elderly (TEMPA): normative data and correlates with sensorimotor parameters. Test d'Evaluation des Membres Supérieurs de Personnes Agées. Arch Phys Med Rehabil1995; 76: 1125–1129.
46.
Desrosiers J, Hebert R, Bravo G, Dutil E. Upper extremity motor co-ordination of healthy elderly people. Age Ageing1995; 24: 108–112.
47.
Kraft GH, Fitts SS, Hammond CH. Techniques to improve function of the arm and hand in chronic hemiplegia. Arch Phys Med Rehabil1992; 73: 220–227.
48.
Rice C, Cunningham D, Paterson D, Rechnitzer P. Strength in an elderly population. Arch Phys Med Rehabil1989; 70: 391–396.
49.
Schmidt R, Toews J. Grip strength as measured by the Jamar dynamometer. Arch Phys Med Rehabil1970; 51: 321–327.
50.
Walamies M, Turjanmaa V. Assessment of the reproductibility of strength and endurance handgrip parameters using a digital analyser. Eur J Appl Physiol1993; 67: 83–86.
51.
Duncan P, Badke M. Stroke rehabilitation: the recovery of motor control. New York: Year Book, 1987.
