Changes in Unimanual and Bimanual Upper Extremity Use During the Subacute Phase Post-Stroke Assessed in Supervised...

The subacute phase post-stroke is a critical period for recovery, yet it remains unclear how spontaneous use of the paretic upper extremity (UE) increases during this period.

This longitudinal study aimed to characterize changes in patterns of UE use during the subacute phase, focusing on unimanual and bimanual use, and to examine the influence of different clinical contexts on UE use.

Participants (n = 41; 28.4 [8.0] days since stroke) were assessed at admission to inpatient rehabilitation, prior to discharge, and at 6 months post-stroke. UE use was measured with wrist-worn accelerometers over 7 consecutive days in 3 contexts: daily life, therapy sessions, and functional assessments. Metrics included the use ratio (UR; paretic/non-paretic) and the percentage of unimanual and bimanual use.

UR improved from admission to discharge (P < .001), reflecting a more symmetrical UE use, but no further change was observed after discharge (P = .09). Percentage of unimanual non-paretic use decreased while bimanual use increased across all time points (P ≤ .03). Percentage of unimanual paretic use remained low, with no change over time (P = .28). An effect of context was observed for all variables (P ≤ .003), showing more asymmetric UE use outside of supervised clinical contexts (therapies and assessments).

The subacute phase is characterized by substantial improvements in bimanual UE use during rehabilitation, followed by subtler changes in UE use patterns during the late subacute phase. The discrepancy between UE use during supervised clinical contexts and spontaneous use in daily life highlights the need for accelerometry-based monitoring in clinical practice.