Compensation in recovery of upper extremity function after stroke: the Copenhagen Stroke Study

Compensation by the unaffected upper extremity (UE) was studied in stroke patients who were unable to use the affected UE. The main aim was to evaluate the need of teaching compensatory techniques to stroke patients during rehabilitation of UE function. The study was prospective and community based and included 636 consecutive acute stroke patients. UE function and UE paresis were assessed weekly using the Barthel Index subscores for feeding and grooming and the Scandinavian Stroke Scale (SSS) subscores for arm and hand. Rehabilitation was performed according to the Bobath technique. Initially, 214 had severe UE paresis according to SSS; the arm could not move against gravity and the fingertips could not reach palm. In 64 of the 115 patients discharged alive, the affected UE definitely remained useless despite intensive and longstanding rehabilitation. Improvement of UE function was seen in 25 of these patients (39%) and was possible only through compensation by the unaffected UE. Patients who gained UE function by compensation were younger (p < 0.01), had less severe stroke (p < 0.01), smaller (p < 0.01), and subcortically located (p = 0.02) lesions and less affection of higher cortical function (p = 0.01). Recovery of UE function in more than half of the stroke patients with initial severe UE paresis can be achieved only by compensation by the unaffected UE.