Disparity between functional recovery and daily use of the upper and lower extremities during subacute stroke rehabilitation

Background. Although inpatient rehabilitation may enhance an individual's functional ability after stroke, it is not known whether these improvements are accompanied by an increase in daily use of the arms and legs. Objectives. To determine the change in daily use of the upper and lower extremities of stroke patients during rehabilitation and to compare these values with that of community-dwelling older adults. Methods. A total of 60 stroke patients underwent functional assessments and also wore 3 accelerometers for 3 consecutive weekdays on admission to rehabilitation and 3 weeks later prior to hospital discharge. The number of steps and upper-extremity activity counts were measured over the waking hours and during daily use for occupational therapy (OT) and physical therapy (PT) sessions. Healthy older adults (n = 40) also wore 3 accelerometers for 5 consecutive days. Results. Stroke patients demonstrated a significant increase in mobility function, and this was accompanied by an increase in daily walking over the entire day as well as in PT. However, increases in daily walking were found predominantly in patients who were wheelchair users (and not walkers) at the time of admission. Control walking values (5202 steps) were more than 17 times that of stroke patients. Despite significant improvements in paretic hand function, no increase in daily use of the paretic or nonparetic hand was found over the entire day or in PT. Conclusions. A disparity between functional recovery and increases in daily use of the upper and lower extremities was found during inpatient stroke rehabilitation.