Academic journal article British Journal of Occupational Therapy

The Influence of Hand Use on Dressing Outcome in Cognitively Impaired Stroke Survivors

Academic journal article British Journal of Occupational Therapy

The Influence of Hand Use on Dressing Outcome in Cognitively Impaired Stroke Survivors

Article excerpt


In everyday life, individuals use a range of bimanual (both arms) and uni-manual (one arm) skills when carrying out daily activities. Arm paresis is the dominant functional impairment in up to 85% of acute stroke survivors (Jorgensen et al 1995, Wolf et al 2006, Langhorne et al 2009, Saposnik et al 2010), leaving many unable to perform bimanual tasks (Dean and Mackey 1992). Previous studies suggest the importance of bimanual skills to the dressing success of cognitively impaired stroke survivors (Walker and Lincoln 1991, Walker et al 2004).

Dressing is a complex task, which is often taken for granted. It is fundamental to a person's sense of dignity and independence. Stroke survivors commonly experience difficulty in performing this once routine and habitual self-care activity. Independent performance of such activities of daily living (ADL) is a focus of much of the occupational therapy in the subacute phase of assessment and rehabilitation post-stroke. Indeed, the most frequent measure of recovery is the degree of functional independence that the individual has achieved in ADL such as dressing (Reed 2001).

Arm paresis and cognitive impairment are two common consequences of stroke that affect independent performance of ADL. Kilbreath and Heard (2005) studied the frequency of hand use in healthy older adults and demonstrated that this older population showed an increase in the frequency of bilateral hand use to perform everyday activities. The more complex unilateral actions were typically performed by the dominant arm. For simpler skills either arm was used, although the dominant hand was more likely to perform the action with greater speed and accuracy (Kilbreath and Heard 2005). One activity that usually requires bimanual activity is the complex task of dressing. When an individual survives a stroke resulting in upper limb paresis, it is likely to have a significant impact on his or her ability to use the affected hand in daily activities, such as dressing. Improving upper limb function is, therefore, often a core element of stroke rehabilitation in order to reduce disability for the patient (Langhorne and Legg 2003, Langhorne et al 2009).

Literature review

Kilbreath and Heard (2005) conducted a structured observational study involving 15 healthy older adults as they went about their normal daily routine. The aim was to describe the type and frequency of hand use in healthy older adults. They found that while the dominant hand was used more than the non-dominant hand, the hands were used predominantly together to perform bimanual tasks. Various studies have discussed the importance of being able to use both hands for the specific activity of dressing.

Walker and Lincoln (1991) investigated the factors that influence dressing performance following stroke. They assessed 60 patients on the Nottingham Stroke Dressing Assessment (NSDA) (Walker and Lincoln 1990) within a week of admission to the Nottingham Stroke Unit, and also on 10 physical and cognitive assessments, including standardised assessments where available. The percentage score of dressing independence was correlated with the physical and cognitive assessment results using a Spearman rank correlation coefficient. Of the 16 abilities assessed, 9 were significantly correlated with dressing ability (Walker and Lincoln 1991). It was discovered that the items of clothing worn on the lower half of the body were significantly correlated with the physical assessments, and the items of clothing worn on the upper half of the body were significantly correlated with the cognitive assessments. This means that, following a stroke, physical impairments are likely to affect an individual's ability to dress his or her lower body, and cognitive impairments will cause difficulty in managing upper body dressing. Although Walker and Lincoln (1991) demonstrated that perceptual skills, as well as physical, are important determinants of dressing ability, they determined that severity of hemiparesis was the strongest correlate of dressing ability. …

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