Distribution of Weakness in the Upper and Lower Limbs Post-stroke

Objective: To assess the distribution of weakness in the upper and lower limbs post-stroke and the factors associated with weakness.

Method: The design was a prospective cross-sectional survey. A consecutive sample of 75 patients (37 (49%) men, mean age 71.5 (SD 12.2) years, 46 (61%) left hemiplegics) with a first-time anterior-circulation stroke, tested 2 - 4 weeks post-stroke, were recruited from two NHS trusts.

Main Outcome Measures: Weakness (Motricity Index, MI).

Results: Mean MI score was 58.5 (SD 39.6) and 69.1 (SD 33.6) for the upper and lower limb (p < 0.001), but examination of individual data indicated 36 (48%) had no/ negligible difference (0 +/- 9 points) in MI score between the limbs. When there was a difference, the lower limb was more frequently the stronger. There was no significant difference between the proximal and distal joints in either limb (p < 0.217 and 0.410). Severity of weakness was not associated with the subjects' demographics or stroke pathology, but was associated with neglect and sensation.

Conclusions: Although group analysis showed that the leg was significantly stronger than the arm, individual analysis showed that most participants had a similar degree of weakness in both limbs. When there was a difference, the lower limb was more frequently the stronger. Proximal joints were not more severely affected than distal joints. Patient demographics and stroke pathology factors were not associated with weakness, but stroke-related impairments were.