Beyond Arm Capacity in Chronic Stroke: Evaluating Paretic Arm Non-Use Through Arm Efficiency-A Cross-Sectional Study

Background: After a stroke, the use of the paretic arm is determined by its capacity (what it can or cannot do). When both arms have capacity to perform a task, the choice of which arm to use must be based on another criterion, probably by comparing the efficiency of each arm. Two numerical models account for this: the capacity model (the paretic arm is chosen in preference) and the efficiency model (the most efficient arm is chosen).

Objective: To numerically determine whether capacity or efficiency best predict the use of the paretic arm in activities of daily living.

Methods: We performed numerical simulations to predict paretic arm use with either the capacity model or the efficiency model. We used the Bayesian Information Criterion (BIC) to compare the adequacy of the 2 models in predicting clinical and accelerometric data collected from 30 patients with chronic stroke.

Results: The efficiency model predicted arm use in activities of daily living better than the capacity model (BIC = -66.95 vs -5.89; root mean square error = 0.26 vs 0.72).

Conclusions: The study highlights the importance of considering efficiency when assessing paretic arm non-use. Assessing individuals' arm efficiency should help personalize rehabilitation strategies after stroke.