title: Quantifying nonuse in chronic stroke patients: a study into paretic, nonparetic, and bimanual upper-limb use in daily life.
abstract: OBJECTIVE
  To quantify uni- and bimanual upper-limb use in patients with chronic stroke in daily life compared with healthy controls.
  
  
  METHODS
  Cross-sectional observational study.
  
  
  METHODS
  Outpatient rehabilitation center.
  
  
  METHODS
  Patients with chronic stroke (n=38) and healthy controls (n=18).
  
  
  METHODS
  Not applicable.
  
  
  METHODS
  Upper-limb use in daily life was measured with an accelerometry-based upper-limb activity monitor, an accelerometer based measurement device. Unimanual use of the paretic and the nonparetic side and bimanual upper-limb use were measured for a period of 24 hours. Outcomes were expressed in terms of both duration and intensity.
  
  
  RESULTS
  Patients used their unaffected limb much more than their affected limb (5.3h vs 2.4h), while controls used both limbs a more equal amount of time (5.4h vs 5.1h). Patients used their paretic side less than controls used their nondominant side and their nonparetic side more than controls their dominant side. The intensity with which patients used their paretic side was lower than that with which controls used their nondominant side, while that of the nonparetic side was higher than that of the dominant side of controls. Finally, patients used their paretic side almost exclusively in bimanual activities. During bimanual activities, the intensity with which they used their affected side was much lower than that of the nonaffected side.
  
  
  CONCLUSIONS
  Our data show considerable nonuse of the paretic side, both in duration and in intensity, and both during unimanual and bimanual activities in patients with chronic stroke. Patients do compensate for this with increased use of the nonparetic side.
authors.affiliation: Department of Rehabilitation Medicine and Physical Therapy, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
authors.forename: Marian E
authors.initials: ME
authors.lastname: Michielsen
authors.forename: Ruud W
authors.initials: RW
authors.lastname: Selles
authors.forename: Henk J
authors.initials: HJ
authors.lastname: Stam
authors.forename: Gerard M
authors.initials: GM
authors.lastname: Ribbers
authors.forename: Johannes B
authors.initials: JB
authors.lastname: Bussmann
mesh_terms: D061725:Accelerometry; D000203:Activities of Daily Living; D000328:Adult; D016022:Case-Control Studies; D002908:Chronic Disease; D003430:Cross-Sectional Studies; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018670:Monitoring, Ambulatory / Q000379:methods; D009043:Motor Activity; D010291:Paresis / Q000209:etiology / Q000534:rehabilitation*; D011187:Posture; D012047:Rehabilitation Centers; D015203:Reproducibility of Results; D020521:Stroke / Q000150:complications; D000071939:Stroke Rehabilitation; D013997:Time Factors; D034941:Upper Extremity / Q000503:physiopathology*