Poor upper limb performance despite the absence of notable upper limb motor impairment in adults with acute stroke–the influence of cognitive deficits

Introduction: To assess the impact of cognitive impairment, upper limb apraxia, and spatial neglect on upper limb performance in adults with stroke. Methods: This prospective cross-sectional study evaluated upper limb performance dependency in adults with acute/early subacute stroke. The Upper Limb (UL)-LIMOS assessed upper limb performance; while upper limb motor impairment was evaluated with the Fugl Meyer Assessment-Upper Extremity (FMA-UE), general cognitive function with the Montreal Cognitive Assessment, spatial neglect with the Catherine Bergego Scale, and upper limb apraxia with the Apraxia Screen of TULIA. Results: We recruited 407 adults with stroke. Minimal or no upper limb motor impairments were present in 270 out of 407 (66.3%) adults, among whom 38.5% still exhibited poor upper limb performance. There were weak to moderate correlations between UL-LIMOS and MoCA (r =.213), spatial neglect (r = −.415), and apraxia (r =.190). General cognition, spatial neglect strongly predicted upper limb performance (R2 = 0.34). Conclusion: Almost 40% of adults with acute stroke, who do display minimal upper limb impairments, demonstrate poor performance in upper limb tasks, attributed to impaired general cognition, spatial neglect, and/or, to a lesser extent, upper limb apraxia. Hence, there is need for cognitive-motor therapies to be integrated into early rehabilitation settings to address these challenges effectively.