Association between postural patterns of spastic upper extremity and functional independence after TBI and stroke

BACKGROUND: Spastic hypertonia of the upper limb after stroke or traumatic brain injuries (TBI) is a prevalent clinical sign causing abnormal postures and movement patterns due to hyperexcitability of the upper motor neurons and rheological alterations in the affected muscles. These alterations limit the use of the upper limb, restricting its functional activities and affecting the individual's quality of life and social participation. OBJECTIVE: To determine the association between spastic patterns of the upper limb, wrist, fingers and thumb, and independence in everyday activities after a stroke or TBI. METHODS: The design is a cross-sectional descriptive and correlational study. The sample consisted of 206 individuals who complied with the eligibility criteria and signed an informed consent. Clinical evaluation was carried out, including determination of the postural pattern of the upper extremity according to Hefter's taxonomy and postural pattern classification of the wrist, fingers and thumb. Functional independence was evaluated using the Functional Independence Measure (FIM) and the Barthel Index (BI). RESULTS: Univariate between-subject ANOVAs were used to examine associations of the four pattern classifications with the two independence measures, FIM and BI. Results indicate that Pattern I of Hefter's upper limb taxonomy is associated with lesser functional independence according to FIM and BI mean scores. CONCLUSIONS: The postural pattern of the upper limb after TBI or stroke is related to the patient's functional independence. Specifically, Pattern I tends to co-occur with low independence.