An Exploratory Analysis of the Self-Reported Goals of Individuals With Chronic Upper-Extremity Paresis Following Stroke

Abstract

Purpose-To classify the self-identified goals of individuals post-stroke with chronic upper extremity (UE) paresis, and determine if age, UE functional capacity, and pre-stroke hand dominance influence overall goal selection.Method-Sixty five subjects participated. Using the Canadian Occupational Performance Measure (COPM) to establish treatment goals, the top five goals were categorized using the Occupational Therapy Practice Framework into five categories: activities of daily living (ADL), instrumental activities of daily living (IADL), leisure, work, and general UE movement. A chisquare analysis determined if age, UE functional capacity (measured by the Action Research Arm Test), and UE hand dominance influenced individual goal selection.Results-The majority of goals were in the ADL (37%) and IADL (40%) categories. A small percentage (12%) was related to general UE movement. Individuals with moderate UE functional capacity identified more ADL goals than those with higher UE functional capacity. There was not a difference between age and UE dominance across all five goal areas.Conclusions-Individuals with chronic UE paresis had specific goals that were not influenced by age or hand dominance, but partially influenced by severity. General UE movement goals were identified less than goals related to specific activities.After a stroke, an individual's capacity to participate in activities that are personally meaningful is often compromised. On average, individuals post-stroke discontinue 57% of their activities [1]. Decreased participation is often a result of many stroke-related deficits, the primary one being upper extremity (UE) paresis. At 6 months post-stroke, 65% of survivors cannot incorporate their affected hand into routine activity [2]. Given the vital role of both upper extremities in daily activities [3], deficits in participation following a stroke can be attributed, in part, to UE paresis and its resulting loss of function.