Predictors of arm non-use in chronic stroke: a preliminary investigation

Background: The phenomenon of non-use after stroke is characterized by failure to use the contralesional arm despite adequate capacity. It has been suggested that non-use is a consequence of the greater effort and/or attention required to use the affected limb, but such accounts have not been tested, and we have poor understanding of the characteristics of individuals who exhibit non-use. Objective: We aimed to provide preliminary evidence regarding the demographic, neuropsychological, and psychological factors that may influence non-use in chronic stroke. Methods: Twenty chronic stroke survivors (10 left and 10 right hemisphere stroke) with mild-to-moderate sensory-motor impairment on the upper extremity Fugl-Meyer (UEFM) were assessed with the Actual Amount of Use Test (AAUT), which measures the disparity between amount of use and quality of movement in "spontaneous" versus "forced" conditions. Participants were als assessed with measures of limb apraxia, spatial neglect, attention/arousal, and self-efficacy (confidence in arm movement). Using stepwise multiple regression, we determined whether demographic information and/or performance on these measures predicted AAUT non-use scores. Results: Scores on the UEFM as well as attention/arousal and self-efficacy predicted the degree of non-use. Attention/arousal predicted non-use above and beyond UEFM. Conclusions: Given the complexity of the non-use phenomenon, it follows that a combination of impairment, attention/arousal, and perceived confidence predicted non-use behavior. That a measure of attention/arousal predicted non-use behavior above and beyond sensory-motor functioning highlights the importance of motivated engagement to drive use of the paretic limb. Larger-scale studies incorporating additional measures (e.g., mental health, lesion volume and white matter connectivity, pain, motivation) will be important for future investigations.