Contractures in the post-stroke wrist: a pilot study of its time course of development and its association with upper limb recovery

Background: Contractures are common in a stroke population, yet there is little information on the time course of development. Objectives: Investigate quantitatively changes associated with contracture formation in an acute stroke population. Study design: Longitudinal study on 22 subjects who were 2-4 weeks post stroke. Outcome measures: Contractures were assessed by quantifying the resting posture, resistance to passive movement and passive range of movement. Upper limb function was measured using the Action Research Arm Test and the Nine-Hole Peg Test. Active range of extension, wrist extension strength (isometric), grip strength and neglect were also measured. Repeated measures: Following an initial assessment, repeated measurements were taken at 4, 8, 20 and 32 weeks after recruitment. Results: Two distinct subgroups, one capable of some functional movement (F group-, 8 subjects) and another which was not (NF group-, 14 subjects), were identified at the start of the study. The NF group showed changes associated with contracture formation at the wrist, i.e., reduction in the passive range of movement, an increase in resistance to passive movement and a worsening of the flexion posture. Changes were observed from the time of recruitment even though neglect improved. The F group showed improvements in upper limb function and there was no evidence to support contracture formation. Conclusions: Subjects most prone to contracture formation were those who showed no signs of early functional recovery (2-4 weeks after the stroke). Changes consistent with adaptive shortening were seen from week 4 of the study period.