Loss of strength contributes more to physical disability after stroke than loss of dexterity Colleen G Canning, Louise Ada, Roger Adams and Nicholas J O’Dwyer School of Physiotherapy, The University of Sydney, Australia Received 15th November 2002; returned for revisions 28th January 2003; revised manuscript accepted 16th March 2003. Objective: The major contributors to physical disability after stroke are considered to be the negative impairments of loss of dexterity (defined here as loss of the ability to co-ordinate muscle activity in the performance of any motor task) and loss of strength. The aims of this study were: (1) to determine the relative contributions of strength and dexterity to function during recovery after stroke; and (2) to determine the predictive value of initial strength, dexterity and function on long-term function after stroke. Design: A longitudinal descriptive study. Setting: The inpatient and outpatient rehabilitation departments of two metropolitan hospitals. Subjects: Twenty-two patients undergoing rehabilitation after acute stroke participated. Main outcome measures: Strength and dexterity of the elbow flexors and extensors were measured, along with arm function, at 3, 5, 7, 9, 11, 15, 19, 23 and 27 weeks after stroke. Results: Standard multiple linear regression analysis demonstrated that strength and dexterity in total contributed significantly to function at all times (r 2 5 /0.66 ]/0.82, p B/ 0.0001). Furthermore, strength always made an additional separate contribution to function (r 2 5 /0.05 ] /0.26, p B/0.05). Function at week 3 was the best clinical predictor of function at week 27 (r 2 5 /0.55, p B/0.001). Conclusions: Loss of strength is a more significant contributor than loss of dexterity to physical disability after stroke. This suggests that, where significant weakness is present, exercise designed to increase strength will be required to decrease disability. Introduction It has been argued that rehabilitation strategies designed to improve motor function after stroke should rely upon an understanding of the nature of the impairments as well as knowledge of the relative importance of their contribution to dis- ability. 1,2 Current evidence suggests that, generally after stroke, it is the negative impairments that limit recovery of function, rather than the positive impairments. 3] 7 In line with this evidence, it is now accepted that rehabilitation strategies should be directed towards remediating the negative impair- ments of loss of strength and loss of dexterity. 2,8 ] 11 Dexterity is considered to be the ability to Address for correspondence: Colleen Canning, School of Physiotherapy, The University of Sydney, PO Box 170, Lidcombe, N SW 1825, Australia. e-mail: C.Canning@fhs. usyd.edu.au Clinical Rehabilitation 2004; 18: 300 ]/308 # Arnold 2004 10.1191/0269215504cr715oa