What is the hand grip strength for grading stroke impairment?

From the Guidelines

Hand grip strength after stroke is best assessed using grip dynamometry, which correlates with function, morbidity, and mortality, and has available reliability and validity data 1.

Assessment of Hand Grip Impairment

When evaluating hand grip impairment after stroke, several tools can be utilized. The most commonly used assessments include:

• Grip dynamometry: measures unilateral hand strength and correlates with function, morbidity, and mortality 1
• Handheld dynamometry: measures unilateral muscle strength and is quick to administer, but results can depend on the strength of the therapist 1
• Fugl-Meyer Motor Assessment: a comprehensive assessment that evaluates sensorimotor impairment, but is lengthy and has ceiling effects in mild stroke patients 1

Recommended Assessment Tools

The American Heart Association/American Stroke Association recommends the use of grip and pinch dynamometers to assess hand grip strength, as they are widely available and have normative data for comparison 1.

Clinical Considerations

In clinical practice, it is essential to regularly reassess hand grip strength, as recovery can continue for months after stroke. Treatment should involve a combination of physical therapy, occupational therapy, and possibly medications to manage spasticity, with a focus on task-specific training and repetitive movements to improve hand function 1.

Key Points

• Grip dynamometry is a reliable and valid assessment tool for hand grip strength after stroke
• Regular reassessment is crucial to monitor recovery and guide rehabilitation strategies
• A combination of physical therapy, occupational therapy, and medications can improve hand function after stroke
• Task-specific training and repetitive movements are essential for optimal outcomes 1

From the Research

Hand Grip Strength as an Indicator of Upper Limb Function in Stroke Patients

• Hand grip strength is a good indicator of upper limb (UL) function in stroke subjects and may reflect the global strength deficits of the whole paretic UL 2.
• The Modified Sphygmomanometer Test (MST) and handgrip dynamometer provide objective and adequate measures of grip strength, with similar correlations with global strength and motor function of the paretic UL in subacute and chronic stroke subjects 2.

Recovery of Grip Strength After Stroke

• Grip strength in the affected hand improves considerably in the first year post-stroke, with rapid improvement during the first weeks, slower improvement until 6 months, and minimal progress from 6-12 months post-stroke 3.
• The rate of force development and sustainability of grip force are also impaired in the affected hand after stroke, but approach the values of the non-affected hand after 6 months 3.

Factors Influencing Grip Strength in Stroke Patients

• Stabilization of the shoulder improves motor coordination parameters of the fingers and wrist, and results in greater grip strength in post-stroke patients and healthy subjects 4.
• Local stabilization of the shoulder is particularly beneficial for improving hand motor coordination in females and non-dominant hands 4.
• Factors such as age, gender, body weight, grip strength, BMI, non/dominant hand, and rater experience can influence the results of dynamometry 5.

Interventions to Improve Grip Strength and Hand Function in Stroke Patients

• Stretching interventions, including splinting, can be effective in reducing upper extremity spasticity, increasing hand function, and improving functional tasks in adults with poststroke spasticity 6.
• Static splinting, dynamic splinting, and manual stretching have moderate to strong evidence supporting their use in improving hand function and functional tasks, while stretching devices have low strength of evidence 6.