1% when the FMA wrist component score at baseline was added (F2,27=9.424; P=.001).

All other clinical variables were excluded because they did not significantly add to the predictive power of the model (all P>.11). For the participants with the dominant hand affected, the baseline FMA wrist score predicted 30.6% of the variability in change in the amount of use (F1,15=6.601; P=.021). For participants with the nondominant hand affected, the change in the grasp component of the ARAT predicted 58.8% of change in the amount of use (F1,11=15.674; P=.002). This exploratory study describes the relation between functional ability and self-reported amount of paretic arm use in survivors of chronic stroke (≥3mo) at baseline and after 4 weeks of TST. Although most participants were fairly independent (average Barthel Index score of 18.2), the paretic arm was reportedly used for daily activities for Selleck IDH inhibitor less than half of the time. Upper limb function predicted the amount of use rating at baseline, and the change in function predicted the change in the amount of use rating after TST, indicating that good functional ability is necessary to promote upper limb utilization. Both the ARAT and FMA were found to correlate positively with the baseline MAL score, confirming previous findings8, 20 and 21; spasticity (MAS) was negatively correlated with the amount of use.

However, 31 of the 33 participants scored <2.5 on the MAL, indicating that they use buy Trametinib their paretic hand substantially less

than prior to stroke. Participants with an ARAT score ≤20 or a FMA score ≤30 had average MAL scores of 0.6 and 0.7 respectively, indicating virtually no use of the paretic limb (see fig 1). For the participants who scored the maximum of 20 on the Barthel Index (indicating full independence), the average MAL score was 1.6, providing further support that Rebamipide global measures lack sensitivity and, therefore, may be unsuitable to capture the effects of therapy in clinical trials.9 The regression model indicated that an ARAT score ≥54 (out of 57) would be necessary before the amount of use rating would exceed 2.5 (between rarely and half as much as before the stroke). This suggests that the functional ability of the upper limb needs to be almost perfect before patients will begin to habitually engage the arm in daily activities. When the dominant hand was affected by stroke, the predictive power of the ARAT score was higher than when all patients were grouped together, and the ARAT score necessary to achieve an MAL score of 2.5 was reduced to 46. This indicates that survivors of stroke are more likely to use their affected hand, even in the presence of more severe paresis, if they habitually used it for most activities prior to the stroke. This may suggest that learned disuse is easier to overcome if the dominant hand is affected.