Participation Restriction due to Arm and Leg Motor Impairment after Stroke Rehabilitation in the Tamale Metropolitan Area, Ghana

Frank Twum, Joslin Alexei Dogbe, Anthony Kweku Edusei, Joseph Ampratwum


Purpose: The study was conducted to examine the relationship between arm and leg motor impairment in stroke survivors and participation restriction, post rehabilitation, within the Tamale metropolis.

Method: The participants were 102 stroke survivors from the Tamale metropolitan area, who had undergone at least 3 months of rehabilitation. Upper limb motor assessment was followed by lower limb motor assessment based on the Manual Muscle Test. Levels of participation restriction were measured using the London Handicap Scale. Correlation analysis of motor impairment and participation restriction were done using Spearman rank correlation analysis.

Results: The mean age of post-stroke participants was 62.08 years (95% CI= 59.77-64.39), with men comprising 67.65% and 32.35% women. The Spearman rank correlation co-efficient between arm motor impairment and participation was 0.8343, depicting a strong positive relationship between the aforementioned variables. The correlation between leg motor impairment and participation yielded 0.8013. Conversely, leg motor impairment was found to have a stronger relationship with participation restriction in comparison to arm motor impairment.

Conclusion and Implications: The strong relationship between limb motor impairment and participation restriction suggests that clinicians and disability experts involved in rehabilitation should take cognisance of the social implication of motor impairment in order to make informed decisions. Further to this, arm and leg assistive devices could be useful in reducing the levels of participation restriction among persons with stroke within the Tamale metropolis.

Limitations: A major limitation is that motor impairment was assessed solely on the ability to perform voluntary movement (muscle power). Sensory disturbances and motor coordination difficulties also have the potential to influence participation restriction, so the exclusion of stroke survivors who are unable to communicate implies that external validity of the research is limited.


Disability; upper limb; lower limb; manual muscle scale; London handicap scale

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Agyemang C, Attah-Adjepong G, Owusu-Dabo E, De-Graft Aikins A, Addo J, Edusei A K, Nkum BC, Ogedegbe G (2012). Stroke in the Ashanti region of Ghana. Ghana Medical Journal; 46(2): 12–17.

PMid:23661812. PMCid:PMC3645146

Anderson S, Marlett NJ (2004). Communication in stroke: The overlooked rehabilitation tool. Age Ageing; 33(5): 440-443. PMid:14752125

Carr JH, Shepherd RB (2011). Enhancing physical activity and brain reorganisation after stroke. Neurological Research International; 2011: 515938. PMid:21766024. PMCid:PMC3135088

Chau PC, Thompson DR, Twinn S, Chang AM, Woo J (2009). Determinants of participation restriction among community dwelling stroke survivors: A path analysis. BioMed Central Neurology; 9: 49.

D'Alisa S, Baudo S, Mauro A, Miscio G (2005). How does stroke restrict participation in long-term post-stroke survivors? Acta Neurologica Scandinavica; 112(3): 157–162. PMid:16097957

Desrosiers J, Malouin F, Bourbonnais D, Rochette A, Bravo G, Richards CL (2003). Arm and leg impairments and disabilities after stroke rehabilitation: Relation to handicap. Clinical Rehabilitation; 17(6): 666-673. PMid:12971712

Dimyan MA, Cohen LG (2011). Neuroplasticity in the context of motor rehabilitation after stroke. Nature Reviews Neurology; 7: 76–85. PMid:21243015. PMCid:PMC4886719

Donnan GA, Fisher M, Macleod M, Davis SM (2008). Stroke. Lancet; 371(9624): 1612–23.

Douiri A, Rudd AG, Wolfe CD (2013). Prevalence of post-stroke cognitive impairment: South London Stroke Register 1995-2010. Stroke; 44: 138-45. PMid:23150656

Ghana Statistical Service (2014). 2010 Population and Housing Census: District Analytical Report. [Online]. Available from: [Accessed on 28 July 2015].

Gresham GE, Fitzpatrick TE, Wolf PA, McNamara PM, Kannel WB, Dawber TR (1995). Residual capacity in survivors of stroke: the Framingham study. New England Journal of Medicine; 293: 954-956. PMid:1178004

Hamzat TK, Peters GO (2009). Motor function and participation among Nigerian stroke survivors: 6-month follow-up study. Neurorehabilitation; 25(2): 137–142. PMid:19822945

Harwood RH, Jitapunkul S, Dickinson E, Ebrahim S (1994): Measuring handicap: motives, methods, and a model. Quality Health Care; 3: 53-7.

Hawker GA, Gignac MA (2006). How meaningful is our evaluation of meaningful change in osteoarthritis? Journal of Rheumatology; 33: 639-41. PMid:16583467

Hedna VS, Bodhit AN, Ansari S (2013). Hemispheric differences in ischaemic stroke: Is left-hemisphere stroke more common? The Journal of Clinical Neurology; 9(2): 97-102. PMid:23626647. PMCid:PMC3633197

Higgins J, Mayo NE, Desrosiers J, Salbach NM, Ahmed S (2005). Upper-limb function and recovery in the acute phase post-stroke. Journal of Rehabilitation Research and Development; 42: 65–76. PMid:15742251

Kwakkel G, Kollen BJ, van der GJ, Prevo AJ (2003). Probability of regaining dexterity in the flaccid upper limb: impact of severity of paresis and time since onset in acute stroke. Stroke; 34: 2181-2186. PMid:12907818

Langhorne P, Duncan PW (2001). 'Does the organisation of post-acute stroke care really matter? Stroke; 32: 268–274. PMid:11136947

Lennon S, McKenna S, Jones F (2013). Self-management programmes for people post stroke: a systematic review. Clinical Rehabilitation; 27(10): 867-78. PMid:23543340

Lo RSK, Cheng JOY, Wong EMC, Tang WK, Wong LKS, Woo J, Kwok T (2008). Handicap and its determinants of change in stroke survivors: One-year follow-up study. Stroke; 39(1): 148–153. PMid:18048853

Naess H, Waje-Andreassen U, Thomassen L, Myhr KM (2006). High incidence of infarction in the left cerebral hemisphere among young adults. Journal of Stroke and Cerebrovascular Diseases; 15: 241-244. PMid:17904082

National Institute of Neurological Disorders and Stroke (2015). Brain basics: Preventing stroke. [Online]. Available from [Accessed on 19 May 2015].

Nijland RH, van Wegen EE, Harmeling-van der Wel BC, Kwakkel G (2010). Presence of finger extension and shoulder abduction within 72 hours after stroke predicts functional recovery: Early prediction of functional outcome after stroke: the epos cohort study. Stroke; 41: 745–750. PMid:20167916

Nys GM, van Zandvoort MJ, de Kort PL, Jansen BP, Kappelle LJ, de Hann EH (2005). Restrictions of the mini-mental state examination in acute stroke. Archives of Clinical Neuropsychology; 20: 623-9. PMid:15939186

Rodríguez Hernández SA, Kroon AA, van Boxtel MP, Mess WH, Lodder J, Jolles J, de Leeuw PW (2003). Is there a side predilection for cerebrovascular disease? Hypertension; 42: 56-60. PMid:12810754

Roth EJ (1998). The elderly stroke patient: Principles and practices of rehabilitation management. Topics in Geriatric Rehabilitation; 3: 27–61.

Sarfo FS, Nichols M, Qanungo S, Teklehaimanot A, Singh A Mensah N, Saulson R, Gebregziabher M, Ezinne U, Owolabi M, Jenkins C, Ovbiagele B (2017). Stroke-related stigma among West Africans: Patterns and predictors. Journal Neurological Science; 15(375): 270-274. PMid:28320146

Staines W, Richard M, William E, Brooks Dina (2009). Functional impairments following stroke: Implications for rehabilitation. Canadian Association of Cardiac Rehabilitation; 17: 5-8.

Sturm JW, Dewey HM, Donnan GA, Macdonell RAL, McNeil JJ, Thrift AG (2002). Handicap after stroke: How does it relate to disability, perception of recovery, and stroke subtype? The North East Melbourne Stroke Incidence Study (NEMESIS). Stroke; 33(3): 762–768. PMid:11872901

Verheyden G, Nieuwboer A, De Wit L, Thijs V, Dobbelaere J, Devos H, Severijns D,Vanbeveren S, De Weerdt W (2008). Time course of trunk, arm, leg, and functional recovery after ischaemic stroke. Neurorehabilitation and Neural Repair; 22(2): 173-9. PMid:17876069

World Health Organisation (1980). International classification of impairments, disabilities and handicaps. Geneva: WHO.

World Health Organisation (2001). International classification of Functioning, Disability and Health (ICF). [Online]. Available from [Accessed on 8 May 2015].

Zhou DH, Wang JY, Li J, Deng J, Gao C, Chen M (2004). Study on frequency and predictors of dementia after ischaemic stroke: The Chongqing stroke study. Journal of Neurology; 251: 421-7. PMid:15083286


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