Date Presented 04/21/2023

Actual arm use is a complex construct related to the characteristics of the person, contextual environment, and the nature of the task. Our results support the growing call to adopt a broader biopsychosocial framework in stroke rehabilitation.

Primary Author and Speaker: Grace J. Kim

Contributing Authors: Shir Lebovich, Debbie Rand

PURPOSE: Our aim was to gain a deeper understanding of perceived predictors for actual arm use during daily functional activities.

DESIGN: Qualitative study.

METHOD: Semi-structured interview data collected from individuals with chronic stroke living in the community. Codebook thematic analysis used for the data analysis.

RESULTS: Six participants 5-18 years post stroke with moderate to severe UE impairment. Three domains were identified: Person, Context, and Task. Themes for the Person domain included mental (cognitive effort, lack of acceptance), behavioral (routines/habits, self-evaluation), and physical (stiffness/fatigue). Themes for the Context domain included social environment (being in public, presence and actions of others) and time constraints (being in a hurry). Themes for the task domain included necessity to complete bilateral and unilateral tasks, and safety (increased risk of accidents).

CONCLUSION: Actual arm use is a complex construct related to the characteristics of the person, contextual environment, and the nature of the task. Facilitators included cognitive effort, routines/habits, self-evaluation, and the perceived necessity. Barriers included in lack of acceptance, stiffness/fatigue, being in public, being in a hurry, and risk of accidents. Social support was both a facilitator and a barrier.

IMPACT STATEMENT: Our results support the growing literature that actual arm use in real world situations is a broad construct beyond upper extremity motor impairment and functional ability. Improvements made in the clinic will not necessarily translate to daily arm use in the real world.


Kim, G. J., Lebovich, S., & Rand, D. (2022). Perceived facilitators and barriers for actual arm use during everyday activities in community-dwelling individuals with chronic stroke. International Journal of Environmental and Public Health, 19, 11707.

Barker, R. N., & Brauer, S. G. (2005). Upper limb recovery after stroke: The stroke survivors’ perspective. Disability and rehabilitation, 27(20), 1213–1223.

Rand, D., & Eng, J. J. (2012). Disparity between functional recovery and daily use of the upper and lower extremities during subacute stroke rehabilitation. Neurorehabilitation and Neural Repair, 26(1), 76–84.

Doman, C. A., Waddell, K. J., Bailey, R. R., Moore, J. L., & Lang, C. E. (2016). Changes in Upper-Extremity Functional Capacity and Daily Performance During Outpatient Occupational Therapy for People With Stroke. The American Journal of Occupational Therapy : Official Publication of the American Occupational Therapy Association, 70(3).