Quantifying arm nonuse in individuals poststroke

Cheol E. Han, Sujin Kim, Shuya Chen, Yi Hsuan Lai, Jeong Yoon Lee, Rieko Osu, Carolee J. Winstein, Nicolas Schweighofer*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

47 Citations (Scopus)


Background. Arm nonuse, defined as the difference between what the individual can do when constrained to use the paretic arm and what the individual does when given a free choice to use either arm, has not yet been quantified in individuals poststroke. Objectives. (1) To quantify nonuse poststroke and (2) to develop and test a novel, simple, objective, reliable, and valid instrument, the Bilateral Arm Reaching Test (BART), to quantify arm use and nonuse poststroke. Methods. First, we quantify nonuse with the Quality of Movement (QOM) subscale of the Actual Amount of Use Test (AAUT) by subtracting the AAUT QOM score in the spontaneous use condition from the AAUT QOM score in a subsequent constrained use condition. Second, we quantify arm use and nonuse with BART by comparing reaching performance to visual targets projected over a 2D horizontal hemi-work space in a spontaneous-use condition (in which participants are free to use either arm at each trial) with reaching performance in a constrained-use condition. Results. All participants (N = 24) with chronic stroke and with mild to moderate impairment exhibited nonuse with the AAUT QOM. Nonuse with BART had excellent test-retest reliability and good external validity. Conclusions. BART is the first instrument that can be used repeatedly and practically in the clinic to quantify the effects of neurorehabilitation on arm use and nonuse and in the laboratory for advancing theoretical knowledge about the recovery of arm use and the development of nonuse and "learned nonuse" after stroke.

Original languageEnglish
Pages (from-to)439-447
Number of pages9
JournalNeurorehabilitation and Neural Repair
Issue number5
Publication statusPublished - 2013 Jun
Externally publishedYes


  • hemiparesis
  • outcomes assessment
  • physical therapy
  • stroke rehabilitation
  • upper extremity

ASJC Scopus subject areas

  • Rehabilitation
  • Neurology
  • Clinical Neurology


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