Poor upper limb performance despite the absence of notable upper limb motor impairment in adults with acute stroke - the influence of cognitive deficits.

Introduction
To assess the impact of cognitive impairment, upper limb apraxia, and spatial neglect on upper limb performance in adults with stroke.Methods
This prospective cross-sectional study evaluated upper limb performance dependency in adults with acute/early subacute stroke. The Upper Limb (UL)-LIMOS assessed upper limb performance; while upper limb motor impairment was evaluated with the Fugl Meyer Assessment-Upper Extremity (FMA-UE), general cognitive function with the Montreal Cognitive Assessment, spatial neglect with the Catherine Bergego Scale, and upper limb apraxia with the Apraxia Screen of TULIA.Results
We recruited 407 adults with stroke. Minimal or no upper limb motor impairments were present in 270 out of 407 (66.3%) adults, among whom 38.5% still exhibited poor upper limb performance. There were weak to moderate correlations between UL-LIMOS and MoCA (r = .213), spatial neglect (r = -.415), and apraxia (r = .190). General cognition, spatial neglect strongly predicted upper limb performance (R2 = 0.34).Conclusion
Almost 40% of adults with acute stroke, who do display minimal upper limb impairments, demonstrate poor performance in upper limb tasks, attributed to impaired general cognition, spatial neglect, and/or, to a lesser extent, upper limb apraxia. Hence, there is need for cognitive-motor therapies to be integrated into early rehabilitation settings to address these challenges effectively.