Associated reactions in the hemiplegic arm.

Of 40 stroke patients attending a rehabilitation department, 32 (80%) had associated reactions affecting the hemiplegic arm. These involuntary movements nearly always occurred in association with yawning and less frequently with stretching, coughing, sneezing and laughing. In many patients the pattern of these reactions differed from previous descriptions. In the majority of patients they raised false hopes about the recovery of arm function, but sometimes they were a cause of distress. All 8 patients who did not have associated reactions had some voluntary movement of the affected arm and 4 of them had very useful manipulative function. By contrast, 25% of those with associated reactions had no voluntary arm movement and only 2 (6%) had very useful hand function. Involuntary arm movements are common in hemiplegia and those involved in care of stroke patients should be aware of them.