In addition, any degree of asymmetry in posture and alignment may be accentuated after several years of improper or prolonged sitting. Thus, thoracic kyphosis and kyphoscoliosis often progress after several years of disability. This in turn can lead to other problems including restrictive respiratory dysfunction and development of decubiti, as well as increased physical demand for accomplishing tasks such as wheelchair propulsion and transfers. Searching for and addressing these factors in a timely fashion can prevent many of the secondary problems associated with long-standing stroke.

Several other focal conditions merit brief discussion. Patients who tend to sit for long periods of time will often lean on their elbows, precipitating olecranon bursitis or ulnar nerve dysfunction at the olecranon groove. Swelling or pain about the elbow, or changing sensory or motor function distally, should lead to a search for these conditions. Similarly, the stroke patient who walks with a cane or a hemi-walker, is predisposed to develop carpal tunnel syndrome in the unaffected limb.

This can be especially devastating since these patients often rely on their one "good" arm for all of their activities of daily living. Modification of the assistive device and other preventive measures are essential if carpal tunnel syndrome begins to develop.

Likewise, patients seated for long periods of time may develop secondary peroneal palsy at the fibular head. This is especially true if there is contact between the outer leg and the foot rest attachments. This bears examination and modification where appropriate.

Finally, although rarely reported, stroke patients often walk with a somewhat flexed, rotated posture. They often spend increased time sitting in flexed posture. This predisposes them to discogenic lower back pain and may progress to lumbosacral radiculopathy. These can be disabling and can compromise the patient’s ability to function.

This is by no means an exhaustive discussion. However, often we think of stroke patients as having suffered a "static" deficit, with which they must now function. It is important to appreciate that this deficit predisposes these patients to numerous other conditions which can worsen the patient’s level of disability. Timely diagnosis, preventive measures, and judicious treatment can reduce the morbidity associated with these musculoskeletal sequelae.