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Generalizability of the Maximum Proportional Recovery Rule to Visuospatial Neglect Early Poststroke.
Neurorehabil Neural Repair 2017; 31(4):334-342NN

Abstract

BACKGROUND AND OBJECTIVE

Proportional recovery of upper-extremity motor function and aphasia after stroke may suggest common mechanisms for spontaneous neurobiological recovery. This study aimed to investigate if the proportional recovery rule also applies to visuospatial neglect (VSN) in right-hemispheric first-ever ischemic stroke patients and explored the possible common underlying mechanisms.

METHODS

Patients with upper-limb paresis and VSN were included. Recovery defined as the change in Letter Cancellation Test (LCT) score at ~8 days and 6 months poststroke. Potential recovery defined as LCTmax-LCTinitial = 20 - LCTinitial. Hierarchical clustering separated fitters and nonfitters of the prediction rule. A cutoff value on LCTmax-LCTinitial was determined. The change in LCT and Fugl-Meyer Assessment Upper Extremity was expressed as a percentage of the total possible score to investigate the communality of proportional recovery.

RESULTS

Out of 90 patients, 80 displayed proportional recovery of VSN (ie, "fitters," 0.97; 95% CI = 0.82-1.12). All patients who did not follow the prediction rule for VSN (ie, "nonfitters") had ≥15 missing O's at baseline and failed to show proportional recovery of the upper limb.

CONCLUSIONS

This study shows that the proportional recovery rule also applies to patients with VSN poststroke. Patients who fail to show proportional recovery of VSN are the same patients who fail to show proportional recovery of the upper limb. These findings support the idea of common intrahemispheric mechanisms underlying spontaneous neurobiological recovery in the first months poststroke. Future studies should investigate the prognostic clinical and neurobiological markers of these subgroups.

Authors+Show Affiliations

1 Department of Rehabilitation Medicine, VU University Medical Center, MOVE Research Institute Amsterdam, Amsterdam, The Netherlands. 2 Neuroscience Campus Amsterdam, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.1 Department of Rehabilitation Medicine, VU University Medical Center, MOVE Research Institute Amsterdam, Amsterdam, The Netherlands. 2 Neuroscience Campus Amsterdam, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.3 Department of Human Movement Sciences, Faculty of Behaviour and Movement Sciences, Vrije Universiteit Amsterdam, MOVE Research Institute Amsterdam, Amsterdam, The Netherlands.1 Department of Rehabilitation Medicine, VU University Medical Center, MOVE Research Institute Amsterdam, Amsterdam, The Netherlands. 2 Neuroscience Campus Amsterdam, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands. 4 Amsterdam Rehabilitation Research Center, Reade, Amsterdam, The Netherlands. 5 Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, USA.

Pub Type(s)

Clinical Trial
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

27913798

Citation

Winters, Caroline, et al. "Generalizability of the Maximum Proportional Recovery Rule to Visuospatial Neglect Early Poststroke." Neurorehabilitation and Neural Repair, vol. 31, no. 4, 2017, pp. 334-342.
Winters C, van Wegen EE, Daffertshofer A, et al. Generalizability of the Maximum Proportional Recovery Rule to Visuospatial Neglect Early Poststroke. Neurorehabil Neural Repair. 2017;31(4):334-342.
Winters, C., van Wegen, E. E., Daffertshofer, A., & Kwakkel, G. (2017). Generalizability of the Maximum Proportional Recovery Rule to Visuospatial Neglect Early Poststroke. Neurorehabilitation and Neural Repair, 31(4), pp. 334-342. doi:10.1177/1545968316680492.
Winters C, et al. Generalizability of the Maximum Proportional Recovery Rule to Visuospatial Neglect Early Poststroke. Neurorehabil Neural Repair. 2017;31(4):334-342. PubMed PMID: 27913798.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Generalizability of the Maximum Proportional Recovery Rule to Visuospatial Neglect Early Poststroke. AU - Winters,Caroline, AU - van Wegen,Erwin E H, AU - Daffertshofer,Andreas, AU - Kwakkel,Gert, Y1 - 2016/12/13/ PY - 2016/12/4/pubmed PY - 2017/7/19/medline PY - 2016/12/4/entrez KW - prognosis KW - stroke KW - upper extremity KW - visuospatial neglect SP - 334 EP - 342 JF - Neurorehabilitation and neural repair JO - Neurorehabil Neural Repair VL - 31 IS - 4 N2 - BACKGROUND AND OBJECTIVE: Proportional recovery of upper-extremity motor function and aphasia after stroke may suggest common mechanisms for spontaneous neurobiological recovery. This study aimed to investigate if the proportional recovery rule also applies to visuospatial neglect (VSN) in right-hemispheric first-ever ischemic stroke patients and explored the possible common underlying mechanisms. METHODS: Patients with upper-limb paresis and VSN were included. Recovery defined as the change in Letter Cancellation Test (LCT) score at ~8 days and 6 months poststroke. Potential recovery defined as LCTmax-LCTinitial = 20 - LCTinitial. Hierarchical clustering separated fitters and nonfitters of the prediction rule. A cutoff value on LCTmax-LCTinitial was determined. The change in LCT and Fugl-Meyer Assessment Upper Extremity was expressed as a percentage of the total possible score to investigate the communality of proportional recovery. RESULTS: Out of 90 patients, 80 displayed proportional recovery of VSN (ie, "fitters," 0.97; 95% CI = 0.82-1.12). All patients who did not follow the prediction rule for VSN (ie, "nonfitters") had ≥15 missing O's at baseline and failed to show proportional recovery of the upper limb. CONCLUSIONS: This study shows that the proportional recovery rule also applies to patients with VSN poststroke. Patients who fail to show proportional recovery of VSN are the same patients who fail to show proportional recovery of the upper limb. These findings support the idea of common intrahemispheric mechanisms underlying spontaneous neurobiological recovery in the first months poststroke. Future studies should investigate the prognostic clinical and neurobiological markers of these subgroups. SN - 1552-6844 UR - https://www.unboundmedicine.com/medline/citation/27913798/Generalizability_of_the_Maximum_Proportional_Recovery_Rule_to_Visuospatial_Neglect_Early_Poststroke_ L2 - http://journals.sagepub.com/doi/full/10.1177/1545968316680492?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -