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Proportional Motor Recovery After Stroke: Implications for Trial Design.
Stroke 2017; 48(3):795-798S

Abstract

BACKGROUND AND PURPOSE

Recovery of upper-limb motor impairment after first-ever ischemic stroke is proportional to the degree of initial impairment in patients with a functional corticospinal tract (CST). This study aimed to investigate whether proportional recovery occurs in a more clinically relevant sample including patients with intracerebral hemorrhage and previous stroke.

METHODS

Patients with upper-limb weakness were assessed 3 days and 3 months poststroke with the Fugl-Meyer scale. Transcranial magnetic stimulation was used to test CST function, and patients were dichotomized according to the presence of motor evoked potentials in the paretic wrist extensors. Linear regression modeling of Δ Fugl-Meyer score between 3 days and 3 months was performed, with predictors including initial impairment (66 - baseline Fugl-Meyer score), age, sex, stroke type, previous stroke, comorbidities, and upper-limb therapy dose.

RESULTS

One hundred ninety-two patients were recruited, and 157 completed 3-month follow-up. Patients with a functional CST made a proportional recovery of 63% (95% confidence interval, 55%-70%) of initial motor impairment. The recovery of patients without a functional CST was not proportional to initial impairment and was reduced by greater CST damage.

CONCLUSIONS

Recovery of motor impairment in patients with intact CST is proportional to initial impairment and unaffected by previous stroke, type of stroke, or upper-limb therapy dose. Novel interventions that interact with the neurobiological mechanisms of recovery are needed. The generalizability of proportional recovery is such that patients with intracerebral hemorrhage and previous stroke may usefully be included in interventional rehabilitation trials.

CLINICAL TRIAL REGISTRATION

URL: http://www.anzctr.org.au. Unique identifier: ANZCTR12611000755932.

Authors+Show Affiliations

From the Department of Medicine (C.M.S., S.J.A., M.-C.S., V.M.B., P.A.B.), Centre for Brain Research (C.M.S., W.D.B., S.J.A., M.-C.S., V.M.B., P.A.B.); and Department of Exercise Sciences (W.D.B.), University of Auckland, New Zealand. c.stinear@auckland.ac.nz.From the Department of Medicine (C.M.S., S.J.A., M.-C.S., V.M.B., P.A.B.), Centre for Brain Research (C.M.S., W.D.B., S.J.A., M.-C.S., V.M.B., P.A.B.); and Department of Exercise Sciences (W.D.B.), University of Auckland, New Zealand.From the Department of Medicine (C.M.S., S.J.A., M.-C.S., V.M.B., P.A.B.), Centre for Brain Research (C.M.S., W.D.B., S.J.A., M.-C.S., V.M.B., P.A.B.); and Department of Exercise Sciences (W.D.B.), University of Auckland, New Zealand.From the Department of Medicine (C.M.S., S.J.A., M.-C.S., V.M.B., P.A.B.), Centre for Brain Research (C.M.S., W.D.B., S.J.A., M.-C.S., V.M.B., P.A.B.); and Department of Exercise Sciences (W.D.B.), University of Auckland, New Zealand.From the Department of Medicine (C.M.S., S.J.A., M.-C.S., V.M.B., P.A.B.), Centre for Brain Research (C.M.S., W.D.B., S.J.A., M.-C.S., V.M.B., P.A.B.); and Department of Exercise Sciences (W.D.B.), University of Auckland, New Zealand.From the Department of Medicine (C.M.S., S.J.A., M.-C.S., V.M.B., P.A.B.), Centre for Brain Research (C.M.S., W.D.B., S.J.A., M.-C.S., V.M.B., P.A.B.); and Department of Exercise Sciences (W.D.B.), University of Auckland, New Zealand.

Pub Type(s)

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

Language

eng

PubMed ID

28143920

Citation

Stinear, Cathy M., et al. "Proportional Motor Recovery After Stroke: Implications for Trial Design." Stroke, vol. 48, no. 3, 2017, pp. 795-798.
Stinear CM, Byblow WD, Ackerley SJ, et al. Proportional Motor Recovery After Stroke: Implications for Trial Design. Stroke. 2017;48(3):795-798.
Stinear, C. M., Byblow, W. D., Ackerley, S. J., Smith, M. C., Borges, V. M., & Barber, P. A. (2017). Proportional Motor Recovery After Stroke: Implications for Trial Design. Stroke, 48(3), pp. 795-798. doi:10.1161/STROKEAHA.116.016020.
Stinear CM, et al. Proportional Motor Recovery After Stroke: Implications for Trial Design. Stroke. 2017;48(3):795-798. PubMed PMID: 28143920.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Proportional Motor Recovery After Stroke: Implications for Trial Design. AU - Stinear,Cathy M, AU - Byblow,Winston D, AU - Ackerley,Suzanne J, AU - Smith,Marie-Claire, AU - Borges,Victor M, AU - Barber,P Alan, Y1 - 2017/01/31/ PY - 2016/10/03/received PY - 2016/12/05/revised PY - 2016/12/16/accepted PY - 2017/2/2/pubmed PY - 2017/5/24/medline PY - 2017/2/2/entrez KW - impairment KW - magnetic resonance imaging KW - rehabilitation KW - stroke KW - transcranial magnetic stimulation SP - 795 EP - 798 JF - Stroke JO - Stroke VL - 48 IS - 3 N2 - BACKGROUND AND PURPOSE: Recovery of upper-limb motor impairment after first-ever ischemic stroke is proportional to the degree of initial impairment in patients with a functional corticospinal tract (CST). This study aimed to investigate whether proportional recovery occurs in a more clinically relevant sample including patients with intracerebral hemorrhage and previous stroke. METHODS: Patients with upper-limb weakness were assessed 3 days and 3 months poststroke with the Fugl-Meyer scale. Transcranial magnetic stimulation was used to test CST function, and patients were dichotomized according to the presence of motor evoked potentials in the paretic wrist extensors. Linear regression modeling of Δ Fugl-Meyer score between 3 days and 3 months was performed, with predictors including initial impairment (66 - baseline Fugl-Meyer score), age, sex, stroke type, previous stroke, comorbidities, and upper-limb therapy dose. RESULTS: One hundred ninety-two patients were recruited, and 157 completed 3-month follow-up. Patients with a functional CST made a proportional recovery of 63% (95% confidence interval, 55%-70%) of initial motor impairment. The recovery of patients without a functional CST was not proportional to initial impairment and was reduced by greater CST damage. CONCLUSIONS: Recovery of motor impairment in patients with intact CST is proportional to initial impairment and unaffected by previous stroke, type of stroke, or upper-limb therapy dose. Novel interventions that interact with the neurobiological mechanisms of recovery are needed. The generalizability of proportional recovery is such that patients with intracerebral hemorrhage and previous stroke may usefully be included in interventional rehabilitation trials. CLINICAL TRIAL REGISTRATION: URL: http://www.anzctr.org.au. Unique identifier: ANZCTR12611000755932. SN - 1524-4628 UR - https://www.unboundmedicine.com/medline/citation/28143920/Proportional_Motor_Recovery_After_Stroke:_Implications_for_Trial_Design_ L2 - http://www.ahajournals.org/doi/full/10.1161/STROKEAHA.116.016020?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -