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Spontaneous Recovery of Upper Extremity Motor Impairment After Ischemic Stroke: Implications for Stem Cell-Based Therapeutic Approaches.
Transl Stroke Res 2017; 8(4):351-361TS

Abstract

Preclinical studies suggest that stem cell therapy (SCT) may improve sensorimotor recovery after stroke. Upper extremity motor impairment (UEMI) is common after stroke, often entailing substantial disability. To evaluate the feasibility of post-stroke UEMI as a target for SCT, we examined a selected sample of stroke patients potentially suitable for SCT, aiming to assess the frequency and recovery of UEMI, as well as its relation to activity limitations and participation restrictions. Patients aged 20-75 years with first-ever ischemic stroke, and National Institutes of Health Stroke Scale (NIHSS) scores 1-18, underwent brain diffusion-weighted MRI within 4 days of stroke onset (n = 108). Survivors were followed up after 3-5 years, including assessment with NIHSS, Fugl-Meyer assessment of upper extremity (FMA-UE), modified Rankin Scale (mRS), and Stroke Impact Scale (SIS). UEMI was defined as NIHSS arm/hand score ≥1. UEMI recovery was evaluated with change in NIHSS arm/hand scores between baseline and follow-up. Of 97 survivors, 84 were available to follow-up. Among 76 subjects (of 84) without recurrent stroke, 41 had UEMI at baseline of which 10 had residual UEMI at follow-up. The FMA-UE showed moderate-severe impairment in seven of 10 survivors with residual UEMI. UEMI was correlated to mRS (r s = 0.49, p < 0.001) and the SIS social participation domain (r s = -0.38, p = 0.001). Nearly 25% of the subjects with UEMI at baseline had residual impairment after 3-5 years, whereas about 75% showed complete recovery. Most of the subjects with residual UEMI had moderate-severe impairment, which correlated strongly to dependency in daily activities and social participation restrictions. Our findings suggest that SCT targeting post-stroke UEMI may be clinically valuable with significant meaningful benefits for patients but also emphasize the need of early prognostication to detect patients that will have residual impairment in order to optimize patient selection for SCT.

Authors+Show Affiliations

Department of Clinical Sciences Lund, Division of Neurology, Lund University, Lund, Sweden. hossein.delavaran@med.lu.se. Department of Neurology and Rehabilitation Medicine, Skåne University Hospital, Lund, Sweden. hossein.delavaran@med.lu.se.Department of Clinical Sciences Lund, Division of Neurology, Lund University, Lund, Sweden.Center for Medical Imaging and Physiology, Skåne University Hospital, Lund, Sweden.Department of Clinical Sciences Lund, Division of Neurology, Lund University, Lund, Sweden. Department of Neurology and Rehabilitation Medicine, Skåne University Hospital, Lund, Sweden. Laboratory of Stem Cells and Restorative Neurology, Lund Stem Cell Center, Lund University, Lund, Sweden.Department of Clinical Sciences Lund, Division of Neurology, Lund University, Lund, Sweden. Department of Neurology and Rehabilitation Medicine, Skåne University Hospital, Lund, Sweden.Department of Clinical Sciences Lund, Division of Neurology, Lund University, Lund, Sweden. Laboratory of Stem Cells and Restorative Neurology, Lund Stem Cell Center, Lund University, Lund, Sweden.Department of Clinical Sciences Lund, Division of Neurology, Lund University, Lund, Sweden. Department of Neurology and Rehabilitation Medicine, Skåne University Hospital, Lund, Sweden.

Pub Type(s)

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

Language

eng

PubMed ID

28205065

Citation

Delavaran, Hossein, et al. "Spontaneous Recovery of Upper Extremity Motor Impairment After Ischemic Stroke: Implications for Stem Cell-Based Therapeutic Approaches." Translational Stroke Research, vol. 8, no. 4, 2017, pp. 351-361.
Delavaran H, Aked J, Sjunnesson H, et al. Spontaneous Recovery of Upper Extremity Motor Impairment After Ischemic Stroke: Implications for Stem Cell-Based Therapeutic Approaches. Transl Stroke Res. 2017;8(4):351-361.
Delavaran, H., Aked, J., Sjunnesson, H., Lindvall, O., Norrving, B., Kokaia, Z., & Lindgren, A. (2017). Spontaneous Recovery of Upper Extremity Motor Impairment After Ischemic Stroke: Implications for Stem Cell-Based Therapeutic Approaches. Translational Stroke Research, 8(4), pp. 351-361. doi:10.1007/s12975-017-0523-9.
Delavaran H, et al. Spontaneous Recovery of Upper Extremity Motor Impairment After Ischemic Stroke: Implications for Stem Cell-Based Therapeutic Approaches. Transl Stroke Res. 2017;8(4):351-361. PubMed PMID: 28205065.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Spontaneous Recovery of Upper Extremity Motor Impairment After Ischemic Stroke: Implications for Stem Cell-Based Therapeutic Approaches. AU - Delavaran,Hossein, AU - Aked,Joseph, AU - Sjunnesson,Håkan, AU - Lindvall,Olle, AU - Norrving,Bo, AU - Kokaia,Zaal, AU - Lindgren,Arne, Y1 - 2017/02/15/ PY - 2016/11/01/received PY - 2017/01/29/accepted PY - 2017/2/17/pubmed PY - 2018/4/3/medline PY - 2017/2/17/entrez KW - Recovery KW - Stem cell therapy KW - Stroke KW - Upper extremity motor impairment SP - 351 EP - 361 JF - Translational stroke research JO - Transl Stroke Res VL - 8 IS - 4 N2 - Preclinical studies suggest that stem cell therapy (SCT) may improve sensorimotor recovery after stroke. Upper extremity motor impairment (UEMI) is common after stroke, often entailing substantial disability. To evaluate the feasibility of post-stroke UEMI as a target for SCT, we examined a selected sample of stroke patients potentially suitable for SCT, aiming to assess the frequency and recovery of UEMI, as well as its relation to activity limitations and participation restrictions. Patients aged 20-75 years with first-ever ischemic stroke, and National Institutes of Health Stroke Scale (NIHSS) scores 1-18, underwent brain diffusion-weighted MRI within 4 days of stroke onset (n = 108). Survivors were followed up after 3-5 years, including assessment with NIHSS, Fugl-Meyer assessment of upper extremity (FMA-UE), modified Rankin Scale (mRS), and Stroke Impact Scale (SIS). UEMI was defined as NIHSS arm/hand score ≥1. UEMI recovery was evaluated with change in NIHSS arm/hand scores between baseline and follow-up. Of 97 survivors, 84 were available to follow-up. Among 76 subjects (of 84) without recurrent stroke, 41 had UEMI at baseline of which 10 had residual UEMI at follow-up. The FMA-UE showed moderate-severe impairment in seven of 10 survivors with residual UEMI. UEMI was correlated to mRS (r s = 0.49, p < 0.001) and the SIS social participation domain (r s = -0.38, p = 0.001). Nearly 25% of the subjects with UEMI at baseline had residual impairment after 3-5 years, whereas about 75% showed complete recovery. Most of the subjects with residual UEMI had moderate-severe impairment, which correlated strongly to dependency in daily activities and social participation restrictions. Our findings suggest that SCT targeting post-stroke UEMI may be clinically valuable with significant meaningful benefits for patients but also emphasize the need of early prognostication to detect patients that will have residual impairment in order to optimize patient selection for SCT. SN - 1868-601X UR - https://www.unboundmedicine.com/medline/citation/28205065/Spontaneous_Recovery_of_Upper_Extremity_Motor_Impairment_After_Ischemic_Stroke:_Implications_for_Stem_Cell_Based_Therapeutic_Approaches_ L2 - https://www.ncbi.nlm.nih.gov/pmc/articles/pmid/28205065/ DB - PRIME DP - Unbound Medicine ER -