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Proportional Recovery From Lower Limb Motor Impairment After Stroke.
Stroke 2017; 48(5):1400-1403S

Abstract

BACKGROUND AND PURPOSE

In people with preserved corticospinal tract (CST) function after stroke, upper limb impairment resolves by ≈70% within 3 months. This is known as the proportional recovery rule. Patients without CST function do not fit this rule and have worse upper limb outcomes. This study investigated resolution of motor impairment in the lower limb (LL).

METHODS

Patients with stroke and LL weakness were assessed 3 days and 3 months after stroke with the LL Fugl-Meyer. CST integrity was determined in a subset of patients using transcranial magnetic stimulation to test for LL motor-evoked potentials and magnetic resonance imaging to measure CST lesion load. Linear regression analyses were conducted to predict resolution of motor impairment (ΔFugl-Meyer) including factors initial impairment, motor-evoked potential status, CST lesion load, and LL therapy dose.

RESULTS

Thirty-two patients completed 3-month follow-up and recovered 74% (95% confidence interval, 60%-88%) of initial LL motor impairment. Initial impairment was the only significant predictor of resolution of motor impairment. There was no identifiable cluster of patients who did not fit the proportional recovery rule. Measures of CST integrity did not predict proportional LL recovery.

CONCLUSIONS

LL impairment resolves by ≈70% within 3 months after stroke. The absence of a nonfitter group may be because of differences in the neuroanatomical organization of descending motor tracts to the upper limb and LL. Proportional recovery of the LL is not influenced by therapy dose providing further evidence that it reflects a fundamental biological process.

Authors+Show Affiliations

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

Pub Type(s)

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

Language

eng

PubMed ID

28341754

Citation

Smith, Marie-Claire, et al. "Proportional Recovery From Lower Limb Motor Impairment After Stroke." Stroke, vol. 48, no. 5, 2017, pp. 1400-1403.
Smith MC, Byblow WD, Barber PA, et al. Proportional Recovery From Lower Limb Motor Impairment After Stroke. Stroke. 2017;48(5):1400-1403.
Smith, M. C., Byblow, W. D., Barber, P. A., & Stinear, C. M. (2017). Proportional Recovery From Lower Limb Motor Impairment After Stroke. Stroke, 48(5), pp. 1400-1403. doi:10.1161/STROKEAHA.116.016478.
Smith MC, et al. Proportional Recovery From Lower Limb Motor Impairment After Stroke. Stroke. 2017;48(5):1400-1403. PubMed PMID: 28341754.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Proportional Recovery From Lower Limb Motor Impairment After Stroke. AU - Smith,Marie-Claire, AU - Byblow,Winston D, AU - Barber,P Alan, AU - Stinear,Cathy M, Y1 - 2017/03/24/ PY - 2016/12/22/received PY - 2017/01/26/revised PY - 2017/02/01/accepted PY - 2017/3/28/pubmed PY - 2017/7/1/medline PY - 2017/3/26/entrez KW - lower extremity KW - motor KW - stroke KW - upper extremity SP - 1400 EP - 1403 JF - Stroke JO - Stroke VL - 48 IS - 5 N2 - BACKGROUND AND PURPOSE: In people with preserved corticospinal tract (CST) function after stroke, upper limb impairment resolves by ≈70% within 3 months. This is known as the proportional recovery rule. Patients without CST function do not fit this rule and have worse upper limb outcomes. This study investigated resolution of motor impairment in the lower limb (LL). METHODS: Patients with stroke and LL weakness were assessed 3 days and 3 months after stroke with the LL Fugl-Meyer. CST integrity was determined in a subset of patients using transcranial magnetic stimulation to test for LL motor-evoked potentials and magnetic resonance imaging to measure CST lesion load. Linear regression analyses were conducted to predict resolution of motor impairment (ΔFugl-Meyer) including factors initial impairment, motor-evoked potential status, CST lesion load, and LL therapy dose. RESULTS: Thirty-two patients completed 3-month follow-up and recovered 74% (95% confidence interval, 60%-88%) of initial LL motor impairment. Initial impairment was the only significant predictor of resolution of motor impairment. There was no identifiable cluster of patients who did not fit the proportional recovery rule. Measures of CST integrity did not predict proportional LL recovery. CONCLUSIONS: LL impairment resolves by ≈70% within 3 months after stroke. The absence of a nonfitter group may be because of differences in the neuroanatomical organization of descending motor tracts to the upper limb and LL. Proportional recovery of the LL is not influenced by therapy dose providing further evidence that it reflects a fundamental biological process. SN - 1524-4628 UR - https://www.unboundmedicine.com/medline/citation/28341754/Proportional_Recovery_From_Lower_Limb_Motor_Impairment_After_Stroke_ L2 - http://www.ahajournals.org/doi/full/10.1161/STROKEAHA.116.016478?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -