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Is the proportional recovery rule applicable to the lower limb after a first-ever ischemic stroke?
PLoS One 2018; 13(1):e0189279Plos

Abstract

OBJECTIVE

To investigate (a) the applicability of the proportional recovery rule of spontaneous neurobiological recovery to motor function of the paretic lower extremity (LE); and (b) the presence of fitters and non-fitters of this prognostic rule poststroke. When present, the clinical threshold for fitting nor non-fitting would be determined, as well as within-subject generalizability to the paretic upper extremity (UE).

METHODS

Prospective cohort study in which the Fugl-Meyer Assessment (FMA)-LE and FMA-UE were measured <72 hours and 6 months poststroke. Predicted maximum potential recovery was defined as [FMA-LEmax-FMA-LEinitial = 34 -FMA-LEinitial]. Hierarchical clustering in 202 first-ever ischemic stroke patients distinguished between fitting and not fitting the rule. Descriptive statistics determined whether fitters and non-fitters for LE were the same persons as for UE.

RESULTS

175 (87%) patients fitted the FMA-LE recovery rule. The observed average improvement of the fitters was ~64% of the predicted maximum potential recovery. In the non-fitter group, the maximum initial FMA-LE score was 13 points. Fifty-one out of 78 patients (~65%) who scored below the identified 14-point threshold at baseline fitted the FMA-LE rule. Non-fitters were more severely affected than fitters. All non-fitters of the FMA-LE rule did also not fit the proportional recovery rule for FMA-UE.

CONCLUSIONS

Proportional recovery seems to be consistent within subjects across LE and UE motor impairment at the hemiplegic side in first-ever ischemic hemispheric stroke subjects. Future studies should investigate prospectively distinguishing between fitters and not-fitters within the subgroup of patients who have initial low FMA-LE scores. Subsequently, patients could be stratified based on fitting or not fitting the recovery rule as this would impact rehabilitation management and trial design.

Authors+Show Affiliations

Department of Rehabilitation Medicine, VU University Medical Center, Amsterdam, The Netherlands. Amsterdam Movement Sciences, Amsterdam, the Netherlands. Amsterdam Neuroscience, Amsterdam, the Netherlands. Division of Vascular Neurology and Neurorehabilitation, University of Zurich, Zurich, Switzerland. Cereneo, Center for Neurology and Rehabilitation, Vitznau, Switzerland.Department of Rehabilitation Medicine, VU University Medical Center, Amsterdam, The Netherlands. Amsterdam Movement Sciences, Amsterdam, the Netherlands. Amsterdam Neuroscience, Amsterdam, the Netherlands.Department of Rehabilitation Medicine, VU University Medical Center, Amsterdam, The Netherlands. Amsterdam Movement Sciences, Amsterdam, the Netherlands. Amsterdam Neuroscience, Amsterdam, the Netherlands.Department of Rehabilitation Medicine, VU University Medical Center, Amsterdam, The Netherlands. Amsterdam Movement Sciences, Amsterdam, the Netherlands. Amsterdam Neuroscience, Amsterdam, the Netherlands. Rehabilitation Research Center, Reade, Amsterdam, the Netherlands. Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, Illinois, United States of America.

Pub Type(s)

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

Language

eng

PubMed ID

29329286

Citation

Veerbeek, Janne M., et al. "Is the Proportional Recovery Rule Applicable to the Lower Limb After a First-ever Ischemic Stroke?" PloS One, vol. 13, no. 1, 2018, pp. e0189279.
Veerbeek JM, Winters C, van Wegen EEH, et al. Is the proportional recovery rule applicable to the lower limb after a first-ever ischemic stroke? PLoS ONE. 2018;13(1):e0189279.
Veerbeek, J. M., Winters, C., van Wegen, E. E. H., & Kwakkel, G. (2018). Is the proportional recovery rule applicable to the lower limb after a first-ever ischemic stroke? PloS One, 13(1), pp. e0189279. doi:10.1371/journal.pone.0189279.
Veerbeek JM, et al. Is the Proportional Recovery Rule Applicable to the Lower Limb After a First-ever Ischemic Stroke. PLoS ONE. 2018;13(1):e0189279. PubMed PMID: 29329286.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Is the proportional recovery rule applicable to the lower limb after a first-ever ischemic stroke? AU - Veerbeek,Janne M, AU - Winters,Caroline, AU - van Wegen,Erwin E H, AU - Kwakkel,Gert, Y1 - 2018/01/12/ PY - 2017/07/06/received PY - 2017/11/20/accepted PY - 2018/1/13/entrez PY - 2018/1/13/pubmed PY - 2018/1/30/medline SP - e0189279 EP - e0189279 JF - PloS one JO - PLoS ONE VL - 13 IS - 1 N2 - OBJECTIVE: To investigate (a) the applicability of the proportional recovery rule of spontaneous neurobiological recovery to motor function of the paretic lower extremity (LE); and (b) the presence of fitters and non-fitters of this prognostic rule poststroke. When present, the clinical threshold for fitting nor non-fitting would be determined, as well as within-subject generalizability to the paretic upper extremity (UE). METHODS: Prospective cohort study in which the Fugl-Meyer Assessment (FMA)-LE and FMA-UE were measured <72 hours and 6 months poststroke. Predicted maximum potential recovery was defined as [FMA-LEmax-FMA-LEinitial = 34 -FMA-LEinitial]. Hierarchical clustering in 202 first-ever ischemic stroke patients distinguished between fitting and not fitting the rule. Descriptive statistics determined whether fitters and non-fitters for LE were the same persons as for UE. RESULTS: 175 (87%) patients fitted the FMA-LE recovery rule. The observed average improvement of the fitters was ~64% of the predicted maximum potential recovery. In the non-fitter group, the maximum initial FMA-LE score was 13 points. Fifty-one out of 78 patients (~65%) who scored below the identified 14-point threshold at baseline fitted the FMA-LE rule. Non-fitters were more severely affected than fitters. All non-fitters of the FMA-LE rule did also not fit the proportional recovery rule for FMA-UE. CONCLUSIONS: Proportional recovery seems to be consistent within subjects across LE and UE motor impairment at the hemiplegic side in first-ever ischemic hemispheric stroke subjects. Future studies should investigate prospectively distinguishing between fitters and not-fitters within the subgroup of patients who have initial low FMA-LE scores. Subsequently, patients could be stratified based on fitting or not fitting the recovery rule as this would impact rehabilitation management and trial design. SN - 1932-6203 UR - https://www.unboundmedicine.com/medline/citation/29329286/Is_the_proportional_recovery_rule_applicable_to_the_lower_limb_after_a_first_ever_ischemic_stroke L2 - http://dx.plos.org/10.1371/journal.pone.0189279 DB - PRIME DP - Unbound Medicine ER -