Deans' stroke musings: Size Doesn’t Matter: Cortical Stroke Lesion Volume is Not Associated with Upper Extremity Motor Impairment and Function in Mild, Chronic, Hemiparesis

Changing stroke rehab and research worldwide now.Time is Brain! trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 523 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.

Sunday, January 27, 2013

Size Doesn’t Matter: Cortical Stroke Lesion Volume is Not Associated with Upper Extremity Motor Impairment and Function in Mild, Chronic, Hemiparesis

Why would you even expect lesion size to make a difference in upper extremity hemiparesis? Its so blatently obvious that you have to look at location.
http://www.archives-pmr.org/article/S0003-9993%2813%2900031-2/abstract

Abstract

Objective

To determine: (a) the relationship between lesion volume and upper extremity (UE) motor impairment using the UE section of the Fugl-Meyer (FM); and (b) the relationship between lesion volume and UE functional outcomes using the Arm Motor Ability Test (AMAT) Functional Ability (FA) and Time scales.

Design

Secondary, retrospective analysis of randomized controlled trial data

Setting

Not applicable

Participants

139 subjects with chronic stroke (83 males; mean age of all subjects = 56.7 + 11.2 years; mean time since stroke onset = 59.6 + 65.6 months; 90 subjects with right hemiparesis) and stable, active, distal UE movement.

Intervention

Data were collected related to subjects’ lesion volum and UE movement prior to their participation in a multicenter randomized controlled trial.

Main Outcome Measures

The FM and the AMAT.

Results

Neither age nor lesion volume was related to FM performance. The p-value for the regression coefficient of lesion volume was 0.045 in the AMAT FA model and 0.016 in the AMAT Time model. Lesion volume accounted for only an additional 1.7% (AMAT FA) to 3.1% (AMAT Time) of the variability in motor function, and was not clinically meaningful.

Conclusions

Data suggest no relationship between lesion volume and UE impairment, and a small, clinically insignificant relationship between lesion volume and UE motor function. Stroke affects metabolic changes in intact regions, and causes diffuse structural loss in anatomically remote regions from the infarction. These other factors may account for variance in motor outcomes following stroke.