http://nnr.sagepub.com/content/early/2014/11/21/1545968314562115?papetoc
- Caroline Winters, MSc1
- Erwin E. H. van Wegen, PhD1
- Andreas Daffertshofer, PhD2
- Gert Kwakkel, PhD1,3
- 1Department of Rehabilitation Medicine, MOVE Research Institute Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
- 2MOVE Research Institute Amsterdam, Faculty of Human Movement Sciences, VU University, Amsterdam, The Netherlands
- 3Department of Neurorehabilitation, Reade Centre for Rehabilitation and Rheumatology, Amsterdam, The Netherlands
- Erwin E. H. van Wegen, PhD, Department of Rehabilitation Medicine, MOVE Research Institute Amsterdam, VU University Medical Center; PO Box 7057, 1007 MB, Amsterdam, Netherlands. Email: e.vanwegen@vumc.nl
Abstract
Background and objective.
Spontaneous neurological recovery after stroke is a poorly understood
process. The aim of the present article was to test
the proportional recovery model for the upper
extremity poststroke and to identify clinical characteristics of
patients who
do not fit this model. Methods. A change
in the Fugl-Meyer Assessment Upper Extremity score (FMA-UE) measured
within 72 hours and at 6 months poststroke
served to define motor recovery. Recovery on FMA-UE
was predicted using the proportional recovery model: ΔFMA-UEpredicted = 0.7·(66 − FMA-UEinitial)
+ 0.4. Hierarchical cluster analysis on 211 patients was used to
separate nonfitters (outliers) from fitters, and differences
between these groups were studied using clinical
determinants measured within 72 hours poststroke. Subsequent logistic
regression
analysis served to predict patients who may not fit
the model. Results. The majority of patients (~70%; n = 146)
showed a fixed proportional upper extremity motor recovery of about 78%;
65 patients
had substantially less improvement than predicted.
These nonfitters had more severe neurological impairments within 72
hours
poststroke (P values <.01). Logistic
regression analysis revealed that absence of finger extension, presence
of facial palsy, more severe
lower extremity paresis, and more severe type of
stroke as defined by the Bamford classification were significant
predictors
of not fitting the proportional recovery model. Conclusions.
These results confirm in an independent sample that stroke patients
with mild to moderate initial impairments show an almost
fixed proportional upper extremity motor recovery.
Patients who will most likely not achieve the predicted amount of
recovery
were identified using clinical determinants
measured within 72 hours poststroke.
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