Deans' stroke musings: Does Transcranial Magnetic Stimulation Have an Added Value to Clinical Assessment in Predicting Upper-Limb Function Very Early After Severe Stroke?

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.

Tuesday, July 10, 2018

Does Transcranial Magnetic Stimulation Have an Added Value to Clinical Assessment in Predicting Upper-Limb Function Very Early After Severe Stroke?

Survivors don't fucking care about predictions, they want to know about the exact protocols that deliver 100% recovery. That may not be possible now but that is the goal. GET THERE!
http://journals.sagepub.com/doi/abs/10.1177/1545968318785044

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Maurits H. J. Hoonhorst, MD¹ , Rinske H. M. Nijland, PhD²

2Amsterdam Rehabilitation Research Center, Reade, Amsterdam, Netherlands
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, Peter J. S. van den Berg, MD, PhD³ , , ,

Cornelis H. Emmelot, MD, PhD³

3Isala Klinieken, Zwolle, Netherlands
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, Boudewijn J. Kollen, PhD⁴

4University of Groningen, University Medical Center Groningen, Department of General Practice and Elderly Care, Groningen, Netherlands
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, Gert Kwakkel, PhD²⁵⁶⁷

2Amsterdam Rehabilitation Research Center, Reade, Amsterdam, Netherlands5MOVE Research Institute, Amsterdam, Netherlands6Amsterdam University Medical Centre, Amsterdam, Netherlands7Northwestern University of Chicago, IL, USA
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, Maurits H. J. Hoonhorst, MD¹

1Rehabilitation Center Vogellanden, Zwolle, Netherlands
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, Rinske H. M. Nijland, PhD²

2Amsterdam Rehabilitation Research Center, Reade, Amsterdam, Netherlands
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, Peter J. S. van den Berg, MD, PhD³

3Isala Klinieken, Zwolle, Netherlands
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, Cornelis H. Emmelot, MD, PhD³

3Isala Klinieken, Zwolle, Netherlands
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, Boudewijn J. Kollen, PhD⁴

4University of Groningen, University Medical Center Groningen, Department of General Practice and Elderly Care, Groningen, Netherlands
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, Gert Kwakkel, PhD²⁵⁶⁷

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...

First Published July 4, 2018 Research Article

https://doi.org/10.1177/1545968318785044

Article Information

Article first published online: July 4, 2018

https://doi.org/10.1177/1545968318785044

Maurits H. J. Hoonhorst, MD¹, Rinske H. M. Nijland, PhD², Peter J. S. van den Berg, MD, PhD³, Cornelis H. Emmelot, MD, PhD³, Boudewijn J. Kollen, PhD⁴, Gert Kwakkel, PhD²^,⁵^,⁶^,⁷

¹Rehabilitation Center Vogellanden, Zwolle, Netherlands

²Amsterdam Rehabilitation Research Center, Reade, Amsterdam, Netherlands

³Isala Klinieken, Zwolle, Netherlands

⁴University of Groningen, University Medical Center Groningen, Department of General Practice and Elderly Care, Groningen, Netherlands

⁵MOVE Research Institute, Amsterdam, Netherlands

⁶Amsterdam University Medical Centre, Amsterdam, Netherlands

⁷Northwestern University of Chicago, IL, USA

Corresponding Author: Maurits H. J. Hoonhorst, MD, Rehabilitation Center Vogellanden, Zwolle, 8013 XZ, Netherlands. Email: m.hoonhorst@vogellanden.nl

This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (http://www.creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage).

Abstract

Abstract

Background. The added prognostic value of transcranial magnetic stimulation (TMS)-induced motor-evoked potentials (MEPs) to clinical modeling for the upper limb is still unknown early poststroke.
Objective. To determine the added prognostic value of TMS of the adductor digiti minimi (TMS-ADM) to the clinical model based on voluntary shoulder abduction (SA) and finger extension (FE) during the first 48 hours and at 11 days after stroke. (And the point of this prediction?)
Methods. This was a prospective cohort study with 3 logistic regression models, developed to predict upper-limb function at 6 months poststroke. The first model showed the predictive value of SA and FE measured within 48 hours and at 11 days poststroke. The second model included TMS-ADM, whereas the third model combined clinical and TMS-ADM information. Differences between derived models were tested with receiver operating characteristic curve analyses.
Results. A total of 51 patients with severe, first-ever ischemic stroke were included. Within 48 hours, no significant added value of TMS-ADM to clinical modeling was found (P = .369). Both models suffered from a relatively low negative predictive value within 48 hours poststroke. TMS-ADM combined with SA and FE (SAFE) showed significantly more accuracy than TMS-ADM alone at 11 days poststroke (P = .039).
Conclusion. TMS-ADM showed no added value to clinical modeling when measured within first 48 hours poststroke, whereas optimal prediction is achieved by SAFE combined with TMS-ADM at 11 days poststroke. Our findings suggest that accuracy of predicting upper-limb motor function by TMS-ADM is mainly determined by the time of assessment early after stroke onset.