Fuck proportional recovery and the failure it represents. Have you EVER talked to any stroke survivor that accepted proportional recovery without them being brain-washed into accepting your tyranny of low expectations? I would fire you on the spot for this crapola. 100% RECOVERY IS THE ONLY GOAL IN STROKE.
Proportional Recovery in the Spotlight
Randolph J. Nudo, PhD
Prediction
of who will recover after stroke has been a perennial focus for both
researchers and clinicians in the field of neurorehabilitation. The
prospects of applying a population-based model to predict outcome in
individual patients might ultimately allow more focused approaches to
stroke rehabilitation and foster a better distribution of precious
health care resources. Aside from anatomical biomarkers, such as the
integrity of the corticospinal tract, recent attention has focused on
the proportional recovery rule, formally proposed in this journal more
than 10 years ago by Prabhakaran et al,1
who described a surprisingly linear relationship between Fugl-Meyer
Assessment upper extremity scores obtained within 3 days after stroke
and those obtained at 3 months poststroke, illustrating the general
principle of spontaneous recovery with a level of predictability not
previously appreciated.(The fact that you accept this relationship as normal and expected is what is so fucking bad about this. You expect the status quo to stay the same. For that reason alone you need to be fired.) This relationship appears to hold for most
individuals (so-called “fitters” or “recoverers”), but a subset of
individuals (so-called “non-fitters” or “non-recoverers”) fall off the
linear regression line. First applied to upper limb motor impairment,
the proportional recovery rule has been examined in a variety of motor
and nonmotor impairments, and results have generally been in agreement
with the initial linear relationship. Recent controversy surrounding the
proportional recovery rule has been based on statistical factors such
as mathematical coupling and nonlinearity of outcome scales, questioning
not only the accuracy but also the underlying validity of this
predictive population-based model. Two articles in the current issue of Neurorehabilitation and Neural Repair
highlight some of the emerging views and suggestions for future
research regarding this model. The first article by Senesh and
Reinkensmeyer examines the reasons why “non-fitters” do not recover
according to the proportional recovery algorithm. They argue that the
local slope of the linear regression reflects the difficulty of test
item scores related to arm and hand movement at follow-up, consistent
with the view that non-fitters lack sufficient corticospinal tract. They
suggest that at least some non-fitters may have a heightened response
to intensive movement training and should be targeted early after stroke
for such rehabilitative training. In the second article by Kundert et
al, the statistical validity of the proportional recovery rule is
examined in the context of recent criticisms regarding its underlying
assumptions. Despite 2 recent articles critical of statistical
relationships of baseline impairment scores to follow-up scores,
especially when used for patient-level predictions, Kundert et al
contend that the systematic non-artifactual relationship between initial
impairment and motor recovery provides a valid statistical and
biologically meaningful model, and that future studies of proportional
recovery should use more sophisticated analysis techniques and rigorous
methods to assess validity, including comparisons to alternative models.
Randolph J. Nudo, PhD
Editor-in-Chief
Editor-in-Chief
Reference
| 1. |
Prabhakaran, S, Zarahn, E, Riley, C, et al. Inter-individual variability in the capacity for motor recovery after ischemic stroke. Neurorehabil Neural Repair. 2008;22:64-71. doi:10.1177/1545968307305302 Google Scholar | SAGE Journals | ISI |
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