In what parallel universe do you live where you think that predicting failure to recover is of any interest to survivors? Except maybe to fire you and get someone competent instead?
Do somatosensory deficits predict efficacy of neurorehabilitation using neuromuscular electrical stimulation for moderate to severe motor paralysis of the upper limb in chronic stroke?
Abstract
Background:
Various neurorehabilitation programs have been developed to promote recovery from motor impairment of upper extremities. However, the response of patients with chronic-phase stroke varies greatly. Prediction of the treatment response is important to provide appropriate and efficient rehabilitation. This study aimed to clarify whether clinical assessments, such as motor impairments and somatosensory deficits, before treatment could predict the treatment response in neurorehabilitation.
Methods:
The data from patients who underwent neurorehabilitation using closed-loop electromyography (EMG)-controlled neuromuscular electrical stimulation were retrospectively analyzed. A total of 66 patients with chronic-phase stroke with moderate to severe paralysis were included. The changes from baseline in the Fugl-Meyer Assessment–Upper Extremity (FMA-UE) and the Motor Activity Log-14 (MAL-14) of amount of use (AOU) and quality of movement (QOM) were used to assess treatment response, and multivariate logistic regression analysis was performed using the extracted candidate predictors, such as baseline clinical assessments, to identify predictors of FMA-UE and MAL-14 improvement.
Results:
FMA-UE and MAL-14 scores improved significantly after the intervention (FMA-UE p < 0.01, AOU p < 0.01, QOM p < 0.01). On multivariate logistic regression analysis, tactile sensory (p = 0.043) and hand function (p = 0.030) were both identified as significant predictors of FMA-UE improvement, tactile sensory (p = 0.047) was a significant predictor of AOU improvement, and hand function (p = 0.026) was a significant predictor of QOM improvement. The regression equations explained 71.2% of the variance in the improvement of FMA-UE, 69.7% of AOU, and 69.7% of QOM.
Conclusion:
Both motor and tactile sensory impairments predict improvement in motor function, tactile sensory impairment predicts improvement in the amount of paralytic hand use, and motor impairment predicts improvement in the quality of paralytic hand use following neurorehabilitation treatment in patients with moderate to severe paralysis in chronic-phase stroke. These findings may help select the appropriate treatment for patients with more severe paralysis and to maximize the treatment effect.
Introduction
Motor impairment of the upper extremities is one of the major symptoms in patients with stroke. Motor impairment occurs in approximately 70% or more of patients,1,2 and various rehabilitation programs have been developed to promote recovery from motor impairment after stroke.3 In addition, with the recent development of neurorehabilitation, reports of interventions for residual motor paralysis in the chronic phase are increasing. However, the response to rehabilitation therapy of patients with chronic stroke varies greatly from patient to patient. Therefore, it is important to define an individualized rehabilitation treatment program according to the severity of stroke to provide appropriate and efficient rehabilitation. For this purpose, accurate prediction of the treatment response is necessary.
Somatosensory deficits, as well as motor impairments, are major symptoms in patients with stroke. Somatosensory deficits occur in more than 60% of patients4 and remain in about 40% of patients in the chronic phase.5 Along with motor impairments, somatosensory deficits affect motor functions and activities of daily living (ADLs), such as hand dexterity6,7 and grasping and manipulating objects.8–10 Although both motor and somatosensory functions are considered important predictors of motor function recovery in rehabilitation, many reports of patients with chronic stroke have focused only on motor function before intervention. In addition, reports using other clinical assessments, including of somatosensory deficits, are limited to mild to moderate paralysis.11 Thus, whether somatosensory impairment has an impact on the recovery of motor function in neurorehabilitation of patients with chronic stroke who have more severe paralysis remains unclear.
In addition to recovery of motor function, increasing the AOU and improving the quality of movement (QOM) of the paralyzed hand are also major goals of neurorehabilitation.12,13 It has been reported that baseline motor and somatosensory functions can both be used as predictors of the AOU and improvement in the QOM of the paralyzed hand by neurorehabilitation in subacute stroke patients.14 A report on chronic stroke patients also showed that both motor and somatosensory functions have a significant impact on prediction.15 However, similar to the recovery of motor function, reports on the AOU and QOM of the paralyzed hand are limited to mild to moderate paralysis.
This study aimed to determine the effects of clinical assessments of motor impairments and somatosensory deficits on the prediction of treatment response, such as recovery of motor impairments (increases in the amount of use and in the QOM of the paralyzed hand) in rehabilitation of patients with moderate to severe paralysis in chronic-phase stroke. We hypothesized that both pretreatment motor and somatosensory functions would be useful predictors of recovery of motor impairments (increased amount of use and improved QOM of the paralyzed hand).
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