Monday, January 15, 2018

Does Stroke Rehabilitation Really Matter? Part A: Proportional Stroke Recovery in the Rat

Then the proportional recovery rule needs to be tossed because the existing rehabilitation practices are a failure. The solution is to prevent the 5 causes of the neuronal cascade of death. Or get neuroplasticity and neurogenesis completely repeatable. 
http://journals.sagepub.com/doi/abs/10.1177/1545968317751210\

Matthew Strider Jeffers, MSc, Sudhir Karthikeyan, MSc, Dale Corbett, PhD*
First Published January 10, 2018 Research Article




Abstract

Background. In human upper-limb stroke, initial level of functional impairment or corticospinal tract injury can accurately predict the degree of poststroke recovery, independent of rehabilitation practices. This proportional recovery rule implies that current rehabilitation practices may play little or no role in brain repair, with recovery largely a result of spontaneous biological recovery processes. 
Objective. The present study sought to determine if similar biomarkers predict recovery of poststroke function in rats, indicating that an endogenous biological recovery process might be preserved across mammalian species.  
Methods. Using a cohort of 593 male Sprague-Dawley rats, we predicted poststroke change in pellet retrieval in the Montoya staircase-reaching task based on initial impairment alone. Stratification of the sample into “fitters” and “nonfitters” of the proportional recovery rule using hierarchical cluster analysis allowed identification of distinguishing characteristics of these subgroups.  
Results. Approximately 30% of subjects were identified as fitters of the rule. These rats showed recovery in proportion to their initial level of impairment of 66% (95% CI = 62%-70%). This interval overlaps with those of multiple human clinical trials. A number of variables, including less severe infarct volumes and initial poststroke impairments distinguished fitters of the rule from nonfitters.  
Conclusions. These findings suggest that proportional recovery is a cross-species phenomenon that can be used to uncover biological mechanisms contributing to stroke recovery.
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1 comment:

  1. Barb PolanJanuary 16, 2018 at 12:17 PM

    Interesting - The benefit of inpatient rehab to me was to learn alternate ways of doing ADL's and other required tasks. Plus, I had to wait 2 weeks for my AFO. And I learned a lot about strokes. Rehab did not, after all, improve any of my function. My abilities on departing, the rehab hospital, 30 days later, were the same as entering. I kept asking why I couldn't go home; the answer was that I needed more rehab (how could I argue w that?). Much later, while I was telling my story to a friend, he said, "My bet is that your insurance company allows up to 30 days."

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