I have zero skilled reaching ability and even if I could get my arm to reach out the hand is useless, will not open due to spasticity. Assessing something is useless with no protocols specified to recover reaching.
Translational Value of Skilled Reaching Assessment in Clinical and Preclinical Studies on Motor Recovery After Stroke
Abstract
Background
Assessment of skilled reaching enables extensive analysis of upper limb function in clinical and preclinical studies on poststroke outcome. However, translational research if often limited by lack of correspondence between tests of human and rodent motor function.
Objectives
To determine (1) the translational value of skilled reaching performance for preclinical research by comparing the behavioral recovery profiles of skilled reaching characteristics between humans and rats recovering from stroke and (2) the relationship between skilled reaching performance and commonly used clinical outcome measures after stroke.
Methods
Twelve patients with ischemic or hemorrhagic stroke and 17 rats with photothrombotic stroke underwent an equivalent skilled reaching test at different time points, representing early to late subacute stages poststroke. Success scores and a movement element rating scale were used to measure the skilled reaching performance. The Fugl-Meyer Upper Extremity (FM-UE) assessment and the Action Research Arm Test (ARAT) were used as clinical outcome measures.
Results
Both species had muscle flaccidity at the early subacute stage after stroke and showed motor recovery following a proximal-distal principle toward the early subacute stage, albeit for rats within a shorter time course. Human skilled reaching scores and FM-UE and ARAT scores in the first 3 months poststroke were significantly correlated (P < .05).
Conclusions
Our study demonstrates that poststroke changes in skilled reaching performance are highly similar between rats and humans and correspond with standard clinical outcome measures. Skilled reaching testing therefore offers an effective and highly translational means for assessment of motor recovery in experimental and clinical stroke settings.
Introduction
Upper limb impairment, such as a hemiparesis of the contralateral limb, is diagnosed in about 75% of the stroke patient population.1,2 Upper limb impairment limits functional independence, participation in social roles, and a return to work.3 Impairments in skilled use of the hands are cardinal features of poststroke motor dysfunction,4 and compensatory movement patterns, for example, excessive trunk displacement and increased reliance on the nonparetic hand, are common responses to hand function loss.5
Compensation is often mistaken for recovery, since some compensatory movement patterns are subtle enough to be undetected in clinical outcome measures that focus little on qualitative aspects of movement.6 In the process of poststroke motor recovery, early adoption of compensation strategies may lead to learned disuse or training-induced misuse of the impaired limb, which in the long term can limit a patient’s rehabilitation.7 In addition, when recovery is evaluated without taking compensation into account, this could distort understanding of the contribution of neural plasticity to poststroke recovery. This is particularly relevant in basic neuroscience studies and translational research on spontaneous recovery or restorative treatments,6,7 which often make use of animal models, mostly involving rodents. However, translational research is often limited by lack of correspondence between tests of human and rodent motor function.8,9 Skilled reaching assessment has been proposed as one of the most potent translational behavioral tests for studying poststroke recovery in rodents.9 The typical task requires that a subject reaches for and subsequently grasps a small food item with a single hand/paw, and subsequently brings it to the mouth for eating.10 Skilled reaching (conventional term for reach-to-eat) movement patterns show significant homologies between rodents and humans,11-13 which offers valuable opportunities for translational research.
Guidelines to enhance the alignment of preclinical and clinical stroke recovery research pipeline have recently been published by the Stroke Recovery and Rehabilitation Roundtable consortium.8 Behavioral outcome measures have received special consideration, and it has been recommended that clinically relevant deficits, such as skilled reaching, should be the main focus of preclinical behavioral testing.14 The time course of recovery is more rapid in rodents than in humans,14,15 and it remains to be determined to what extent behavioral recovery profiles in rodent stroke models are representative for functional recovery patterns in stroke patients. To our knowledge, the development of skilled reaching performance over time after stroke has not yet been directly compared between rats and humans. Therefore, the aim of our study was to determine the degree of correspondence of temporal changes in several skilled reaching characteristics in rats and humans between early and late subacute stages poststroke. To further evaluate the translational value of skilled reaching, our second aim was to determine the relationship between skilled reaching performance and commonly used clinical outcome measures (ie, Fugl-Meyer Upper Extremity assessment [FM-UE] and Action Research Arm Test [ARAT] scores) in subacute stroke patients.
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