ABSOLUTELY FUCKING USELESS. Describing impairments and not providing any protocols to fix those impairments is your first step to getting fired! Survivors would like recovery protocols. GET THERE!
Impairments of the ipsilesional upper-extremity in the first 6-months post-stroke
Journal of NeuroEngineering and Rehabilitation volume 20, Article number: 106 (2023)
Abstract
Background
Ipsilesional motor impairments of the arm are common after stroke. Previous studies have suggested that severity of contralesional arm impairment and/or hemisphere of lesion may predict the severity of ipsilesional arm impairments. Historically, these impairments have been assessed using clinical scales, which are less sensitive than robot-based measures of sensorimotor performance. Therefore, the objective of this study was to characterize progression of ipsilesional arm motor impairments using a robot-based assessment of motor function over the first 6-months post-stroke and quantify their relationship to (1) contralesional arm impairment severity and (2) stroke-lesioned hemisphere.
Methods
A total of 106 participants with first-time, unilateral stroke completed a unilateral assessment of arm motor impairment (visually guided reaching task) using the Kinarm Exoskeleton. Participants completed the assessment along with a battery of clinical measures with both ipsilesional and contralesional arms at 1-, 6-, 12-, and 26-weeks post-stroke.
Results
Robotic assessment of arm motor function revealed a higher incidence of ipsilesional arm impairment than clinical measures immediately post-stroke. The incidence of ipsilesional arm impairments decreased from 47 to 14% across the study period. Kolmogorov–Smirnov tests revealed that ipsilesional arm impairment severity, as measured by our task, was not related to which hemisphere was lesioned. The severity of ipsilesional arm impairments was variable but displayed moderate significant relationships to contralesional arm impairment severity with some robot-based parameters.
Conclusions
Ipsilesional
arm impairments were variable. They displayed relationships of varying
strength with contralesional impairments and were not well predicted by
lesioned hemisphere. With standard clinical care, 86% of ipsilesional
impairments recovered by 6-months post-stroke.(86% is still failure!)
Introduction
Stroke is one of the leading causes of death and disability around the world, with over 13.7 million new cases each year [1]. Upper extremity motor impairment after stroke can be profound, impacting nearly 75% of survivors [2]. These impairments have traditionally been viewed as mainly affecting the contralesional limb, and as a result, recovery has primarily been gauged by contralesional arm motor performance [3,4,5]. Previous work has stressed the importance of analyzing ipsilesional impairments throughout stroke recovery [6, 7], and has demonstrated that up to 37% of stroke survivors experience motor impairments in their ipsilesional limb [8]. In cases where the contralesional limb is unable to recover sufficiently, the ipsilesional limb then becomes the dominant limb required to complete activities of daily living [9]. If the ipsilesional limb is also impaired, activities of daily living can become increasingly difficult to complete [10], and functional recovery could prove challenging [11].
A number of studies have examined ipsilesional arm impairments after stroke [8, 11,12,13,14]. While ipsilesional arm impairments seem to improve with time post-stroke [6, 15, 16], there are incongruent findings around the influence of the stroke-lesioned hemisphere on ipsilesional impairments. Some studies have suggested that left-hemisphere damage impacts movement trajectory direction and curvature, and right-hemisphere damage impacts movement endpoint control [14, 17,18,19]. As these studies only recruited right-hand dominant chronic stroke participants, the findings must be interpreted carefully, particularly in those with subacute stroke. Other studies have suggested no hemispheric differences are present in ipsilesional arm motor behaviour following stroke [6, 8, 20, 21]. This incongruency must be sorted out to provide a definitive answer as to if lesioned hemisphere impacts the severity and/or type of motor impairments observed in the ipsilesional arm, better informing clinical practice when prescribing rehabilitation for stroke survivors [18].
Another area of debate in the literature focuses on whether ipsilesional motor impairments scale with the severity of contralesional motor impairments. The current literature presents conflicting results, with a recent study finding that ipsilesional impairments scale with the severity of the contralesional impairments [18], yet another recent study suggesting that ipsilesional impairments are unrelated to contralesional impairment [6]. However, one of these studies examined behaviour in a smaller subacute stroke sample (n = 19) [6], and the other focused on chronic stroke [18]. Better understanding the relationship between the severity of ipsilesional and contralesional arm impairments is important, and a larger, longitudinal study is required to determine how this relationship changes.
The main goal of the present study was to characterize ipsilesional arm motor impairments throughout the first 6-months post-stroke. Here, we examined how motor impairments change from their initial presentation in the subacute phase at 1-week post stroke to the chronic phase at 6-months post-stroke in both the ipsilesional and contralesional arm. Second, we determined the proportion of participants with persistent ipsilesional and contralesional motor impairments at 6-months post-stroke. Third, we determined if ipsilesional arm motor impairments scaled with the severity of contralesional arm motor impairments. Last, we determined if the side of the stroke-lesioned hemisphere was related to the severity and type of motor impairments seen in the ipsilesional arm.
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