Use the labels in the right column to find what you want. Or you can go thru them one by one, there are only 33,991 posts. Searching is done in the search box in upper left corner. I blog on anything to do with stroke. DO NOT DO ANYTHING SUGGESTED HERE AS I AM NOT MEDICALLY TRAINED, YOUR DOCTOR IS, LISTEN TO THEM. BUT I BET THEY DON'T KNOW HOW TO GET YOU 100% RECOVERED. I DON'T EITHER BUT HAVE PLENTY OF QUESTIONS FOR YOUR DOCTOR TO ANSWER.
Changing stroke rehab and research worldwide now.Time is Brain!trillions and trillions of neuronsthatDIEeach day because there areNOeffective hyperacute therapies besides tPA(only 12% effective). I have 523 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.
What this blog is for:
My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.
Showing posts with label what would Dean do?. Show all posts
Showing posts with label what would Dean do?. Show all posts
My God, we've known of this problem forever! You're fired for not even trying to solve it, including your mentors and senior researchers! A vast amount of dead wood needs to be removed in stroke, put me in charge and there will be a bloodbath of firing! There are no excuses for such incompetency!
Disruption
of the blood–brain barrier (BBB) is an important pathological hallmark
of ischemic stroke. Blood–brain barrier disruption (BBBD) is a
consequence of ischemia and may also exacerbate damage to brain
parenchyma. Therefore, maintaining BBB integrity is critical for the
central nervous system (CNS) homeostasis. This review offers a concise
overview of BBB structure and function, along with the mechanisms
underlying its impairment following a stroke. In addition, we review the
recent imaging techniques employed to study blood–brain barrier
permeability (BBBP) in the context of ischemic brain injury with the
goal of providing imaging guidance for stroke diagnosis and treatment
from the perspective of the BBBD. This knowledge is vital for developing
strategies to safeguard the BBB during cerebral ischemia.
So effective but you did nothing with it. NO protocol, nothing. I'd fire you immediately. The whole point of stroke research is to get survivors recovered. This did nothing of the sort.
Masato Sato Department of Rehabilitation, Hashimoto Municipal Hospital
Abstract:
Introduction:
The perceptive exploration approach is a therapy for upper extremity movement disorders in patients with acute stroke hemiparesis. It facilitates the organization of actions in terms of perceptual information exploration and motor control, and may help develop the functional use of the upper extremities. The purpose of this study was to determine whether the perceptive exploration approach is effective in improving upper extremity movement disorders in patients with acute stroke hemiparesis. Methods:I used pretest posttest data to examine the therapeutic effects of the perceptive exploration approach in eight hemiparesis patients. In addition to a standard occupational therapy program, the therapy included a tailored perceptive exploration activity based on the assessment of patient-specific upper extremity function. I examined three main outcome measurements: Fugl-Meyer Assessment (FMA), and amount of use (AOU) and quality of movement (QOM) in the motor activity log (MAL). Results:
Outcome data measured before and after therapy showed improvement in all patients. FMA scores for motor function (p= 0.01, Δ = 0.55) and sensory function (p= 0.02, Δ = 0.59) assessment were significantly improved, and the effect size was moderate. AOU (p= 0.01, Δ = 0.81) and QOM (p= 0.01, Δ = 0.80) in the MAL were also significantly improved, and the effect size showed a large change. Conclusion:
The present results suggest that the perceptive exploration approach may be useful for the recovery of upper extremity movement in patients with acute stroke hemiparesis.
2014, Archives of Physical Medicine and Rehabilitation
Please cite this article as: McCabe J, Monkiewicz M, Holcomb J, Pundik S, Daly JJ, Comparisonof Robotics, FES, and Motor Learning Methods for Treatment of Persistent Upper ExtremityDysfunction after Stroke: a Randomized Controlled Trial,
ARCHIVES OF PHYSICAL MEDICINE AND REHABILITATION
Authors: Jessica McCabe, M.P.T. 1 ; Michelle Monkiewicz, D.P.T. 1 ; John Holcomb, Ph.D. 2 , Svetlana Pundik, M.D., M.S. 1 ; Janis J. Daly, Ph.D., M.S. 1*
Author affiliations:
1. Stroke Motor Control/Motor Learning Laboratory of the Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, OH 44106 2. Department of Mathematics and Statistics, Cleveland State University, Cleveland OH 44016 * Dr. Daly currently holds the position of Director, Brain Rehabilitation Research Center of Excellence, Malcom Randall Gainesville DVA Medical Center. Research Career Scientist, DVA.; Professor, Department of Neurology, College of Medicine, University of Florida.; Director, Brain Rehabilitation Research Program, McKnight Brain Institute, University of Florida.
Abstract
Objective:
To compare response to upper limb treatment using robotics (ROB) + motor learning (ML) vs. functional electrical stimulation (FES) + ML vs. ML alone, according to a measure of complex functional everyday tasks for chronic, severely impaired stroke survivors.Design:single-blind, randomized trial.
Setting:
Clinical research lab, Medical Center.Participants:39 enrolled subjects, >1 year post single stroke (attrition rate=10%; 35 completed the study). No adverse effects.Interventions:All groups received treatment 5 days/week, 5hrs/day (60 sessions), with unique treatment as follows: ML alone (n=11), 5hrs/day partial and whole task practice of complex
functional tasks; ROB+ML (n=12), 3.5hrs/day ML and 1.5hrs/day shoulder/elbow robotics; FES+ML (n=12), 3.5hrs/day ML and 1.5hrs/day FES wrist/hand coordination training.
Main Outcome Measures:
Primary measure: Arm Motor Ability Test (AMAT), 13 complex functional tasks; secondary measure: upper limb Fugl-Meyer coordination (FM).Results: No significant difference found in treatment response across groups (AMAT (p.584)and FM (p.590)). All three treatment groups demonstrated clinically and statistically significant improvement in response to treatment (AMAT and FM, p≤.009). A group treatment paradigm of 1:3 (therapist:patient) ratio proved feasible for provision of the intensive treatment.Conclusions:Severely impaired stroke survivors with persistent (>1yr) upper extremity dysfunction can make clinically and statistically significant gains in coordination and functional task performance, in response to ROB+ML, FES+ML, and ML alone, in an intensive and long-duration intervention, and no group difference was found. Additional study is warranted to determine the effectiveness of these methods in the clinical setting.
And you somehow think predicting delirium rather than preventing delirium does stroke survivors any fucking bit of good? Do you even have two functioning neurons to rub together? I'd have you all fired.
Solve the fucking delirium problem, you've known about it for years.
1 in 4 have delirium post stroke from this research:
Post-stroke
delirium (PSD) is a modifiable predictor for worse outcome in stroke.
Knowledge of its risk factors would facilitate clinical management of
affected patients, but recently updated national guidelines consider
available evidence insufficient.
Aims:
The study aimed to establish risk factors for PSD incidence and duration using high-frequency screening.
Methods:
We
prospectively investigated patients with ischemic stroke admitted
within 24 h. Patients were screened twice daily for the presence of PSD
throughout the treatment period. Sociodemographic, treatment-related,
and neuroimaging characteristics were evaluated as predictors of either
PSD incidence (odds ratios (OR)) or duration (PSD days/unit of the
predictor, b), using logistic and linear regression models, respectively.
Results:
PSD
occurred in 55/141 patients (age = 73.8 ± 10.4 years, 61 female,
National Institutes of Health Stroke Scale (NIHSS) = 6.4 ± 6.5). Age
(odds ratio (OR) = 1.06 (95% confidence interval (CI): 1.02–1.10), b = 0.08 (95% CI = 0.04–0.13)), and male gender (b = 0.99
(95% CI = 0.05–1.93)) were significant non-modifiable risk factors. In a
multivariable model adjusted for age and gender, presence of pain
(OR < sub > mvar </sub >= 1.75 (95% CI = 1.12–2.74)), urinary catheter (OR < sub > mvar </sub > = 3.16 (95% CI = 1.10–9.14)) and post-stroke infection (PSI; OR < sub > mvar </sub > = 4.43 (95% CI = 1.09–18.01)) were predictors of PSD incidence. PSD duration was impacted by presence of pain (b < sub > mvar </sub >= 0.49 (95% CI = 0.19–0.81)), urinary catheter (b < sub > mvar </sub > = 1.03 (95% CI = 0.01–2.07)), intravenous line (b < sub > mvar </sub >= 0.36 (95% CI = 0.16–0.57)), and PSI (b < sub > mvar </sub >= 1.60
(95% CI = 0.42–2.78)). PSD (OR = 3.53 (95% CI = 1.48–5.57)) and PSI
(OR = 5.29 (95% CI = 2.92–7.66)) independently predicted inferior NIHSS
at discharge. Insular and basal ganglia lesions increased the PSD risk
about four- to eight-fold.
Discussion/Conclusion:
This study identified modifiable risk factors, the management of which might reduce the negative impact PSD has on outcome.(My conclusion is you have no fucking clue on how to solve stroke!)
Ischemic
stroke is becoming increasingly prevalent with an aging population; yet
even most advanced reperfusion therapies are viable in only about 20%
of patients.1,2
There is hence a pivotal role for the management of secondary
complications to enhance long-term outcome in patients not amenable for
or with unsuccessful reperfusion attempts. Post-stroke delirium (PSD)
affects up to 39% of patients with ischemic stroke, is associated with
inferior functional and cognitive outcome, and poses a critical, yet
modifiable, predictor for poor recovery.3,4
Unfortunately, PSD management is generally unstandardized, affected
patients remain unrecognized, and initiation of pharmacological and
non-pharmacological interventions is delayed.3,5
While it remains to be clarified to what extent interventional
approaches can reduce the impact of manifest PSD, prevention of PSD is
effective and can avert up to one-third of cases.4,6
Prevention could be facilitated by knowledge of risk factors for PSD
since patients at risk could be easier identified and effects of
modifiable risk factors mitigated.
We performed a review of studies that investigated risk factors for PSD (Supplemental Table 1),
which generally identified age, stroke severity, infection,
deliriogenic medication, and pre-stroke cognitive or functional
impairment. Unfortunately, most studies are methodologically biased
(retrospective designs, inappropriate choice of screening tools or
frequency) and none evaluated risk factors for PSD duration, which
substantially impacts neurocognitive outcome following delirium.7
Consequently, recently updated German guidelines on acute stroke
management concluded that evidence for the clinical management of PSD is
insufficient.8
And you're that stupid that you think napping is the problem? Rather than figuring the real cause of what is causing the napping. I'd have you all fired for incompetence, not understanding cause and effect.
Adults who reported taking frequent daily naps had greater risk for
essential hypertension and stroke compared with those who never or
rarely nap, researchers reported.
Participants who napped more frequently
were also more likely to have poorer social determinants of health,
more comorbidities and more self-reported sleep problems such as
insomnia, snoring or evening chronotype, according to data published in Hypertension.
Data were derived from Yang M, et al. Hypertension. 2022;doi:10.1161/HYPERTENSIONAHA.122.19120.
“These results are especially interesting since millions of people might enjoy a regular, or even daily, nap,” E. Wang, PhD, MD,
professor and chair of the department of anesthesiology at Xiangya
Hospital Central South University in Hunan, China, said in a press
release.
“This may be because, although taking a nap itself is not harmful,
many people who take naps may do so because of poor sleep at night. Poor
sleep at night is associated with poorer health, and naps are not
enough to make up for that,” Michael A. Grandner, PhD, MTR,
director of the Sleep and Health Research Program and the Behavioral
Sleep Medicine Clinic, associate professor of psychiatry at the
University of Arizona in Tucson and co-author of the American Heart
Association’s new Life’s Essential 8 CV health score, said in the
release. “This study echoes other findings that generally show that
taking more naps seems to reflect increased risk for problems with heart
health and other issues.”
Sleep duration was added to the AHA’s Life’s Simple 7 tool in June as the eighth metric for optimal CV and brain health.
As Healio previously reported,
the updated checklist that now includes sleep health metrics showed
about 80% of Americans have low to moderate CV health, with the largest
gaps noted in diet, physical activity and BMI.
Daily napping and risk
To better understand the relationship between the frequency of
daytime napping and the incidence of essential hypertension or stroke,
researchers in China assessed the data of 358,451 participants in the UK
Biobank free of hypertension or stroke at baseline (mean age, 55 years,
43% men). The median follow-up duration was 11.16 years.
Daytime napping was self-reported with the following responses: never/rarely, sometimes, usually or prefer not to answer.
The researchers observed individuals who reported usually napping had
higher risk for essential hypertension (HR = 1.12; 95% CI, 1.08-1.17),
stroke (HR = 1.24; 95% CI, 1.1-1.39) and ischemic stroke (HR = 1.2; 95%
CI, 1.05-1.36) compared with individuals who reported never or rarely
napping.
Risk for essential hypertension, stroke and ischemic stroke was
slightly lower among those who reported sometimes napping compared with
usually napping but remained elevated compared with never/rarely
napping.
The researchers noted that people who reported daytime napping were
more likely to be men, older, non-European, less educated; to have lower
income, higher BMI, higher waist-hip ratio, higher Townsend deprivation
index; and to have a history of smoking, psychiatric disorder, high
cholesterol and diabetes. Individuals who reported daytime napping were
also more likely to sleep longer at nighttime and reported sleep
problems, including insomnia, snoring or evening chronotype.
Validation using Mendelian randomizations
To validate these results, researchers conducted a two-sample
Mendelian randomization for the association between daytime napping
frequency and essential hypertension using the FinnGen Biobank, and
stroke and ischemic stroke were validated using the MEGASTROKE
consortium and a corresponding one-sample Mendelian randomization.
In both the one- and two-sample Mendelian randomizations, researchers
reported that increased daytime napping frequency was linked in a
causal manner to risk for essential hypertension in the FinnGen Biobank
(OR = 1.43; 95% CI, 1.06-1.92) and UK Biobank (OR = 1.4; 95% CI,
1.28-1.58).
Moreover, the results of the two-sample Mendelian randomization in
the MEGATROKE also validated daytime napping frequency as a potential
causal risk factor for ischemic stroke (OR = 1.29; 95% CI, 1.04-1.62).
“The specific biological mechanism for the effect of daytime napping
on BP regulation or stroke has not yet been discovered. The underlying
mechanisms are poorly understood but may include increased inflammatory
indices or the long-term effect of a BP peak after a daytime nap,” the
researchers wrote. “Our study, along with previous clinical studies,
suggests that further examination of the mechanistic basis of the
association between a healthy sleep pattern, including daytime napping,
and cardiovascular disease is necessary.”
IN WHAT MULTIVERSE DO YOU LIVE WHERE PREDICTIONS OF STROKE IMPAIRMENT HELP SURVIVORS RECOVER ONE IOTA? In my stroke world you'd all be fired for not solving stroke, just wasting time and money.
Stroke
survivors are at an increased risk of developing post-stroke cognitive
impairment and post-stroke dementia; those at risk could be identified
by brain imaging routinely performed at stroke onset.
Aim:
This
systematic review aimed to identify features which are associated with
post-stroke cognitive impairment (including dementia), on magnetic
resonance imaging (MRI) performed at stroke diagnosis.
Summary of review:
We
searched the literature from inception to January 2022 and identified
10,284 records. We included studies that performed MRI at the time of
stroke (0-30 days after a stroke) and assessed cognitive outcome at
least three months after stroke. We synthesised findings from 26 papers,
comprising 27 stroke-populations (N=13,114, average age range=40-80
years, 19-62% female). When data were available, we pooled unadjusted
(ORu) and adjusted (ORa) odds ratios.
We found associations
between cognitive outcomes and presence of cerebral atrophy (3 studies,
N=453, ORu=2.48, 95%CI=1.15-4.62), presence of microbleeds (2 studies,
N=9151, ORa=1.36, 95%CI=1.08-1.70), and increasing severity of white
matter hyperintensities (3 studies, N=704, ORa=1.26, 95%CI=1.06-1.49).
Increasing cerebral small vessel disease score was associated with
cognitive outcome following unadjusted analysis only (2 studies, N=499,
ORu=1.34, 95%CI=1.12-1.61; 3 studies, N=950, ORa=1.23, 95%CI=0.96-1.57).
Associations remained after controlling for pre-stroke cognitive
impairment. We did not find associations between other stroke features
and cognitive outcome, or there were insufficient data.
Conclusions:
Acute
stroke MRI features may enable healthcare professionals to identify
patients at risk of post-stroke cognitive problems. However, there is
still substantial uncertainty about the prognostic utility(Really, There is no utility in this prediction. Do you even have a brain?)of acute MRI
for this.
I guess that no one took the initiative and created protocols from Margaret
Yekutiel writing a whole book about this in 2001, 'Sensory Re-Education of the Hand After Stroke'. And 21 years later the protocol still hasn't been done. I'd fire a whole lot of people for such long lasting incompetence.
Stroke-induced
somatosensory impairments seem to be clinically overlooked, despite
their prevalence and influence on motor recovery post-stroke. Interest
in technology has been gaining traction over the past few decades as a
promising method to facilitate stroke rehabilitation. This
questionnaire-based cross-sectional study aimed to identify current
clinical practice and perspectives on the management of somatosensory
impairments post-stroke and the use of technology in assessing outcome
measures and providing intervention. Participants were 132
physiotherapists and occupational therapists currently working with
stroke patients in public hospitals and rehabilitation centres in
Singapore. It was found that the majority (64.4%) of the therapists
spent no more than half of the time per week on somatosensory
interventions. Functional or task-specific training was the primary form
of intervention applied to retrain somatosensory functions in stroke
survivors. Standardised assessments (43.2%) were used less frequently
than non-standardised assessments (97.7%) in clinical practice, with the
sensory subscale of the Fugl-Meyer Assessment being the most popular
outcome measure, followed by the Nottingham Sensory Assessment. While
the adoption of technology for assessment was relatively scarce, most
therapists (87.1%) reported that they have integrated technology into
intervention. There was a common agreement that proprioception is an
essential component in stroke rehabilitation, and that robotic
technology combined with conventional therapy is effective in enhancing
stroke rehabilitation, particularly for retraining proprioception. Most
therapists identified price, technology usability, and lack of available
space as some of the biggest barriers to integrating robotic technology
in stroke rehabilitation. Standardised assessments and interventions
targeting somatosensory functions should be more clearly delineated in
clinical guidelines. Although therapists were positive about
technology-based rehabilitation, obstacles that make technology
integration challenging ought to be addressed.
Figures
Citation: Sidarta
A, Lim YC, Wong RA, Tan IO, Kuah CWK, Ang WT (2022) Current clinical
practice in managing somatosensory impairments and the use of technology
in stroke rehabilitation. PLoS ONE 17(8):
e0270693.
https://doi.org/10.1371/journal.pone.0270693
In this multicenter, randomized, placebo-controlled trial we study whether Levodopa
given in addition to usual rehabilitative therapies is associated with a
patient-relevant enhancement of motor recovery after acute stroke.
Methods:
ESTREL (Enhancement of Stroke REhabilitation with Levodopa) is a multicenter, placebo-controlled randomized superiority trial. Patients
with an acute ischemic or hemorrhagic stroke ≤7 days leading to a
clinically meaningful hemiparesis in need of in-hospital rehabilitation
are enrolled in stroke units and later transferred to experienced
neurorehabilitation centers. Participants receive Levodopa 100mg/Carbidopa 25mg three times daily or matching placebo
for 5 weeks in addition to standardized rehabilitative therapy. The
primary outcome is the Fugl-Meyer- Motor Assessment score 3 months after
randomization. We present the characteristics of the first 200 of 610 patients to be enrolled.
Results:
13 certified stroke units and 13 neurorehabilitation centers are
involved (“stroke-pathway-trial”). The first 200 participants had a
median age of 73 [IQR 64-82] years and 43.5 % were female. 169 patients
(84.5%) had ischemic stroke. At baseline, the median NIH-Stroke scale
score was 8 [5-10]. Successful 3-month assessment was performed in 183 patients
(91.5%);11 (5%) died, 5 (2.5%) withdrew from the study and 1 patient
missed the clinical 3 months-visit due to the COVID-19 pandemic.
Conclusions:
The ESTREL study will provide evidence whether the additional use of Levodopa in the rehabilitation process of stroke patients is safe and effective. The ESTREL-study started successfully due to the good cooperation between acute stroke units and rehabilitation centers, as well as the high acceptance rate among patients.
Archives of Physical Medicine and Rehabilitation , Volume 103(5) , Pgs. 964-969.
NARIC Accession Number: J89032. What's this? ISSN: 0003-9993. Author(s):de Havenon, Adam; Heitsch, Laura; Sunmonu, Abimbola; Braun, Robynne; Lohse, Keith R.; Cole, John W.; Mistry, Eva; Lindgren, Arne; Worrall, Bradford B.; Cramer, Steven C.. Publication Year: 2022. Number of Pages: 6. Abstract:
Study developed a simple and effective risk score for predicting which
patients will have persistent impairment of upper-extremity motor
function at 90 days post stroke. Data were analyzed for clinical trial
patients hospitalized with acute ischemic stroke who were followed for
90 days to determine functional outcome; the cohort was divided into
balanced derivation and validation samples. The primary outcome was
persistent arm impairment, defined as a National Institutes of Health
Stroke Scale (NIHSS) arm domain score of 2 to 4 at 90 days in patients
who had a 24-hour NIHSS arm score of 1 or more. Least absolute shrinkage
and selection operator regression were used to determine the elements
of the persistent upper-extremity impairment (PUPPI) index. Analyses
included 1,653 patients (827 derivation, 826 validation), of whom 803
(48.6 percent) had persistent arm impairment. The PUPPI index gives 1
point each for age 55 years or older and NIHSS values of worse arm,
worse leg, facial palsy, and total NIHSS (≥10). The optimal cut point
for the PUPPI index was 3 or greater, at which the area under the curve
was greater than 0.75 for the derivation and validation cohorts and when
using NIHSS values from either 24 hours or in a subacute or discharge
time window. Results were similar across different levels of stroke
severity. The PUPPI index can be administered in minutes and could be
used as inclusion criterion in recovery-related clinical trials or, with
additional development, as a prognostic tool for patients, caregivers,
and clinicians. Descriptor Terms: EVALUATION TECHNIQUES, FUNCTIONAL LIMITATIONS, LIMBS, MOBILITY IMPAIRMENTS, MOTOR SKILLS, OUTCOMES, PREDICTION, STROKE.
Citation: de Havenon, Adam, Heitsch, Laura,
Sunmonu, Abimbola, Braun, Robynne, Lohse, Keith R., Cole, John W.,
Mistry, Eva, Lindgren, Arne, Worrall, Bradford B., Cramer, Steven
C.. (2022). Accurate prediction of persistent upper extremity impairment in patients with ischemic stroke. Archives of Physical Medicine and Rehabilitation, 103(5), Pgs. 964-969. Retrieved 7/24/2022, from REHABDATA database.
So what? Nothing here provides survivors with anything at all to get better reaching. Useless. Damn it all, I would have everyone involved with this fired.
Disambiguation
of behavioral restitution from compensation is important to better
understand recovery of upper limb motor control post-stroke and
subsequently design better interventions. Measuring quality of movement
(QoM) during standardized performance assays and functional tasks using
kinematic and kinetic metrics potentially allows for this
disambiguation.
Objectives
To
identify longitudinal studies that used kinematic and/or kinetic
metrics to investigate post-stroke recovery of reaching and assess
whether these studies distinguish behavioral restitution from
compensation.
Methods
A
systematic literature search was conducted using the databases PubMed,
Embase, Scopus, and Wiley/Cochrane Library up to July 1st, 2020. Studies
were identified if they performed longitudinal kinematic and/or kinetic
measurements during reaching, starting within the first 6 months
post-stroke.
Results
Thirty-two
longitudinal studies were identified, which reported a total of
forty-six different kinematic metrics. Although the majority
investigated improvements in kinetics or kinematics to quantify recovery
of QoM, none of these studies explicitly addressed the distinction
between behavioral restitution and compensation. One study obtained
kinematic metrics for both performance assays and a functional task.
Conclusions
Despite
the growing number of kinematic and kinetic studies on post-stroke
recovery, longitudinal studies that explicitly seek to delineate between
behavioral restitution and compensation are still lacking in the
literature. To rectify this situation, future studies should measure
kinematics and/or kinetics during performance assays to isolate
restitution and during a standardized functional task to determine the
contributions of restitution and compensation.
About 80% of stroke survivors suffer from upper extremity motor impairment1 which affects activities of daily living.2
Therefore, being able to use the arm to complete functional tasks is
among the top ten priorities for stroke survivors, caregivers and health
care professionals.3 Upper extremity motor impairment after stroke is comprised of weakness, diminished dexterity and abnormal muscle synergies.4
Most
patients exhibit some degree of spontaneous recovery of upper extremity
motor impairment, with 80-90% of clinical improvements occurring within
the first 8-10 weeks post-stroke.5-7
Studies suggest that reaching movements tend to converge toward healthy
patterns, without necessarily returning fully to pre-stroke patterns
(ie, partial behavioral restitution).8-10
The ability to use the upper limb during functional tasks may further
improve through the use of compensatory strategies, in which patients
accomplish a functional goal in a different way than pre-stroke (ie,
behavioral compensation).11
The ability to distinguish between behavioral restitution and
compensation would help to better identify interventions that can
influence true neurological recovery.
Quality of movement (QoM) reflects the degree of motor control.12 Despite consensus on a standardized set of clinical measures in stroke studies,13 these clinical measures lack the ability to capture small changes in QoM12,14
and cannot distinguish behavioral restitution from compensation.
Longitudinal kinematic studies early after stroke are needed to
investigate the time course of QoM of the upper limb. Recommendations on
suitable study designs were provided by the Stroke Recovery and
Rehabilitation Roundtable (SRRR) task force.12
The arguments in the body of the paper of the SRRR, which are implicit
in the recommendations, suggest kinematic and/or kinetic measurements
during 4 standardized performance assays for quantifying behavioral
restitution in addition to a functional task to distinguish true
recovery from compensation strategies.12
Performance assays are needed to quantify the different components of
motor impairment: weakness, diminished finger individuation and abnormal
muscle synergies. Thereby, performance assays were suggested to serve
as a proxy for behavioral restitution.12 To capture these components of impairment, the SRRR defined the following performance assays: grip strength,15,16 precision grip,16 finger individuation,17,18 and 2D planar reaching.19,20
It was recommended to perform these measurements repeatedly in the
first 6 months post-stroke. Moreover, given the nonlinear time course of
recovery, these measurements should be repeated more frequently in the
first months post-stroke, preferably at fixed times.13
Investigating these performance assays is not only important to
quantify behavioral restitution the in absence of compensation, the
association between performance assays and clinical assessments may also
elucidate which motor impairment component is most strongly represented
by a clinical assessment score. This may make clear whether, for
example, the Fugl-Meyer motor assessment of the upper extremity (FM-UE),
a clinical assessment commonly used in stroke rehabilitation, truly
captures synergy-driven intra-limb coupling or to which degree it is
contaminated by other motor impairment components such as strength.21,22
Furthermore, to determine the degree to which recovery has converged on
normal movement, the SRRR recommended that a healthy control group
should be included.13
A recent review showed that the number of studies that use kinematics
and kinetics to investigate reaching performance is growing
exponentially.23
However, the focus of that particular review was not on longitudinal
studies, nor on the metrics that distinguish between behavioral
restitution and compensation.
Our objective was to review the
literature on the use of kinematic and/or kinetic metrics to measure
recovery of QoM after stroke. We focused on upper limb reaching and
pointing tasks, as they require coordination of the elbow and shoulder,
which is an important component of many daily activities and is often
limited post-stroke as a result of weakness, loss of motor control and
the intrusion of abnormal muscle synergies.19,24 We aimed to:
(1)
identify longitudinal studies that used kinematic and/or kinetic
metrics reflecting QoM to investigate post-stroke recovery of reaching,
to show the reported responsiveness of these metrics over time, and
their longitudinal association with clinical measures and
(2)
assess whether these studies have addressed or provided suggestions on
how to best capture behavioral restitution and distinguish it from
compensation during a reaching task.
