Arguments for the biological and predictive relevance of the proportional recovery rule

Goldsmith, Jeff; Kitago, Tomoko; Garza, Angel Garcia de La; Kundert, Robinson; Luft, Andreas R.; Stinear, Cathy M.; Byblow, Winston D.; Kwakkel, Gert; Krakauer, John W.

doi:10.7554/elife.80458

Cited by 5 publications

(5 citation statements)

References 36 publications

(63 reference statements)

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“…These differences should be explored in future studies with a direct comparison between these two populations and more sophisticated approaches to quantify proportional recovery. The proportional recovery framework remains of biological and predictive relevance in the stroke field 71 and, similar to stroke 68 , is an exciting new venue for predictive studies and clinical trial design in SCI. Finally, here, similar to the stroke field 68,[72][73][74] , we attribute our findings to spontaneous biological recovery.…”

Section: Discussionmentioning

confidence: 99%

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Segmental motor recovery after cervical spinal cord injury relates to density and integrity of corticospinal tract projections

Balbinot

Kalsi-Ryan

et al. 2023

Nat Commun

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Cervical spinal cord injury (SCI) causes extensive impairments for individuals which may include dextrous hand function. Although prior work has focused on the recovery at the person-level, the factors determining the recovery of individual muscles are poorly understood. Here, we investigate the muscle-specific recovery after cervical spinal cord injury in a retrospective analysis of 748 individuals from the European Multicenter Study about Spinal Cord Injury (NCT01571531). We show associations between corticospinal tract (CST) sparing and upper extremity recovery in SCI, which improves the prediction of hand muscle strength recovery. Our findings suggest that assessment strategies for muscle-specific motor recovery in acute spinal cord injury are improved by accounting for CST sparing, and complement person-level predictions.

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Section: Discussionmentioning

confidence: 99%

“…In the present study, we were unable to quantify the dose and timing of therapy delivered to each individual because of the nature of the dataset. Future clinical trials should explore how interventions may induce changes that are different or greater than those expected under the proportional recovery 71 .…”

Section: Discussionmentioning

confidence: 99%

Segmental motor recovery after cervical spinal cord injury relates to density and integrity of corticospinal tract projections

Balbinot

Kalsi-Ryan

et al. 2023

Nat Commun

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“…Interactive gaming, as in Dextrain, provides enhanced sensory feedback which may help to increase intensity of rehabilitation [ 41 ]. We found no relation between baseline BBT and BBT change (T1-T0; Additional file 2 : Figure S4), suggesting that improvements after both CT and Dextrain were not proportional to initial BBT [ 42 ]. Perhaps the therapy (either CT or Dextrain) was sufficiently intense to reopen the neuroplasticity window [ 43 ].…”

Section: Discussionmentioning

confidence: 99%

Efficacy of interactive manual dexterity training after stroke: a pilot single-blinded randomized controlled trial

Térémetz,

Hamdoun,

Colle

et al. 2023

J NeuroEngineering Rehabil

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Objective To compare the efficacy of Dextrain Manipulandum™ training of dexterity components such as force control and independent finger movements, to dose-matched conventional therapy (CT) post-stroke. Methods A prospective, single-blind, pilot randomized clinical trial was conducted. Chronic-phase post-stroke patients with mild-to-moderate dexterity impairment (Box and Block Test (BBT) > 1) received 12 sessions of Dextrain or CT. Blinded measures were obtained before and after training and at 3-months follow-up. Primary outcome was BBT-change (after–before training). Secondary outcomes included changes in motor impairments, activity limitations and dexterity components. Corticospinal excitability and short intracortical inhibition (SICI) were measured using transcranial magnetic stimulation. Results BBT-change after training did not differ between the Dextrain (N = 21) vs CT group (N = 21) (median [IQR] = 5[2–7] vs 4[2–7], respectively; P = 0.36). Gains in BBT were maintained at the 3-month post-training follow-up, with a non-significant trend for enhanced BBT-change in the Dextrain group (median [IQR] = 3[− 1–7.0], P = 0.06). Several secondary outcomes showed significantly larger changes in the Dextrain group: finger tracking precision (mean ± SD = 0.3 ± 0.3N vs − 0.1 ± 0.33N; P < 0.0018), independent finger movements (34.7 ± 25.1 ms vs 7.7 ± 18.5 ms, P = 0.02) and maximal finger tapping speed (8.4 ± 7.1 vs 4.5 ± 4.9, P = 0.045). At follow-up, Dextrain group showed significantly greater improvement in Motor Activity Log (median/IQR = 0.7/0.2–0.8 vs 0.2/0.1–0.6, P = 0.05). Across both groups SICI increased in patients with greater BBT-change (Rho = 0.80, P = 0.006). Comparing Dextrain subgroups with maximal grip force higher/lower than median (61.2%), BBT-change was significantly larger in patients with low vs high grip force (7.5 ± 5.6 vs 2.9 ± 2.8; respectively, P = 0.015). Conclusions Although immediate improvements in gross dexterity post-stroke did not significantly differ between Dextrain training and CT, our findings suggest that Dextrain enhances recovery of several dexterity components and reported hand-use, particularly when motor impairment is moderate (low initial grip force). Findings need to be confirmed in a larger trial. Trial registration ClinicalTrials.gov NCT03934073 (retrospectively registered)

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“…Findings from several longitudinal studies show that for most stroke patients spontaneous neurological recovery and behavioral restitution follow a logistic pattern that plateaus within the first 10 weeks post-stroke, regardless of their age or the type and amount of therapy they complete (Figure 2). 9,16–18 Spontaneous neurological recovery is observed for the upper limb 19–21 and lower limb, 22,23 as well as somatosensory, 24,25 visuospatial, 26 and language functions. 27 Patients with initially mild to moderate motor impairment typically exhibit early spontaneous neurological recovery of upper and lower limb motor functions.…”

Section: Motor Rehabilitation After Stroke Frameworkmentioning

confidence: 99%

Motor rehabilitation after stroke: European Stroke Organisation (ESO) consensus-based definition and guiding framework

Kwakkel,

Stinear,

Essers

et al. 2023

European Stroke Journal

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Purpose: To propose a consensus-based definition and framework for motor rehabilitation after stroke. Methods: An expert European working group reviewed the literature, attaining internal consensus after external feedback. Findings: Motor rehabilitation is defined as a process that engages people with stroke to benefit their motor function, activity capacity and performance in daily life. It is necessary for people with residual motor disability whose goal is to enhance their functioning, independence and participation. Motor rehabilitation operates through learning- and use-dependent mechanisms. The trajectory of motor recovery varies across patients and stages of recovery. Early behavioral restitution of motor function depends on spontaneous biological mechanisms. Further improvements in activities of daily living are achieved by compensations. Motor rehabilitation is guided by regular assessment of motor function and activity using consensus-based measures, including patient-reported outcomes. Results are discussed with the patient and their carers to set personal goals. During motor rehabilitation patients learn to optimize and adapt their motor, sensory and cognitive functioning through appropriately dosed repetitive, goal-oriented, progressive, task- and context-specific training. Motor rehabilitation supports people with stroke to maximize health, well-being and quality of life. The framework describes the International Classification of Functioning, Disability and Health in the context of stroke, describes neurobiological mechanisms of behavioral restitution and compensation, and summarizes recommendations for clinical assessment, prediction tools, and motor interventions with strong recommendations from clinical practice guidelines (2016–2022). Conclusions: This definition and framework may guide clinical educators, inform clinicians on current recommendations and guidelines, and identify gaps in the evidence base.

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Arguments for the biological and predictive relevance of the proportional recovery rule

Cited by 5 publications

References 36 publications

Segmental motor recovery after cervical spinal cord injury relates to density and integrity of corticospinal tract projections

Segmental motor recovery after cervical spinal cord injury relates to density and integrity of corticospinal tract projections

Efficacy of interactive manual dexterity training after stroke: a pilot single-blinded randomized controlled trial

Motor rehabilitation after stroke: European Stroke Organisation (ESO) consensus-based definition and guiding framework

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