Principles of proportional recovery after stroke generalize to neglect and aphasia

Marchi, Nicola Andrea; Ptak, Radek; Pietro, Marie Di; Schnider, Armin; Guggisberg, Adrian G.

doi:10.1111/ene.13296

Cited by 34 publications

(47 citation statements)

References 9 publications

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“…These combined data increasingly point toward a symbiosis between upper limb and aphasia recovery. We agree with Marchi et al [1] that the chief importance behind their recent observations lies in the potential for more robust therapies. Nonetheless, we propose caution regarding statements of certainty that language improvement, while potentially synergistic with upper limb stroke recovery, can appropriately be evaluated using the proportional recovery rule.…”

supporting

confidence: 92%

“…The recent paper by Marchi et al ('Principles of proportional recovery after stroke generalize to neglect and aphasia') adds to an important dialogue regarding proportional recovery in post-stroke aphasia [1]. The authors concur with a seminal 2010 study by Lazar et al on the proportional recovery rule, defined as the maximum attainment of 70% recovery within a 3-month period from day 1 of stroke, predicted by initial impairment [2].…”

mentioning

confidence: 88%

See 1 more Smart Citation

On the generalizability of post‐stroke proportional recovery

Wortman-Jutt

Edwards

2017

Euro J of Neurology

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supporting

confidence: 92%

mentioning

confidence: 88%

On the generalizability of post‐stroke proportional recovery

Wortman-Jutt

Edwards

2017

Euro J of Neurology

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“…When predicting behavioural performance in humans, these effect sizes are unprecedented. Like many of its counterparts 5,10,12 , this study also reported a group of 'non-fitters', who did not make the predicted recovery. But if non-fitters can be distinguished from fitters at the acute stage, as the authors' results also suggest, the implication is that we can predict most patients' recovery near-perfectly, at least during the first few months after stroke onset.…”

Section: Introductionmentioning

confidence: 54%

“…We found reason to suspect inflation in every study (apart from that by Feng and colleagues), which reported enough information for us to make the judgement. The most common reason why we could not make a judgement was when baselines were only related to recovery through multivariable models which included baseline scores 4,11,12 . But inflation in one variable's effect size will inflate the multivariable model's effect size as well: while we cannot estimate the magnitude of that inflation with any confidence for any particular model, we can predict that it's also there in those multivariable models.…”

Section: Re-examining Studies Of Proportional Recovery After Strokementioning

confidence: 99%

“…Taken together, these studies report analyses involving over 500 patients, spread across different countries with different approaches to rehabilitation, regardless of the patients' ages at stroke onset, stroke type, sex, or therapy dose 2 . And there is increasing evidence that the proportional recovery rule also captures recovery from other post-stroke impairments, including impairments of lower limb function 10 , attention 11,12 , and language 12,13 : one recent study suggests that proportional recovery applies quite generally across cognitive domains 14 . Indeed, even rats appear to recover proportionally after stroke 15 .…”

Section: Introductionmentioning

confidence: 99%

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Recovery after stroke: not so proportional after all?

Hope

Friston

Price

et al. 2018

Preprint

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27Background 28The proportional recovery rule asserts that most stroke survivors recover a fixed proportion of lost 29 function. Reports that the rule can be used to predict recovery, extraordinarily accurately, are 30 rapidly accumulating. Here, we show that the rule may not be as powerful as it seems. 31 Methods 32We provide a formal analysis of the relationship between baseline scores (X), outcomes (Y) and 33 recovery (Y-X), to highlight the shortcomings of the proportional recovery rule, and illustrate those 34 problems with simulations in which synthetic recovery data are derived from different types of 35 recovery processes. 36 Findings 37When the correlation between baseline scores and recovery is stronger than that between baselines 38 scores and outcomes, the former can create an inflated impression of how predictable outcomes 39 really are given baseline scores. This often happens when outcomes are less variable than baseline 40 scores, as is common in empirical studies of recovery after stroke. Moreover, we cannot use the 41 results of these correlations to distinguish proportional recovery from recovery which is either not 42 consistently proportional, or not proportional at all. 43 Interpretation 44Analyses relating baseline scores to subsequent change are a minefield: our formal analysis applies 45 as consistently outside the area of stroke as it does within it. One implication of our analysis is that 46 the proportional recovery rule is not as predictive of real recovery after stroke as recent empirical 47 studies suggest. Another is that different analytical methods will be required to ascertain whether 48 recovery is even proportional at all. 49 50 All rights reserved. No reuse allowed without permission.

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Cortical microstructural changes associated with treated aphasia recovery

Chang

Wilmskoetter

Fridriksson

et al. 2021

Ann Clin Transl Neurol

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Objectives To investigate the hypothesis that language recovery in post‐stroke aphasia is associated with structural brain changes. Methods We evaluated whether treatment‐induced improvement in naming is associated with reorganization of tissue microstructure within residual cortical regions. To this end, we performed a retrospective longitudinal treatment study using comprehensive language‐linguistic assessments and diffusion MRI sequences optimized for the assessment of complex microstructure (diffusional kurtosis imaging) to evaluate the relationship between language treatment response and cortical changes in 26 individuals with chronic stroke‐induced aphasia. We employed elastic net statistical models controlling for baseline factors including age, sex, and time since the stroke, as well as lesion volume. Results We observed that improved naming accuracy (Philadelphia Naming Test) was statistically associated with increased post‐treatment microstructural integrity in the left posterior superior temporal gyrus. Moreover, increase in microstructural integrity in the left middle temporal gyrus and left inferior temporal gyrus was specifically associated with a decrease in semantic paraphasias. This longitudinal relationship between brain tissue integrity and language improvement was not observed in other non‐language related brain regions. Interpretation Our findings provide evidence that structural brain changes in the preserved left hemisphere regions are associated with treatment‐induced language recovery in aphasia and are part of the mechanisms supporting language and brain injury recovery.

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Principles of proportional recovery after stroke generalize to neglect and aphasia

Abstract: Our findings indicate that improvement from neglect or aphasia after stroke shows the same dichotomy and proportionality as observed in motor recovery. This is suggestive of common underlying principles of plasticity, which apply to motor and cognitive functions.

Cited by 34 publications

References 9 publications

On the generalizability of post‐stroke proportional recovery

On the generalizability of post‐stroke proportional recovery

Recovery after stroke: not so proportional after all?

Cortical microstructural changes associated with treated aphasia recovery

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