Proportional Motor Recovery After Stroke

Stinear, Cathy M.; Byblow, Winston D.; Ackerley, Suzanne J.; Smith, Marie-Claire; Borges, Victor M.; Barber, P. Alan

doi:10.1161/strokeaha.116.016020

Cited by 121 publications

(144 citation statements)

References 14 publications

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“…The proportional recovery rule is attractive party because it formalises the popular, clinical intuition that initial symptom severity is by far the most, and perhaps the only, important predictor of recovery after stroke. The rule is also striking because it implies that recovery is simple and consistent across patients (non-fitters notwithstanding), and because that implication appears to be justified by an increasing number of extremely strong empirical results 3,7,[9][10][11][12][13][14]21,28,30 . That incredible, empirical power has even begun to encourage the search for some deeper, general recovery mechanism which cuts across cognitive domains 21 .…”

Section: Discussionmentioning

confidence: 99%

“…Evidence in support of this 'proportional recovery rule' is rapidly accumulating, as summarised by Stinear in a recent review 2 . In five separate studies since 2015 [3][4][5][6][7] , researchers used the Fugl-Meyer test to assess stroke patients' upper limb motor function within two weeks after stroke onset, and then again either three or six months post-stroke. The results were consistent with earlier observations 8,9 that most patients recovered around 70% of lost upper limb function.…”

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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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Recovery after stroke: not so proportional after all?

Hope

Friston

Price

et al. 2018

Preprint

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“…35 Based on the congruency of these findings with the human literature, it is plausible that common biological stroke recovery processes that are engaged by these variables might exist across mammalian species. 36 In humans, it has been demonstrated that this proportional recovery rule can be used to predict recovery of impairments within a variety of functional domains, including both upper 32,33,37 and lower limbs, 38 aphasia, 39 and visual neglect. 40 To address this secondary objective, we assessed whether our model of initial poststroke impairment, cortical infarct volume, and rehabilitation intensity 35 could be generalized as predictors of recovery on an additional forelimb motor task (single-pellet reaching).…”

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confidence: 99%

Synergistic Effects of Enriched Environment and Task-Specific Reach Training on Poststroke Recovery of Motor Function

Jeffers

Corbett

2018

Stroke

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Background and Purpose-Reach training in concert with environmental enrichment provides functional benefits after experimental stroke in rats. The present study extended these findings by assessing whether intensive task-specific reach training or enrichment initiated alone would provide similar functional benefit. Additionally, we investigated whether the 70% recovery rule, or a combined model of initial poststroke impairment, cortical infarct volume, and rehabilitation intensity, could predict recovery in the single-pellet task, as previously found for the Montoya staircase. Methods-Rats were trained on single-pellet reaching before middle cerebral artery occlusion via intracerebral injection of ET-1 (endothelin-1). There were 4 experimental groups: stroke+enrichment, stroke+reaching, stroke+enrichment+reaching, and sham+enrichment+reaching. Reaching rehabilitation utilized a modified Whishaw box that encouraged impaired forelimb reaching for 6 hours per day, 5 days per week, for 4 weeks. All treatment paradigms began 7 days after ischemia with weekly assessment on the single-pellet task during rehabilitation and again 4 weeks after rehabilitation concluded. Results-Rats exposed to the combination of enrichment and reaching showed the greatest improvement in pellet retrieval and comparable performance to shams after 3 weeks of treatment, whereas those groups that received a monotherapy remained significantly impaired at all time points. Initial impairment alone did not significantly predict recovery in single-pellet as the 70% rule would suggest; however, a combined model of cortical infarct volume and rehabilitation intensity predicted change in pellet retrieval on the single-pellet task with the same accuracy as previously shown with the staircase, demonstrating the generalizability of this model across reaching tasks. Conclusions-Task-specific reach training and environmental enrichment have synergistic effects in rats that persist long after rehabilitation ends, and this recovery is predicted by infarct volume and rehabilitation intensity.

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“…That is, the observed recovery of a given individual can be predicted based on that individual's initial impairment: approximately 70% of their maximal potential for recovery . This is known as the proportional recovery rule, and has been shown valid for the recovery of movements (including balance control), aspects of cognition, visuospatial neglect, and aphasia . There is variability in this recovery profile whereby the expression of proportional recovery in the motor domain depends on the integrity of the corticospinal tract .…”

Section: Current Challenges In the Field Of Stroke Recoverymentioning

confidence: 99%

“…45 This is known as the proportional recovery rule, 14 and has been shown valid for the recovery of movements (including balance control), aspects of cognition, visuospatial neglect, and aphasia. [45][46][47][48][49][50][51][52] There is variability in this recovery profile whereby the expression of proportional recovery in the motor domain depends on the integrity of the corticospinal tract. 51,52 For example, stroke survivors for whom a motor evoked potential (MEP) can be elicited demonstrate proportional recovery, in contrast to those who do not have an MEP.…”

Section: Current Challenges In the Field Of Stroke Recoverymentioning

confidence: 99%

Music‐supported therapy for stroke motor recovery: theoretical and practical considerations

Chen

2018

Annals of the New York Academy of Sciences

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Music may confer benefits for well-being and health. What is the state of knowledge and evidence for a role of music in supporting the rehabilitation of movements after stroke? In this brief perspective, I provide background context and information about stroke recovery in general, in order to spark reflection and discussion for how we think music may impact motor recovery, given the current clinical milieu.

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Proportional Motor Recovery After Stroke

Abstract: URL: http://www.anzctr.org.au. Unique identifier: ANZCTR12611000755932.

Cited by 121 publications

References 14 publications

Recovery after stroke: not so proportional after all?

Recovery after stroke: not so proportional after all?

Synergistic Effects of Enriched Environment and Task-Specific Reach Training on Poststroke Recovery of Motor Function

Music‐supported therapy for stroke motor recovery: theoretical and practical considerations

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