Understanding the mechanisms underlying recovery after stroke

Kwakkel, Gert; Buma, Floor E.; Selzer, Michael E.

doi:10.1017/cbo9780511995590.004

Cited by 8 publications

(8 citation statements)

References 176 publications

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“…This is in accordance with the logarithmic pattern of sensorimotor recovery after stroke, in which the greatest changes on the body functions and activities domains occur within the first 12 weeks after symptom onset (37,38). In this period, behavioral restitution takes place, and thereafter, changes occur predominantly due to compensational mechanisms, reaching a plateau between ∼3 and 6 months poststroke (33). Low-frequent assessment in the chronic phase allows for monitoring the patient's impairments and disabilities.…”

Section: Measurement Time Pointssupporting

confidence: 82%

“…The consensus-based core set contains nine OMs that cover a wide range of measurement constructs within all ICF domains that are applicable to patients with different stroke severity levels. In addition, a framework with fixed measurement time points was established, following a nonlinear pattern (33), with more frequent measurements within the first 3 months after stroke and larger measurement intervals in the chronic phase. The core set was developed on the basis of independent opinions of international experts of different health care professions.…”

Section: Discussionmentioning

confidence: 99%

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Consensus-Based Core Set of Outcome Measures for Clinical Motor Rehabilitation After Stroke—A Delphi Study

et al. 2020

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Introduction: Outcome measures are key to tailor rehabilitation goals to the stroke patient's individual needs and to monitor poststroke recovery. The large number of available outcome measures leads to high variability in clinical use. Currently, an internationally agreed core set of motor outcome measures for clinical application is lacking. Therefore, the goal was to develop such a set to serve as a quality standard in clinical motor rehabilitation poststroke. Methods: Outcome measures for the upper and lower extremities, and activities of daily living (ADL)/stroke-specific outcomes were identified and presented to stroke rehabilitation experts in an electronic Delphi study. In round 1, clinical feasibility and relevance of the outcome measures were rated on a 7-point Likert scale. In round 2, those rated at least as "relevant" and "feasible" were ranked within the body functions, activities, and participation domains of the International Classification of Functioning, Disability, and Health (ICF). Furthermore, measurement time points poststroke were indicated. In round 3, answers were reviewed in reference to overall results to reach final consensus. Results: In total, 119 outcome measures were presented to 33 experts from 18 countries. The recommended core set includes the Fugl-Meyer Motor Assessment and Action Research Arm Test for the upper extremity section; the Fugl-Meyer Motor Assessment, 10-m Walk Test, Timed-Up-and-Go, and Berg Balance Scale for the lower extremity section; and the National Institutes of Health Stroke Scale, and Barthel Pohl et al. Core Set for Clinical Stroke Rehabilitation Index or Functional Independence Measure for the ADL/stroke-specific section. The Stroke Impact Scale was recommended spanning all ICF domains. Recommended measurement time points are days 2 ± 1 and 7; weeks 2, 4, and 12; 6 months poststroke and every following 6th month. Discussion and Conclusion: Agreement was found upon a set of nine outcome measures for application in clinical motor rehabilitation poststroke, with seven measurement time points following the stages of poststroke recovery. This core set was specifically developed for clinical practice and distinguishes itself from initiatives for stroke rehabilitation research. The next challenge is to implement this clinical core set across the full stroke care continuum with the aim to improve the transparency, comparability, and quality of stroke rehabilitation at a regional, national, and international level.

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Section: Measurement Time Pointssupporting

confidence: 82%

Section: Discussionmentioning

confidence: 99%

Consensus-Based Core Set of Outcome Measures for Clinical Motor Rehabilitation After Stroke—A Delphi Study

et al. 2020

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“…Functional deficits from stroke are not only secondary to focal brain damage in a core lesion and surrounding penumbra but result also from a dysfunction of corresponding neural networks responsible for a given behavior/function. The disturbance of the interplay between the ischemic core and adjacent and remote brain areas is called diaschisis; the reduced neuronal connectivity and excitatory input leads to a decreased metabolism in these remote structures (Kwakkel et al, 2014).…”

Section: Neuroplasticity and Stroke Recoverymentioning

confidence: 99%

“…After the acute phase of stroke the human brain, in the absence of (significant) neuronal regeneration, undergoes a (spontaneous) functional reorganization in order to improve function (Kwakkel et al, 2014). This process of neuroplasticity can be promoted by neurorehabilitation.Neurorehabilitation, including physical therapy, occupational therapy, speech therapy, and neuropsychological therapy, aims at improving activities of daily living and cognitive functioning by extensive exercise and training.…”

Section: Neuroplasticity and Stroke Recoverymentioning

confidence: 99%

The role of sleep in recovery following ischemic stroke: A review of human and animal data

Duss¹,

Seiler²,

Schmidt

et al. 2017

Neurobiology of Sleep and Circadian Rhythms

125

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Despite advancements in understanding the pathophysiology of stroke and the state of the art in acute management of afflicted patients as well as in subsequent neurorehabilitation training, stroke remains the most common neurological cause of long-term disability in adulthood. To enhance stroke patients’ independence and well-being it is necessary, therefore, to consider and develop new therapeutic strategies and approaches. We postulate that sleep might play a pivotal role in neurorehabilitation following stroke. Over the last two decades compelling evidence for a major function of sleep in neuroplasticity and neural network reorganization underlying learning and memory has evolved. Training and learning of new motor skills and knowledge can modulate the characteristics of subsequent sleep, which additionally can improve memory performance. While healthy sleep appears to support neuroplasticity resulting in improved learning and memory, disturbed sleep following stroke in animals and humans can impair stroke outcome. In addition, sleep disorders such as sleep disordered breathing, insomnia, and restless legs syndrome are frequent in stroke patients and associated with worse recovery outcomes. Studies investigating the evolution of post-stroke sleep changes suggest that these changes might also reflect neural network reorganization underlying functional recovery. Experimental and clinical studies provide evidence that pharmacological sleep promotion in rodents and treatment of sleep disorders in humans improves functional outcome following stroke. Taken together, there is accumulating evidence that sleep represents a “plasticity state” in the process of recovery following ischemic stroke. However, to test the key role of sleep and sleep disorders for stroke recovery and to better understand the underlying molecular mechanisms, experimental research and large-scale prospective studies in humans are necessary. The effects of hospital conditions, such as adjusting light conditions according to the patients’ sleep-wake rhythms, or sleep promoting drugs and non-invasive brain stimulation to promote neuronal plasticity and recovery following stroke requires further investigation.

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“…To assess subjective individual goals of a patient, self-reported ICF questionnaires are still needed, and for specific sensory-motor and cognitive dysfunctions, standardized assessments should still be used. Recovery after stroke can be the result of both substitution and restitution within the defined levels of the ICF classification [ 27 ]. LIMOS describes the possibilities of a patient in performing activities, irrespective whether recovery involves restitution (e.g.…”

Section: Discussionmentioning

confidence: 99%

Validation of the New Lucerne ICF Based Multidisciplinary Observation Scale (LIMOS) for Stroke Patients

et al. 2015

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BackgroundValid and multidisciplinary assessment of a stroke patient's ability to perform activities of daily living is very important to define individual goals and to plan targeted rehabilitation. Until today, there is no observation scale that relies on International Classification of Functioning, Disability and Health (ICF). The aim of the present study was to develop and evaluate the reliability and validity of a new multidisciplinary observation scale for stroke patients, shortly called LIMOS, which is based on ICF.MethodsIn a first phase, LIMOS was defined, using a Delphi approach, by an expert panel and a pilot testing was conducted in a small group of stroke patients (n =10) to investigate feasibility and practicability. In a second phase, LIMOS was assessed for its reliability (internal consistency and test-retest reliability) and validity in a large cohort of stroke patients (n = 102). For convergent validity, the correlation between total scores of the LIMOS and the Functional Independence Measure (FIM) was assessed.ResultsLIMOS consisted of seven ICF chapters incorporating 45 domains. A high internal consistency (=0.98) of LIMOS was found. Furthermore, good test-retest reliability at item and subscale level was found. Principal component analysis revealed that among the seven ICF chapters, four components could be found: (1) interpersonal activities, mobility and self-care, (2) communication, (3) knowledge and general tasks, and (4) domestic life. Significant associations were found between LIMOS and the FIM indicating good convergent validity.ConclusionsThe new LIMOS is a reliable and valid observation scale for stroke patients based on ICF, which can be used by a multidisciplinary team working in a neurorehabilitation setting.

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Understanding the mechanisms underlying recovery after stroke

Cited by 8 publications

References 176 publications

Consensus-Based Core Set of Outcome Measures for Clinical Motor Rehabilitation After Stroke—A Delphi Study

Consensus-Based Core Set of Outcome Measures for Clinical Motor Rehabilitation After Stroke—A Delphi Study

The role of sleep in recovery following ischemic stroke: A review of human and animal data

Validation of the New Lucerne ICF Based Multidisciplinary Observation Scale (LIMOS) for Stroke Patients

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