What Do Motor “Recovery” and “Compensation” Mean in Patients Following Stroke?

Levin, Mindy F.; Kleim, Jeffrey A.; Wolf, Steven L.

doi:10.1177/1545968308328727

Cited by 745 publications

(681 citation statements)

References 67 publications

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“…For the chronic group, the intervention was the main factor that influenced the improvement since natural recovery could potentially be excluded. After several years post-stroke, UL impairment small improvements can still occur which might not be a result of true motor recovery but of compensatory movements (Levin, Kleim, & Wolf, 2009). Therefore, integrating UL RT in community hospitals can potentially result in reduction of impairments which can last for three months and lower overall healthcare costs than traditional rehabilitation (Hesse, Werner, Kabbert, & Buschfort, 2014;.…”

Section: Discussionmentioning

confidence: 99%

A double-blinded randomised controlled trial exploring the effect of anodal transcranial direct current stimulation and uni-lateral robot therapy for the impaired upper limb in sub-acute and chronic stroke

Triccas

Burridge

Hughes

et al. 2015

NRE

111

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Abstract. BACKGROUND:Neurorehabilitation technologies such as robot therapy (RT) and transcranial Direct Current Stimulation (tDCS) can promote upper limb (UL) motor recovery after stroke. OBJECTIVE: To explore the effect of anodal tDCS with uni-lateral and three-dimensional RT for the impaired UL in people with sub-acute and chronic stroke. METHODS: A pilot randomised controlled trial was conducted. Stroke participants had 18 one-hour sessions of RT (Armeo ® Spring) over eight weeks during which they received 20 minutes of either real tDCS or sham tDCS during each session. The primary outcome measure was the Fugl-Meyer assessment (FMA) for UL impairments and secondary were: UL function, activities and stroke impact collected at baseline, post-intervention and three-month follow-up. RESULTS: 22 participants (12 sub-acute and 10 chronic) completed the trial. No significant difference was found in FMA between the real and sham tDCS groups at post-intervention and follow-up (p = 0.123). A significant 'time' x 'stage of stroke' was found for FMA (p = 0.016). A higher percentage improvement was noted in UL function, activities and stroke impact in people with sub-acute compared to chronic stroke. CONCLUSIONS: Adding tDCS did not result in an additional effect on UL impairment in stroke. RT may be of more benefit in the sub-acute than chronic phase.

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Section: Discussionmentioning

confidence: 99%

A double-blinded randomised controlled trial exploring the effect of anodal transcranial direct current stimulation and uni-lateral robot therapy for the impaired upper limb in sub-acute and chronic stroke

Triccas

Burridge

Hughes

et al. 2015

NRE

111

View full text Add to dashboard Cite

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“…A possible explanation for the correlation between WMFT but not UE-FM scores and fMRI measures is that the WMFT incorporates measures of task accomplishment and is thought to more accurately distinguish between motor recovery and compensation. 40 …”

Section: Figure 3 Contrast Of Affected Limb Movements Postinterventiomentioning

confidence: 99%

Bihemispheric brain stimulation facilitates motor recovery in chronic stroke patients

Lindenberg

Renga²,

Zhu³

et al. 2010

Neurology

499

448

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Objective: Motor recovery after stroke depends on the integrity of ipsilesional motor circuits and interactions between the ipsilesional and contralesional hemispheres. In this sham-controlled randomized trial, we investigated whether noninvasive modulation of regional excitability of bilateral motor cortices in combination with physical and occupational therapy improves motor outcome after stroke. Methods:Twenty chronic stroke patients were randomly assigned to receive 5 consecutive sessions of either 1) bihemispheric transcranial direct current stimulation (tDCS) (anodal tDCS to upregulate excitability of ipsilesional motor cortex and cathodal tDCS to downregulate excitability of contralesional motor cortex) with simultaneous physical/occupational therapy or 2) sham stimulation with simultaneous physical/occupational therapy. Changes in motor impairment (Upper Extremity Fugl-Meyer) and motor activity (Wolf Motor Function Test) assessments were outcome measures while functional imaging parameters were used to identify neural correlates of motor improvement.

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“…recovery), time-points of measurement, and distinguish between different types of outcomes. 47 Simply stated, our challenge is not just to agree on a core set of measurements but to consider what we need to measure and why, to improve rehabilitation and recovery trial methods.…”

Section: Theme 4: Measurement In Clinical Trialsmentioning

confidence: 99%

Moving rehabilitation research forward: Developing consensus statements for rehabilitation and recovery research

Bernhardt

Borschmann

Boyd

et al. 2016

International Journal of Stroke

132

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Stroke recovery is the next frontier in stroke medicine. While growth in rehabilitation and recovery research is exponential, a number of barriers hamper our ability to rapidly progress the field. Standardized terminology is absent in both animal and human research, methods are poorly described, recovery biomarkers are not well defined, and we lack consistent timeframes or measures to examine outcomes. Agreed methods and conventions for developing, monitoring, evaluating and reporting interventions directed at improving recovery are lacking, and current approaches are often not underpinned by biology. We urgently need to better understand the biology of recovery and its time course in both animals and humans to translate evidence from basic science into clinical trials. A new international partnership of stroke recovery and rehabilitation experts has committed to advancing the research agenda. In May 2016, the first Stroke Recovery and Rehabilitation Roundtable will be held, with the aim of achieving an agreed approach to the development, conduct and reporting of research. A range of methods will be used to achieve consensus in four priority areas: preclinical recovery research; biomarkers of recovery; intervention development, monitoring and reporting; and measurement in clinical trials. We hope to foster a global network of researchers committed to advancing this exciting field. Recovery from stroke is challenging for many survivors. They deserve effective treatments underpinned by our evolving understanding of brain recovery and human behaviour. Working together, we can develop game-changing interventions to improve recovery and quality of life in those living with stroke.

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What Do Motor “Recovery” and “Compensation” Mean in Patients Following Stroke?

Cited by 745 publications

References 67 publications

A double-blinded randomised controlled trial exploring the effect of anodal transcranial direct current stimulation and uni-lateral robot therapy for the impaired upper limb in sub-acute and chronic stroke

A double-blinded randomised controlled trial exploring the effect of anodal transcranial direct current stimulation and uni-lateral robot therapy for the impaired upper limb in sub-acute and chronic stroke

Bihemispheric brain stimulation facilitates motor recovery in chronic stroke patients

Moving rehabilitation research forward: Developing consensus statements for rehabilitation and recovery research

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