Is the proportional recovery rule applicable to the lower limb after a first-ever ischemic stroke?
To investigate (a) the applicability of the proportional recovery rule of spontaneous neurobiological recovery to motor function of the paretic lower extremity (LE); and (b) the presence of fitters and non-fitters of this prognostic rule poststroke. When present, the clinical threshold for fitting n...
| Main Authors: | , , , |
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| Format: | Article |
| Language: | English |
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Public Library of Science (PLoS)
2018-01-01
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| Series: | PLoS ONE |
| Online Access: | http://europepmc.org/articles/PMC5766096?pdf=render |
| _version_ | 1811195095097016320 |
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| author | Janne M Veerbeek Caroline Winters Erwin E H van Wegen Gert Kwakkel |
| author_facet | Janne M Veerbeek Caroline Winters Erwin E H van Wegen Gert Kwakkel |
| author_sort | Janne M Veerbeek |
| collection | DOAJ |
| description | To investigate (a) the applicability of the proportional recovery rule of spontaneous neurobiological recovery to motor function of the paretic lower extremity (LE); and (b) the presence of fitters and non-fitters of this prognostic rule poststroke. When present, the clinical threshold for fitting nor non-fitting would be determined, as well as within-subject generalizability to the paretic upper extremity (UE).Prospective cohort study in which the Fugl-Meyer Assessment (FMA)-LE and FMA-UE were measured <72 hours and 6 months poststroke. Predicted maximum potential recovery was defined as [FMA-LEmax-FMA-LEinitial = 34 -FMA-LEinitial]. Hierarchical clustering in 202 first-ever ischemic stroke patients distinguished between fitting and not fitting the rule. Descriptive statistics determined whether fitters and non-fitters for LE were the same persons as for UE.175 (87%) patients fitted the FMA-LE recovery rule. The observed average improvement of the fitters was ~64% of the predicted maximum potential recovery. In the non-fitter group, the maximum initial FMA-LE score was 13 points. Fifty-one out of 78 patients (~65%) who scored below the identified 14-point threshold at baseline fitted the FMA-LE rule. Non-fitters were more severely affected than fitters. All non-fitters of the FMA-LE rule did also not fit the proportional recovery rule for FMA-UE.Proportional recovery seems to be consistent within subjects across LE and UE motor impairment at the hemiplegic side in first-ever ischemic hemispheric stroke subjects. Future studies should investigate prospectively distinguishing between fitters and not-fitters within the subgroup of patients who have initial low FMA-LE scores. Subsequently, patients could be stratified based on fitting or not fitting the recovery rule as this would impact rehabilitation management and trial design. |
| first_indexed | 2024-04-12T00:36:44Z |
| format | Article |
| id | doaj.art-bc3e499ed19f465eae9c0f7d75f25363 |
| institution | Directory Open Access Journal |
| issn | 1932-6203 |
| language | English |
| last_indexed | 2024-04-12T00:36:44Z |
| publishDate | 2018-01-01 |
| publisher | Public Library of Science (PLoS) |
| record_format | Article |
| series | PLoS ONE |
| spelling | doaj.art-bc3e499ed19f465eae9c0f7d75f253632022-12-22T03:55:08ZengPublic Library of Science (PLoS)PLoS ONE1932-62032018-01-01131e018927910.1371/journal.pone.0189279Is the proportional recovery rule applicable to the lower limb after a first-ever ischemic stroke?Janne M VeerbeekCaroline WintersErwin E H van WegenGert KwakkelTo investigate (a) the applicability of the proportional recovery rule of spontaneous neurobiological recovery to motor function of the paretic lower extremity (LE); and (b) the presence of fitters and non-fitters of this prognostic rule poststroke. When present, the clinical threshold for fitting nor non-fitting would be determined, as well as within-subject generalizability to the paretic upper extremity (UE).Prospective cohort study in which the Fugl-Meyer Assessment (FMA)-LE and FMA-UE were measured <72 hours and 6 months poststroke. Predicted maximum potential recovery was defined as [FMA-LEmax-FMA-LEinitial = 34 -FMA-LEinitial]. Hierarchical clustering in 202 first-ever ischemic stroke patients distinguished between fitting and not fitting the rule. Descriptive statistics determined whether fitters and non-fitters for LE were the same persons as for UE.175 (87%) patients fitted the FMA-LE recovery rule. The observed average improvement of the fitters was ~64% of the predicted maximum potential recovery. In the non-fitter group, the maximum initial FMA-LE score was 13 points. Fifty-one out of 78 patients (~65%) who scored below the identified 14-point threshold at baseline fitted the FMA-LE rule. Non-fitters were more severely affected than fitters. All non-fitters of the FMA-LE rule did also not fit the proportional recovery rule for FMA-UE.Proportional recovery seems to be consistent within subjects across LE and UE motor impairment at the hemiplegic side in first-ever ischemic hemispheric stroke subjects. Future studies should investigate prospectively distinguishing between fitters and not-fitters within the subgroup of patients who have initial low FMA-LE scores. Subsequently, patients could be stratified based on fitting or not fitting the recovery rule as this would impact rehabilitation management and trial design.http://europepmc.org/articles/PMC5766096?pdf=render |
| spellingShingle | Janne M Veerbeek Caroline Winters Erwin E H van Wegen Gert Kwakkel Is the proportional recovery rule applicable to the lower limb after a first-ever ischemic stroke? PLoS ONE |
| title | Is the proportional recovery rule applicable to the lower limb after a first-ever ischemic stroke? |
| title_full | Is the proportional recovery rule applicable to the lower limb after a first-ever ischemic stroke? |
| title_fullStr | Is the proportional recovery rule applicable to the lower limb after a first-ever ischemic stroke? |
| title_full_unstemmed | Is the proportional recovery rule applicable to the lower limb after a first-ever ischemic stroke? |
| title_short | Is the proportional recovery rule applicable to the lower limb after a first-ever ischemic stroke? |
| title_sort | is the proportional recovery rule applicable to the lower limb after a first ever ischemic stroke |
| url | http://europepmc.org/articles/PMC5766096?pdf=render |
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