Abstract 24: Predicting Persistent Upper Extremity Impairment in Ischemic Stroke Patients

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Adam H de Havenon ◽  
Robynne Braun ◽  
N Abimbola Sunmonu ◽  
Laura Heitsch ◽  
Eva Mistry ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Upper Extremity ◽  
Motor Impairment ◽  
Receiver Operating Curve ◽  
Stroke Severity ◽  
Lasso Regression ◽  
Important Challenge ◽  
Upper Extremity Impairment ◽  
Available Information ◽  
Upper Extremity Motor Impairment

Background: Motor impairment after ischemic stroke is common and has variable recovery that depends on patient factors and stroke severity. An important challenge in rehabilitation research is enrolling patients who may benefit from interventions to improve recovery because they will not recover with standard care. Hypothesis: We can accurately predict persistent upper extremity motor impairment at 90 days after acute ischemic stroke. Methods: The primary outcome was an NIHSS arm domain score of 2-4 at 90 days in patients with a 24-hour NIHSS arm score of 1-4, which we termed persistent arm impairment. With the NINDS tPA trial dataset we used LASSO regression to select baseline demographics and 24-hour NIHSS score domains for a predictive model. We gave one point each for age ≥60 years and 24-hour NIHSS values of worst arm=4, worst leg>2, facial palsy=3, and total NIHSS≥10. The optimal cutpoint for a positive Persistent UPPer extremity Impairment (PUPPI) Score was ≥3 points. We validated the PUPPI score in the ALIAS Part 2, IMS-III, and DEFUSE 3 trials. Results: We included 431, 383, 331, and 71 patients from the NINDS tPA, ALIAS Part 2, IMS-III, and DEFUSE 3 trials. PUPPI was most common in the NINDS tPA trial (62%) and least common in ALIAS (31.3%). The PUPPI Score accurately predicted PUPPI with an area under the receiver operating curve (AUC) of >0.75 for all trials (Table 1). The positive predictive value was 74.6%, 90.9%, 86.1%, and 74.5% in the NINDS tPA, ALIAS Part 2, IMS-III, and DEFUSE 3 trials (Table 1). Conclusion: The PUPPI score uses readily available information to provide accurate prediction of patients who will have persistent upper extremity motor impairment at 90 days from stroke onset.

scholarly journals Movement Kinematics of the Ipsilesional Upper Extremity in Persons With Moderate or Mild Stroke

2017 ◽  
Vol 31 (4) ◽  
pp. 376-386 ◽  
Author(s):  
Eva-Lena Bustrén ◽  
Katharina Stibrant Sunnerhagen ◽  
Margit Alt Murphy
Keyword(s):  
Upper Extremity ◽  
Movement Time ◽  
Motor Impairment ◽  
Stroke Severity ◽  
Movement Kinematics ◽  
Movement Performance ◽  
Severe Motor ◽  
Daily Task ◽  
Severe Motor Impairment ◽  
Mild Stroke

Background. An increasing number of studies have indicated that the ipsilesional arm may be impaired after stroke. There is, however, a lack of knowledge whether ipsilesional deficits influence movement performance during purposeful daily tasks. Objective. The aim of this study was to investigate whether, and to what extent, movement impairments are present while performing an ipsilesional upper extremity task during the first 3 months after stroke. Methods. Movement kinematics describing movement time, smoothness, velocity, strategy, and pattern were captured during a standardized drinking task in 40 persons with first-ever stroke and 20 controls. Kinematics were measured early and at 3 months poststroke, and sensorimotor impairment was assessed with Fugl-Meyer Assessment in stroke. Results. Half of the ipsilesional kinematics showed significant deficits early after stroke compared to controls, and the stroke severity had a significant impact on the kinematics. Movements of the ipsilesional arm were slower, less smooth, demonstrated prolonged relative time in deceleration, and increased arm abduction during drinking. Kinematics improved over time and reached a level comparable with controls at 3 months, except for angular velocity of the elbow and deceleration time in reaching for those with more severe motor impairment. Conclusions. This study demonstrates that movements of the ipsilesional arm, during a purposeful daily task, are impaired after stroke. These deficits are more prominent early after stroke and when the motor impairment is more severe. In clinical studies and praxis, the use of less-affected arm as a reference may underestimate the level of impairment and extent of recovery.

Virtual Reality Training for Upper Extremity in Subacute Stroke (VIRTUES)

Neurology ◽  
2017 ◽  
Vol 89 (24) ◽  
pp. 2413-2421 ◽  
Author(s):  
Iris Brunner ◽  
Jan Sture Skouen ◽  
Håkon Hofstad ◽  
Jörg Aßmus ◽  
Frank Becker ◽  
...  
Keyword(s):  
Virtual Reality ◽  
Upper Extremity ◽  
Outcome Measures ◽  
Motor Impairment ◽  
Phase Iii ◽  
Secondary Outcome ◽  
Subacute Phase ◽  
Vr Training ◽  
Upper Extremity Motor Impairment

Objective:To compare the effectiveness of upper extremity virtual reality rehabilitation training (VR) to time-matched conventional training (CT) in the subacute phase after stroke.Methods:In this randomized, controlled, single-blind phase III multicenter trial, 120 participants with upper extremity motor impairment within 12 weeks after stroke were consecutively included at 5 rehabilitation institutions. Participants were randomized to either VR or CT as an adjunct to standard rehabilitation and stratified according to mild to moderate or severe hand paresis, defined as ≥20 degrees wrist and 10 degrees finger extension or less, respectively. The training comprised a minimum of sixteen 60-minute sessions over 4 weeks. The primary outcome measure was the Action Research Arm Test (ARAT); secondary outcome measures were the Box and Blocks Test and Functional Independence Measure. Patients were assessed at baseline, after intervention, and at the 3-month follow-up.Results:Mean time from stroke onset for the VR group was 35 (SD 21) days and for the CT group was 34 (SD 19) days. There were no between-group differences for any of the outcome measures. Improvement of upper extremity motor function assessed with ARAT was similar at the postintervention (p = 0.714) and follow-up (p = 0.777) assessments. Patients in VR improved 12 (SD 11) points from baseline to the postintervention assessment and 17 (SD 13) points from baseline to follow-up, while patients in CT improved 13 (SD 10) and 17 (SD 13) points, respectively. Improvement was also similar for our subgroup analysis with mild to moderate and severe upper extremity paresis.Conclusions:Additional upper extremity VR training was not superior but equally as effective as additional CT in the subacute phase after stroke. VR may constitute a motivating training alternative as a supplement to standard rehabilitation.ClinicalTrials.gov identifier:NCT02079103.Classification of evidence:This study provides Class I evidence that for patients with upper extremity motor impairment after stroke, compared to conventional training, VR training did not lead to significant differences in upper extremity function improvement.

scholarly journals Introductory Analysis of Human Upper Extremity After Stroke

2019 ◽  
Vol 7 (1) ◽  
pp. 45-60
Author(s):  
Esteban Peña-Pitarch ◽  
Jordi Vives Costa ◽  
Joan Lopez Martinez ◽  
Anas Al Omar ◽  
Iñaki Alcelay Larrión ◽  
...  
Keyword(s):  
Upper Extremity ◽  
Muscle Tone ◽  
Demographic Data ◽  
Motor Impairment ◽  
Stroke Severity ◽  
Motor Impairments ◽  
Accurate Identification ◽  
Modified Ashworth Scale ◽  
Muscle Balance ◽  
Prospective Longitudinal

The most reliable prognostic factors associated with upper extremity (UE) recovery are localized motor impairments, especially in the musculature of the hand and abduction of the shoulder in the first days after a stroke. An evaluation of the biomechanics of the hand allows an accurate identification of the motion arcs of the digital joints. This article includes an assess the prognostic value of the range of motion of the finger joints using an instrumental glove (CyberGlove II®) for the time one week after stroke for UE functional recovery. A prospective, longitudinal, observational study is made with follow-ups at 3-4 days, 1 week, 3 and 6 months of the patients with UE motor impairment. Variables collected included: demographic data, level of stroke severity (NIHSS), deep sensitivity, sphincter incontinence, Fugl Meyer assessment of UE (FM-UE), muscle balance with the Medical Research Council (MRC), muscle tone (Modified Ashworth Scale) and pre- and post-stroke functional ability (Barthel Index and Modified Rankin Scale).

Abstract T P329: Preadmission Use of Selective Serotonin Reuptake Inhibitors (SSRIs) in Acute Ischemic Stroke

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Shawna Cutting ◽  
Laurel Smit ◽  
Renee Jhu ◽  
Bichun Ouyang ◽  
Shyam Prabhakaran
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Serotonin Reuptake ◽  
Selective Serotonin Reuptake Inhibitors ◽  
Motor Impairment ◽  
Serotonin Reuptake Inhibitors ◽  
Selective Serotonin ◽  
Stroke Severity ◽  
Discharge Disposition ◽  
And Gender

Objective: To determine if patients admitted with ischemic stroke who were taking selective serotonin reuptake inhibitors (SSRI) at baseline have reduced motor impairment compared to patients not taking an SSRI. Introduction: SSRI use may help patients with motor recovery following ischemic stroke. It is not known whether use of this class of medications prior to stroke leads to decreased stroke severity or motor impairment on admission and improved discharge outcome. Methods: We retrospectively identified all patients admitted to our institution between 2009 and 2012 with first-ever acute ischemic stroke who were taking an SSRI prior to admission (cases). We collected data on patient demographics, clinical stroke severity as measured by the National Institute of Health Stroke Scale (NIHSS), modified Rankin Scale (mRS) score, and disposition at discharge. Controls with acute ischemic stroke who were not taking SSRIs prior to admission were matched 2:1 by age and gender to cases. Results: Eighty cases (mean age 65 +/- 14 years) were identified, of whom 56.2% were female and 63.7% were Caucasian. Median admission NIHSS was 5 (IQR 2-10), and median length of stay (LOS) was 4 days (IQR 3-7). Compared to controls, cases were more likely to have a pre-stroke diagnosis of depression (43.8% vs 7.5%, p=<0.001) or anxiety (13.8% vs 2.5%, p=0.001). Identification of a cardioembolic etiology was more common in cases (41.2% vs 26.6%, p=0.019). Median total NIHSS scores and NIHSS motor component scores on admission (total 5 vs 4, p=0.69; motor 2 vs 1, p=1.0) or at discharge (total 3.5 vs 2, p=0.67; motor 1 vs 0, p=0.76) were not different between cases and controls. Median LOS was similar for controls (5 days, p=0.65). Discharge to home or acute rehab was similar between groups (p=0.85). Conclusions: SSRI use prior to ischemic stroke does not confer a protective effect in reducing initial stroke severity, reducing degree of motor impairment, or improving discharge disposition. Further studies are needed to determine whether there are long-term benefits or other effects.

Accurate Prediction of Persistent Upper Extremity Impairment in Patients with Ischemic Stroke

2021 ◽  
Author(s):  
Adam de Havenon ◽  
Laura Heitsch ◽  
Abimbola Sunmonu ◽  
Robynne Braun ◽  
Keith R. Lohse ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Upper Extremity ◽  
Accurate Prediction ◽  
Upper Extremity Impairment

scholarly journals Cortical disconnection of the ipsilesional primary motor cortex is associated with gait speed and upper extremity motor impairment in chronic left hemispheric stroke

2017 ◽  
Vol 39 (1) ◽  
pp. 120-132 ◽  
Author(s):  
Denise M. Peters ◽  
Julius Fridriksson ◽  
Jill C. Stewart ◽  
Jessica D. Richardson ◽  
Chris Rorden ◽  
...  
Keyword(s):  
Motor Cortex ◽  
Upper Extremity ◽  
Gait Speed ◽  
Primary Motor Cortex ◽  
Motor Impairment ◽  
Hemispheric Stroke ◽  
Upper Extremity Motor Impairment

Robot-assisted therapy for upper extremity motor impairment after stroke: a systematic review and meta-analysis

2021 ◽  
Author(s):  
Jingyi Wu ◽  
Hao Cheng ◽  
Jiaqi Zhang ◽  
Shanli Yang ◽  
Sufang Cai
Keyword(s):  
Randomized Controlled Trials ◽  
Upper Extremity ◽  
Meta Analysis ◽  
Motor Impairment ◽  
Controlled Trials ◽  
Robot Assisted ◽  
Randomized Controlled ◽  
Small Effect Size ◽  
Evidence Database ◽  
Upper Extremity Motor Impairment

Abstract Objective The purpose of this study was to review the effects of robot-assisted therapy (RT) for improving poststroke upper extremity motor impairment. Methods The PubMed, EMBASE, Medline, and Web of Science databases were searched from inception to April 8, 2020. Randomized controlled trials that were conducted to evaluate the effects of RT on upper extremity motor impairment poststroke and that used Fugl-Meyer Assessment Upper Extremity (FMA-UE) scores as an outcome were included. Two authors independently screened articles, extracted data, and assessed the methodological quality of the included studies using the Physiotherapy Evidence Database (PEDro) scale. A random-effects meta-analysis was performed to pool the effect sizes across the studies. Results Forty-one randomized controlled trials with 1916 stroke patients were included. Compared with dose-matched conventional rehabilitation, RT significantly improved the FMA-UE scores of the patients with stroke, with a small effect size (Hedges g = 0.25; 95% CI = 0.11 to 0.38; I2 = 45.9%). The subgroup analysis revealed that the effects of unilateral RT, but not that of bilateral RT, was superior to conventional rehabilitation (Hedges g = 0.32; 95% CI = 0.15 to 0.50; I2 = 55.9%). Regarding the type of robot devices, the effects of the end effector device (Hedges g = 0.22; 95% CI = 0.09 to −0.36; I2 = 35.4%), but not the exoskeleton device, were superior to conventional rehabilitation. Regarding the stroke stage, the between-group difference (ie, RT vs convention rehabilitation) was significant only for people with late subacute or chronic stroke (Hedges g = 0.33; 95% CI = 0.16 to 0.50; I2 = 34.2%). Conclusion RT might be superior to conventional rehabilitation in improving upper extremity motor impairment in people after stroke with notable upper extremity hemiplegia and limited potential for spontaneous recovery.

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