Stroke, Vol. 36, No. 3. (March 2005), pp. 625-629.
BACKGROUND AND PURPOSE: Motor recovery after stroke is associated with cerebral reorganization. However, few studies have investigated the relationship directly, and findings are equivocal. We therefore aimed to characterize the relationship between motor impairment, motor recovery, and task-related changes in regional cerebral blood flow (DeltarCBF) longitudinally. METHODS: We obtained a profile of motor impairment and recovery in the upper limb and conducted positron emission tomography motor activation studies using a simple finger-tapping task in 9 stroke patients 2 to 7 weeks after stroke and 6 months later. For correlation analysis, mean images of task-related DeltarCBF for each individual were linearly regressed with motor impairment scores. Motor recovery was correlated with longitudinal DeltarCBF images. RESULTS: Patients (7 males; 72.0+/-9.8 years) demonstrated a wide range of impairment severity and variable recovery. Upper-limb motor function was linearly correlated with task-related DeltarCBF. Importantly, sites of correlated DeltarCBF differed over time. Subacutely correlated DeltarCBF was observed in supplementary motor area (SMA), bilateral cingulate, and contralesional insula with a small area in ipsilesional primary sensorimotor cortex (SM1). Conversely, at the 6-month study, correlated DeltarCBF was primarily in ipsilesional SM1, extending to the cingulate gyrus. Better motor recovery was correlated with reduction in contralesional activity and increase in ipsilesional SM1. CONCLUSIONS: Upper-limb motor function and recovery are correlated with DeltarCBF in SMA, cingulate, insula, and SM1, highlighting the role of these areas in the recovery process. The dynamic nature of the relationship suggests ongoing adaptation within motor networks.
LM Carey, DF Abbott, GF Egan, J Bernhardt, GA Donnan
Motor impairment and recovery in the upper limb after stroke: behavioral and neuroanatomical correlates.
Stroke, Syndicated
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Feb 242006
Stroke, Vol. 36, No. 3. (March 2005), pp. 625-629.Effect of a Therapeutic Intervention for the Hemiplegic Upper Limb in the Acute Phase After Stroke : A Single-Blind, Randomized, Controlled Multicenter Trial
Stroke, Syndicated
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Feb 222006
Stroke, Vol. 29, No. 4. (1 April 1998), pp. 785-792.
Background and Purpose--Arm function recovery is notoriously poor in stroke patients. The effect of treatment modalities, particularly those directed at improving upper limb function, has been studied primarily in chronic stroke patients. The purpose of this study was to investigate the effect of a specific therapeutic intervention on arm function in the acute phase after stroke. Methods--In a single-blind, randomized, controlled multicenter trial, 100consecutive patients were allocated to either an experimental group that received an additional treatment of sensorimotor stimulation or to a control group. The intervention was applied for 6 weeks. Patients were evaluated for level of impairment (Brunnstrom-Fugl-Meyer test) and disability (Action Research Arm test, Barthel Index) before, midway, and after the intervention period and at follow-up 6 and 12 months after stroke. Results--Patients in the experimental group performed better on the Brunnstrom-Fugl-Meyer test than those in the control group throughout the study period, but differences were significant only at follow-up. Results on the Action Research Arm test and Barthel Index revealed no effect at the level of disability. The effect of the therapy was attributed to the repetitive stimulation of muscle activity. The treatment was most effective in patients with a severe motor deficit and hemianopia or hemi-inattention. No adverse effects due to the intervention were found. Conclusions--Adding a specific intervention during the acute phase after stroke improved motor recovery, which was apparent 1 year later. These results emphasize the potential beneficial effect of therapeutic interventions for the arm.
Hilde Feys, Willy De Weerdt, Beat Selz, Cox, Ruth Spichiger, Luc Vereeck, Koen Putman, Gustaaf Van Hoydonck
Background and Purpose--Arm function recovery is notoriously poor in stroke patients. The effect of treatment modalities, particularly those directed at improving upper limb function, has been studied primarily in chronic stroke patients. The purpose of this study was to investigate the effect of a specific therapeutic intervention on arm function in the acute phase after stroke. Methods--In a single-blind, randomized, controlled multicenter trial, 100consecutive patients were allocated to either an experimental group that received an additional treatment of sensorimotor stimulation or to a control group. The intervention was applied for 6 weeks. Patients were evaluated for level of impairment (Brunnstrom-Fugl-Meyer test) and disability (Action Research Arm test, Barthel Index) before, midway, and after the intervention period and at follow-up 6 and 12 months after stroke. Results--Patients in the experimental group performed better on the Brunnstrom-Fugl-Meyer test than those in the control group throughout the study period, but differences were significant only at follow-up. Results on the Action Research Arm test and Barthel Index revealed no effect at the level of disability. The effect of the therapy was attributed to the repetitive stimulation of muscle activity. The treatment was most effective in patients with a severe motor deficit and hemianopia or hemi-inattention. No adverse effects due to the intervention were found. Conclusions--Adding a specific intervention during the acute phase after stroke improved motor recovery, which was apparent 1 year later. These results emphasize the potential beneficial effect of therapeutic interventions for the arm.
Hilde Feys, Willy De Weerdt, Beat Selz, Cox, Ruth Spichiger, Luc Vereeck, Koen Putman, Gustaaf Van Hoydonck
Feb 222006
Stroke, Vol. 29, No. 5. (1 May 1998), pp. 986-991.
Background and Purpose--Adequate outcome assessment is crucial to randomized trials. We wished to assess the types of outcomes used in acute stroke trials and the appropriateness of these outcomes and their analyses. Methods--Acute stroke trials from the Cochrane Stroke Group's database were included from 1955 to 1995 if they were published in full text in English. For each trial we collected year of publication, number of patients randomized, blinding of outcome assessment, the specific outcome instruments used, the statistical methods used for analysis, and the significance of the results. The validity and reliability of each outcome measure were assessed by review of the literature. Results--Our study included 174 trials. Outcomes were assessed blindly in 69%. Death was recorded in only 76% of trials, impairment in 76%, disability in 42%, and handicap or quality of life in only 2%. Of the trials that measured impairment, 35% used a measure of established validity or reliability. For disability and handicap, the proportions with valid or reliable measures were 70% and 25%, respectively. Impairment and handicap measures were primarily analyzed as continuous variables, while disability was mainly analyzed as a dichotomous variable. Continuous data were usually analyzed with inappropriate parametric statistics. There was no relationship between the method of analysis, the type of outcome, and the statistical significance of results. Conclusions--Most acute stroke trials up to 1995 have used clinical outcome measures that were inadequate in terms of their content, reliability, validity, blinded assessment, and statistical analysis. This has important implications for future stroke research.
Lucy Roberts, Carl Counsell
Background and Purpose--Adequate outcome assessment is crucial to randomized trials. We wished to assess the types of outcomes used in acute stroke trials and the appropriateness of these outcomes and their analyses. Methods--Acute stroke trials from the Cochrane Stroke Group's database were included from 1955 to 1995 if they were published in full text in English. For each trial we collected year of publication, number of patients randomized, blinding of outcome assessment, the specific outcome instruments used, the statistical methods used for analysis, and the significance of the results. The validity and reliability of each outcome measure were assessed by review of the literature. Results--Our study included 174 trials. Outcomes were assessed blindly in 69%. Death was recorded in only 76% of trials, impairment in 76%, disability in 42%, and handicap or quality of life in only 2%. Of the trials that measured impairment, 35% used a measure of established validity or reliability. For disability and handicap, the proportions with valid or reliable measures were 70% and 25%, respectively. Impairment and handicap measures were primarily analyzed as continuous variables, while disability was mainly analyzed as a dichotomous variable. Continuous data were usually analyzed with inappropriate parametric statistics. There was no relationship between the method of analysis, the type of outcome, and the statistical significance of results. Conclusions--Most acute stroke trials up to 1995 have used clinical outcome measures that were inadequate in terms of their content, reliability, validity, blinded assessment, and statistical analysis. This has important implications for future stroke research.
Lucy Roberts, Carl Counsell
Feb 212006
Stroke, Vol. 21, No. 7. (July 1990), pp. 1081-1085.
Most of the members of the therapeutic team in stroke rehabilitation take the effectiveness of physical treatments after stroke for granted. Yet, published data show that the evidence is not so straightforward or easy to evaluate. The majority of the hard evidence, however, does imply that stroke patients benefit from rehabilitation with physiotherapy. This benefit may be statistically small, but for a given individual, it could mean the difference between living at home or in an institution. Few studies address the question of the optimal physiotherapy in stroke rehabilitation. The evidence available today suggests that it does not matter which form of treatment is chosen and that any of the available approaches will improve the patient's functional status. In other words, if an optimal treatment exists, we have, so far, failed to identify it. Until further evidence emerges, we should therefore select therapies that are most cost-effective and that can be given to the largest number of patients. Well-planned clinical trials aimed at finding the best approach and discriminating potential responders from nonresponders are urgently needed.
E Ernst
Most of the members of the therapeutic team in stroke rehabilitation take the effectiveness of physical treatments after stroke for granted. Yet, published data show that the evidence is not so straightforward or easy to evaluate. The majority of the hard evidence, however, does imply that stroke patients benefit from rehabilitation with physiotherapy. This benefit may be statistically small, but for a given individual, it could mean the difference between living at home or in an institution. Few studies address the question of the optimal physiotherapy in stroke rehabilitation. The evidence available today suggests that it does not matter which form of treatment is chosen and that any of the available approaches will improve the patient's functional status. In other words, if an optimal treatment exists, we have, so far, failed to identify it. Until further evidence emerges, we should therefore select therapies that are most cost-effective and that can be given to the largest number of patients. Well-planned clinical trials aimed at finding the best approach and discriminating potential responders from nonresponders are urgently needed.
E Ernst
Feb 202006
Stroke, Vol. 26, No. 6. (June 1995), pp. 1119-1122.
BACKGROUND: Functional assessment in stroke patients is critical in both clinical practice and outcome studies. Ability in the areas relating to instrumental activities of daily living (IADL) that require increased interaction with the environment, whether household or community, appears to be a prerequisite for independent living in the community. The majority of the research in this area has been in the geriatric population. A literature review was undertaken to answer the following questions: What is a working definition of IADL? What are the criteria that determine inclusion with specific applicability in the stroke population? What are the reliability and validity of available measures in the stroke population? What is the relevance of IADL to functional outcome? SUMMARY OF REVIEW: The findings at this time indicate that there is no consensus for a clear definition of IADL. The terminology used includes the original IADL as described by Lawton and Brody, extended ADL, social ADL, and advanced ADL. Four scales that were designed primarily for use in the stroke population were identified: the Nottingham Extended ADL (a self-report scale), the Hamrin Activity Index and the Frenchay Activities Index (both based on patient interviews), and the Household section of the Rivermead ADL Assessment (a performance index). CONCLUSIONS: There is some published evidence concerning the validity, reliability, utility, sensitivity, or hierarchical nature of these indexes, and further testing is needed. The items in each index, however, have inherent relevance with potential for use in future clinical research.
DK Chong
BACKGROUND: Functional assessment in stroke patients is critical in both clinical practice and outcome studies. Ability in the areas relating to instrumental activities of daily living (IADL) that require increased interaction with the environment, whether household or community, appears to be a prerequisite for independent living in the community. The majority of the research in this area has been in the geriatric population. A literature review was undertaken to answer the following questions: What is a working definition of IADL? What are the criteria that determine inclusion with specific applicability in the stroke population? What are the reliability and validity of available measures in the stroke population? What is the relevance of IADL to functional outcome? SUMMARY OF REVIEW: The findings at this time indicate that there is no consensus for a clear definition of IADL. The terminology used includes the original IADL as described by Lawton and Brody, extended ADL, social ADL, and advanced ADL. Four scales that were designed primarily for use in the stroke population were identified: the Nottingham Extended ADL (a self-report scale), the Hamrin Activity Index and the Frenchay Activities Index (both based on patient interviews), and the Household section of the Rivermead ADL Assessment (a performance index). CONCLUSIONS: There is some published evidence concerning the validity, reliability, utility, sensitivity, or hierarchical nature of these indexes, and further testing is needed. The items in each index, however, have inherent relevance with potential for use in future clinical research.
DK Chong
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