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Inter-individual Variability in the Capacity for Motor Recovery After Ischemic Stroke
Shyam Prabhakaran, MD
Neurological Institute, Columbia University, Stroke and Critical Care Division, New York, New York
Eric Zarahn, PhD
Neurological Institute, Columbia University, Stroke and Critical Care Division, New York, New York
Claire Riley, MD
Neurological Institute, Columbia University, Stroke and Critical Care Division, New York, New York
Allison Speizer, MS
Neurological Institute, Columbia University, Stroke and Critical Care Division, New York, New York
Ji Y. Chong, MD
Neurological Institute, Columbia University, Stroke and Critical Care Division, New York, New York
Ronald M. Lazar, PhD
Neurological Institute, Columbia University, Stroke and Critical Care Division, New York, New York
Randolph S. Marshall, MD, MS
Neurological Institute, Columbia University, Stroke and Critical Care Division, New York, New York
John W. Krakauer, MD
Neurological Institute, Columbia University, Stroke and Critical Care Division, New York, New York, jwk18@ columbia.edu
Background. Motor recovery after stroke is predicted only moderately by clinical variables, implying that there is still a substantial amount of unexplained, biologically meaningful variability in recovery. Regression diagnostics can indicate whether this is associated simply with Gaussian error or instead with multiple subpopulations that vary in their relationships to the clinical variables. Objective. To perform regression diagnostics on a linear model for recovery versus clinical predictors. Methods. Forty-one patients with ischemic stroke were studied. Impairment was assessed using the upper extremity Fugl-Meyer Motor Score. Motor recovery was defined as the change in the upper extremity Fugl-Meyer Motor Score from 24 to 72 hours after stroke to 3 or 6 months later. The clinical predictors in the model were age, gender, infarct location (subcortical vs cortical), diffusion weighted imaging infarct volume, time to reassessment, and acute upper extremity Fugl-Meyer Motor Score. Regression diagnostics included a Kolmogorov-Smirnov test for Gaussian errors and a test for outliers using Studentized deleted residuals. Results. In the random sample, clinical variables explained only 47% of the variance in recovery. Among the patients with the most severe initial impairment, there was a set of regression outliers who recovered very poorly. With the outliers removed, explained variance in recovery increased to 89%, and recovery was well approximated by a proportional relationship with initial impairment (recovery  0.70 x initial impairment). Conclusions. Clinical variables only moderately predict motor recovery. Regression diagnostics demonstrated the existence of a subpopulation of outliers with severe initial impairment who show little recovery. When these outliers were removed, clinical variables were good predictors of recovery among the remaining patients, showing a tight proportional relationship to initial impairment.
Key Words: Predictors of Recovery • Hemiparesis • Impairment • Fugl-Meyer Scale.
References
- Broeks JG, Lankhorst GJ, Rumping K., Prevo AJ The long-term outcome of arm function after stroke: results of a follow-up study. Disabil Rehabil. 1999;21:357-364.[CrossRef][Web of Science][Medline]
[Order article via Infotrieve]
- Duncan PW, Goldstein LB, Matchar D., Divine GW, Feussner J. Measurement of motor recovery after stroke: outcome assessment and sample size requirements. Stroke. 1992;23:1084-1089.[Abstract/Free Full Text]
- Kwakkel G., Kollen BJ, van der Grond J., Prevo AJ Probability of regaining dexterity in the flaccid upper limb: impact of severity of paresis and time since onset in acute stroke. Stroke. 2003;34:2181-2186.[Abstract/Free Full Text]
- Meldrum D., Pittock SJ, Hardiman O., Ni Dhuill C., O'Regan M. Recovery of the upper limb post ischaemic stroke and the predictive value of the Orpington Prognostic Score. Clin Rehabil. 2004;18:694-702.[Abstract/Free Full Text]
- Nakayama H., Jorgensen HS, Raaschou HO, Olsen TS Recovery of upper extremity function in stroke patients: the Copenhagen Stroke Study. Arch Phys Med Rehabil. 1994;75:394-398.[CrossRef][Web of Science][Medline]
[Order article via Infotrieve]
- Feys H., De Weerdt W., Nuyens G., van de Winckel A., Selz B., Kiekens C. Predicting motor recovery of the upper limb after stroke rehabilitation: value of a clinical examination. Physiother Res Int. 2000;5:1-18.[CrossRef][Medline]
[Order article via Infotrieve]
- Gladstone DJ, Danells CJ, Black SE The Fugl-Meyer assessment of motor recovery after stroke: a critical review of its measurement properties. Neurorehabil Neural Repair. 2002;16:232-240.[Abstract/Free Full Text]
- Wade DT, Langton-Hewer R., Wood VA, Skilbeck CE, Ismail HM The hemiplegic arm after stroke: measurement and recovery. J Neurol Neurosurg Psychiatry. 1983;46:521-524.[Abstract/Free Full Text]
- Gomez-Marino R., Andre C., Novis SA Volumetric determination of cerebral infarction in the acute phase using skull computed tomography without contrast: comparative study of 3 methods. Arq Neuropsiquiatr. 2001;59:380-383.[Medline]
[Order article via Infotrieve]
- van der Worp HB, Claus SP, Bar PR, et al. Reproducibility of measurements of cerebral infarct volume on CT scans. Stroke. 2001;32:424-430.[Abstract/Free Full Text]
- Adams HP Jr, Bendixen BH, Kappelle LJ, et al. Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in Acute Stroke Treatment. Stroke. 1993;24:35-41.[Abstract/Free Full Text]
- van der Lee JH, Beckerman H., Lankhorst GJ, Bouter LM The responsiveness of the Action Research Arm test and the Fugl-Meyer Assessment scale in chronic stroke patients. J Rehabil Med. 2001;33:110-113.[CrossRef][Web of Science][Medline]
[Order article via Infotrieve]
- Binkofski F., Seitz RJ, Hacklander T., Pawelec D., Mau J., Freund HJ Recovery of motor functions following hemiparetic stroke: a clinical and magnetic resonance-morphometric study. Cerebrovasc Dis. 2001;11:273-281.[CrossRef][Web of Science][Medline]
[Order article via Infotrieve]
- Lie C., Hirsch JG, Rossmanith C., Hennerici MG, Gass A. Clinicotopographical correlation of corticospinal tract stroke: a color-coded diffusion tensor imaging study. Stroke. 2004; 35:86-92.[Abstract/Free Full Text]
- Konishi J., Yamada K., Kizu O., et al. MR tractography for the evaluation of functional recovery from lenticulostriate infarcts. Neurology. 2005;64:108-113.[Abstract/Free Full Text]
- Pineiro R., Pendlebury ST, Smith S., et al. Relating MRI changes to motor deficit after ischemic stroke by segmentation of functional motor pathways. Stroke. 2000;31:672-679.[Abstract/Free Full Text]
- Hendricks HT, Zwarts MJ, Plat EF, van Limbeek J. Systematic review for the early prediction of motor and functional outcome after stroke by using motor-evoked potentials. Arch Phys Med Rehabil. 2002;83:1303-1308.[CrossRef][Web of Science][Medline]
[Order article via Infotrieve]
- Binkofski F., Seitz RJ, Arnold S., Classen J., Benecke R., Freund HJ Thalamic metabolism and corticospinal tract integrity determine motor recovery in stroke. Ann Neurol. 1996;39:460-470.[CrossRef][Web of Science][Medline]
[Order article via Infotrieve]
- Dirnagl U., Iadecola C., Moskowitz MA Pathobiology of ischaemic stroke: an integrated view. Trends Neurosci. 1999;22: 391-397.[CrossRef][Web of Science][Medline]
[Order article via Infotrieve]
- Marshall RS, Perera GM, Lazar RM, Krakauer JW, Constantine RC, DeLaPaz RL Evolution of cortical activation during recovery from corticospinal tract infarction. Stroke. 2000;31:656-661.[Abstract/Free Full Text]
- Nelles G., Spiekermann G., Jueptner M., et al. Reorganization of sensory and motor systems in hemiplegic stroke patients: a positron emission tomography study. Stroke. 1999;30:1510-1516.[Abstract/Free Full Text]
- Heald A., Bates D., Cartlidge NE, French JM, Miller S. Longitudinal study of central motor conduction time following stroke. 2. Central motor conduction measured within 72 h after stroke as a predictor of functional outcome at 12 months. Brain. 1993;116:1371-1385.[Abstract/Free Full Text]
- Schiemanck SK, Post MW, Kwakkel G., Witkamp TD, Kappelle LJ, Prevo AJ Ischemic lesion volume correlates with long-term functional outcome and quality of life of middle cerebral artery stroke survivors. Restor Neurol Neurosci. 2005;23:257-263.[Medline]
[Order article via Infotrieve]
- Lu M., Mitsias PD, Ewing JR, et al. Predicting final infarct size using acute and subacute multiparametric MRI measurements in patients with ischemic stroke. J Magn Reson Imaging. 2005; 21:495-502.[CrossRef][Web of Science][Medline]
[Order article via Infotrieve]
This version was published on February
1, 2008
Neurorehabilitation and Neural Repair, Vol. 22, No. 1,
64-71 (2008)
DOI: 10.1177/1545968307305302
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