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Variability in Motor and Language Recovery during the Acute Stroke Period.

Dunn LE, Schweber AB, Manson DK, Lendaris A, Herber C, Marshall RS, Lazar RM - Cerebrovasc Dis Extra (2016)

Bottom Line: In a group analysis, statistically significant changes in absolute scores were found in the motor (p < 0.001) and comprehension (p < 0.001) domains but not in naming.Day-by-day recovery curves for individual patients displayed wide variation with comparable initial impairment.In addition, patients only achieved about 1/3 of their remaining possible recovery based on the anticipated 70% proportion found at 90 days.

View Article: PubMed Central - PubMed

Affiliation: Baylor College of Medicine, Houston, Tex., USA.

ABSTRACT

Background: Most stroke recovery occurs by 90 days after onset, with proportional recovery models showing an achievement of about 70% of the maximal remaining recovery. Little is known about recovery during the acute stroke period. Moreover, data are described for groups, not for individuals. In this observational cohort study, we describe for the first time the daily changes of acute stroke patients with motor and/or language deficits over the first week after stroke onset.

Methods: Patients were enrolled within 24-72 h after stroke onset with upper extremity hemiparesis, aphasia, or both, and were tested daily until day 7 or discharge with the upper-extremity Fugl-Meyer Assessment of Motor Recovery after Stroke, the Boston Naming Test, and the comprehension domain from the Western Aphasia Battery. Discharge scores, and absolute and proportional changes were examined using t-tests for pairwise comparisons and linear regression to determine relative contributions of initial impairment, lesion volume, and age to recovery over this period.

Results: Thirty-four patients were enrolled: 19 had motor deficits alone, 8 had aphasia alone, and 7 had motor and language deficits. In a group analysis, statistically significant changes in absolute scores were found in the motor (p < 0.001) and comprehension (p < 0.001) domains but not in naming. Day-by-day recovery curves for individual patients displayed wide variation with comparable initial impairment. Proportional recovery calculations revealed that, on average, patients achieved less than 1/3 of their potential recovery by the time of discharge. Multivariate regression showed that the amount of variance accounted for by initial severity, age, and lesion volume in this early time period was not significant for motor or language domains.

Conclusions: Over the first week after stroke onset, recovery of upper extremity hemiparesis and aphasia were not predictable on the basis of initial impairment, lesion volume, or age. In addition, patients only achieved about 1/3 of their remaining possible recovery based on the anticipated 70% proportion found at 90 days. These findings suggest that the complex interaction between poststroke structural repair, regeneration, and functional reorganization during the first week after stroke has yet to be elucidated.

No MeSH data available.


Related in: MedlinePlus

Mean scores on the upper-extremity (UE) FM test (a), mean scores on the BNT (b), and mean scores on the comprehension subtest of the WAB (c) as a function of days since stroke onset. Error bars denote 1 SD above and below the mean.
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Figure 1: Mean scores on the upper-extremity (UE) FM test (a), mean scores on the BNT (b), and mean scores on the comprehension subtest of the WAB (c) as a function of days since stroke onset. Error bars denote 1 SD above and below the mean.

Mentions: The mean FM score at baseline was 25.7 (SD = 19.9), and the mean FM score on the last day of assessment was 36.2 (SD = 22.13), a difference that was statistically significant (p < 0.001). Figure 1a shows that the group mean increased every day. Figure 1b shows that the initial mean BNT score was 5.37 (SD = 1.4), which was unchanged over the hospital stay. The mean for day 7 shows deterioration, although this may be misleading because 3 patients who had made good recoveries (>12/15) were discharged on day 6. The mean comprehension scores are depicted in figure 1c. The mean score at baseline was 81.1 (SD = 63.8), and by the last day of assessment, the score was 107.6 (SD = 75.60), which was a statistically significant improvement (p < 0.001) even with the day 7 score decrease due to the poorer scores of those remaining until day 7.


Variability in Motor and Language Recovery during the Acute Stroke Period.

Dunn LE, Schweber AB, Manson DK, Lendaris A, Herber C, Marshall RS, Lazar RM - Cerebrovasc Dis Extra (2016)

Mean scores on the upper-extremity (UE) FM test (a), mean scores on the BNT (b), and mean scores on the comprehension subtest of the WAB (c) as a function of days since stroke onset. Error bars denote 1 SD above and below the mean.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4836126&req=5

Figure 1: Mean scores on the upper-extremity (UE) FM test (a), mean scores on the BNT (b), and mean scores on the comprehension subtest of the WAB (c) as a function of days since stroke onset. Error bars denote 1 SD above and below the mean.
Mentions: The mean FM score at baseline was 25.7 (SD = 19.9), and the mean FM score on the last day of assessment was 36.2 (SD = 22.13), a difference that was statistically significant (p < 0.001). Figure 1a shows that the group mean increased every day. Figure 1b shows that the initial mean BNT score was 5.37 (SD = 1.4), which was unchanged over the hospital stay. The mean for day 7 shows deterioration, although this may be misleading because 3 patients who had made good recoveries (>12/15) were discharged on day 6. The mean comprehension scores are depicted in figure 1c. The mean score at baseline was 81.1 (SD = 63.8), and by the last day of assessment, the score was 107.6 (SD = 75.60), which was a statistically significant improvement (p < 0.001) even with the day 7 score decrease due to the poorer scores of those remaining until day 7.

Bottom Line: In a group analysis, statistically significant changes in absolute scores were found in the motor (p < 0.001) and comprehension (p < 0.001) domains but not in naming.Day-by-day recovery curves for individual patients displayed wide variation with comparable initial impairment.In addition, patients only achieved about 1/3 of their remaining possible recovery based on the anticipated 70% proportion found at 90 days.

View Article: PubMed Central - PubMed

Affiliation: Baylor College of Medicine, Houston, Tex., USA.

ABSTRACT

Background: Most stroke recovery occurs by 90 days after onset, with proportional recovery models showing an achievement of about 70% of the maximal remaining recovery. Little is known about recovery during the acute stroke period. Moreover, data are described for groups, not for individuals. In this observational cohort study, we describe for the first time the daily changes of acute stroke patients with motor and/or language deficits over the first week after stroke onset.

Methods: Patients were enrolled within 24-72 h after stroke onset with upper extremity hemiparesis, aphasia, or both, and were tested daily until day 7 or discharge with the upper-extremity Fugl-Meyer Assessment of Motor Recovery after Stroke, the Boston Naming Test, and the comprehension domain from the Western Aphasia Battery. Discharge scores, and absolute and proportional changes were examined using t-tests for pairwise comparisons and linear regression to determine relative contributions of initial impairment, lesion volume, and age to recovery over this period.

Results: Thirty-four patients were enrolled: 19 had motor deficits alone, 8 had aphasia alone, and 7 had motor and language deficits. In a group analysis, statistically significant changes in absolute scores were found in the motor (p < 0.001) and comprehension (p < 0.001) domains but not in naming. Day-by-day recovery curves for individual patients displayed wide variation with comparable initial impairment. Proportional recovery calculations revealed that, on average, patients achieved less than 1/3 of their potential recovery by the time of discharge. Multivariate regression showed that the amount of variance accounted for by initial severity, age, and lesion volume in this early time period was not significant for motor or language domains.

Conclusions: Over the first week after stroke onset, recovery of upper extremity hemiparesis and aphasia were not predictable on the basis of initial impairment, lesion volume, or age. In addition, patients only achieved about 1/3 of their remaining possible recovery based on the anticipated 70% proportion found at 90 days. These findings suggest that the complex interaction between poststroke structural repair, regeneration, and functional reorganization during the first week after stroke has yet to be elucidated.

No MeSH data available.


Related in: MedlinePlus