Six-month functional recovery of stroke patients: a multi-time-point study

Kyoung Bo Lee, Seong Hoon Lim, Kyung Hoon Kim, Ki Jeon Kim, Yang Rae Kim, Woo Nam Chang, Jun Woo Yeom, Young Dong Kim, Byong Yong Hwang, Kyoung Bo Lee, Seong Hoon Lim, Kyung Hoon Kim, Ki Jeon Kim, Yang Rae Kim, Woo Nam Chang, Jun Woo Yeom, Young Dong Kim, Byong Yong Hwang

Abstract

The aim of this study is to compare the time-course changes in neurologic impairments (trunk control, motor function, sensory, and cognition) and recovery in functional impairments (activity of daily livings and gait) simultaneously from initiating rehabilitation to 6 months after stroke. Consecutive stroke patients were recruited from the department of nervous surgery, and transferred into the department of rehabilitation medicine and continued on treatment during the acute stage. Outcome measures were examined at the initial rehabilitation baseline, 1, 2, and 4 weeks after rehabilitation treatment, and 3, 4, 5, and 6 months after stroke. Patients were assessed using the Trunk Impairment Scale, the Fugl-Meyer Motor and Sensory Assessments for the upper and lower limbs, Mini-Mental State Examination, Functional Ambulation Category, and Modified Barthel Index. Twenty consecutive patients were analyzed in the study with complete assessments. The recovery was relatively rapid during the 4 weeks after treatment (P value ranges from <0.001 to <0.007) and then to a lesser extent decelerated between 3 and 6 months after stroke (P value between <0.001 and 0.080). Statistical comparison by repeated measures analysis showed a significant interaction between time points and measures of all recovery variables (P<0.001). Significant differences in level of impairments and functional recovery were found at the different time points. In comparison with the lower leg and trunk control, the upper arm showed less recovery, with a significant difference. All variables except for leg motor function improved continuously over 6 months after stroke. Nevertheless, this study confirms the importance of the period within 3 months for recovery after stroke, during which most of the recovery occurred, ranging from 48 to 91%. Therefore, intensive treatment targeting motor and sensory functions early after stroke may be beneficial for recovery of impairments and functional performance.

Figures

Fig. 1
Fig. 1
Flow diagram of patients recruited into this study.
Fig. 2
Fig. 2
Comparison of recovery rates following stroke. LE, lower extremity; TIS, Trunk Impairment Scale; UE, upper extremity.

References

    1. Anderson TP, Bourestom N, Greenberg FR, Hildyard VG. (1974). Predictive factors in stroke rehabilitation. Arch Phys Med Rehabil 55:545–553.
    1. Bohannon RW. (2007). Muscle strength and muscle training after stroke. J Rehabil Med 39:14–20.
    1. Carr LJ, Harrison LM, Stephens JA. (1994). Evidence for bilateral innervation of certain homologous motoneurone pools in man. J Physiol 475:217–227.
    1. Cauraugh JH, Summers JJ. (2005). Neural plasticity and bilateral movements: a rehabilitation approach for chronic stroke. Prog Neurobiol 75:309–320.
    1. Connell LA, Lincoln NB, Radford KA. (2008). Somatosensory impairment after stroke: frequency of different deficits and their recovery. Clin Rehabil 22:758–767.
    1. Duncan PW, Lai SM. (1997). Stroke recovery. Topics Stroke Rehabil 1997:51–58.
    1. Duncan PW, Goldstein LB, Matchar D, Divine GW, Feussner J. (1992). Measurement of motor recovery after stroke. Outcome assessment and sample size requirements. Stroke 23:1084–1089.
    1. Duncan PW, Goldstein LB, Horner RD, Landsman PB, Samsa GP, Matchar DB. (1994). Similar motor recovery of upper and lower extremities after stroke. Stroke 25:1181–1188.
    1. Folstein MF, Folstein SE, McHugh PR. (1975). ‘Mini-mental state’. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 12:189–198.
    1. Friedman PJ. (1990). Gait recovery after hemiplegic stroke. Int Disabil Stud 12:119–122.
    1. Fugl-Meyer AR, Jääskö L, Leyman I, Olsson S, Steglind S. (1975). The post-stroke hemiplegic patient. 1. a method for evaluation of physical performance. Scand J Rehabil Med 7:13–31.
    1. Hendricks HT, van Limbeek J, Geurts AC, Zwarts MJ. (2002). Motor recovery after stroke: a systematic review of the literature. Arch Phys Med Rehabil 83:1629–1637.
    1. Holden MK, Gill KM, Magliozzi MR. (1986). Gait assessment for neurologically impaired patients. Standards for outcome assessment. Phys Ther 66:1530–1539.
    1. Hsueh IP, Lin JH, Jeng JS, Hsieh CL. (2002). Comparison of the psychometric characteristics of the functional independence measure, 5 item Barthel index, and 10 item Barthel index in patients with stroke. J Neurol Neurosurg Psychiatry 73:188–190.
    1. Jang SH. (2007). A review of motor recovery mechanisms in patients with stroke. NeuroRehabilitation 22:253–259.
    1. Jørgensen HS, Nakayama H, Raaschou HO, Vive-Larsen J, Støier M, Olsen TS. (1995). Outcome and time course of recovery in stroke. Part II: time course of recovery. The Copenhagen Stroke Study. Arch Phys Med Rehabil 76:406–412.
    1. Kwakkel G, Kollen B, Lindeman E. (2004). Understanding the pattern of functional recovery after stroke: facts and theories. Restor Neurol Neurosci 22:281–299.
    1. Mehrholz J, Wagner K, Rutte K, Meissner D, Pohl M. (2007). Predictive validity and responsiveness of the functional ambulation category in hemiparetic patients after stroke. Arch Phys Med Rehabil 88:1314–1319.
    1. Nudo RJ. (2003). Functional and structural plasticity in motor cortex: implications for stroke recovery. Phys Med Rehabil Clin N Am 14 (Suppl):S57–S76.
    1. Platz T, Pinkowski C, van Wijck F, Kim IH, di Bella P, Johnson G. (2005). Reliability and validity of arm function assessment with standardized guidelines for the Fugl-Meyer Test, Action Research Arm Test and Box and Block Test: a multicentre study. Clin Rehabil 19:404–411.
    1. Shah S, Vanclay F, Cooper B. (1989). Improving the sensitivity of the Barthel Index for stroke rehabilitation. J Clin Epidemiol 42:703–709.
    1. Verheyden G, Nieuwboer A, Mertin J, Preger R, Kiekens C, De Weerdt W. (2004). The Trunk Impairment Scale: a new tool to measure motor impairment of the trunk after stroke. Clin Rehabil 18:326–334.
    1. Verheyden G, Nieuwboer A, De Wit L, Thijs V, Dobbelaere J, Devos H, et al. (2008). Time course of trunk, arm, leg, and functional recovery after ischemic stroke. Neurorehabil Neural Repair 22:173–179.
    1. Wade DT, Hewer RL. (1987). Motor loss and swallowing difficulty after stroke: frequency, recovery, and prognosis. Acta Neurol Scand 76:50–54.
    1. Winward CE, Halligan PW, Wade DT. (2007). Somatosensory recovery: a longitudinal study of the first 6 months after unilateral stroke. Disabil Rehabil 29:293–299.

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