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Rodrigues NAG, da Silva SLA, Nascimento LR, de Paula Magalhães J, Sant'Anna RV, de Morais Faria CDC, Faria-Fortini I. R3-Walk and R6-Walk, Simple Clinical Equations to Accurately Predict Independent Walking at 3 and 6 Months After Stroke: A Prospective, Cohort Study. Arch Phys Med Rehabil 2024; 105:1116-1123. [PMID: 38281578 DOI: 10.1016/j.apmr.2024.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 01/12/2024] [Indexed: 01/30/2024]
Abstract
OBJECTIVE To investigate if independent walking at 3 and 6 months poststroke can be accurately predicted within the first 72 hours, based on simple clinical bedside tests. DESIGN Prospective observational cohort study with 3-time measurements: immediately after stroke, and 3 and 6 months poststroke. SETTING Public hospital. PARTICIPANTS Adults with first-ever stroke evaluated at 3 (N=263) and 6 (N=212) months poststroke. INTERVENTION Not applicable. MAIN OUTCOME MEASURES The outcome of interest was independent walking at 3 and 6 months after stroke. Predictors were age, walking ability, lower limb strength, motor recovery, spatial neglect, continence, and independence in activities of daily living. RESULTS The equation for predicting walking 3 months poststroke was 3.040 + (0.283 × FAC baseline) + (0.021 × Modified Barthel Index), and for predicting walking 6 months poststroke was 3.644 + (-0.014 × age) + (0.014 × Modified Barthel Index). For walking ability 3 months after stroke, sensitivity was classified as high (91%; 95% CI: 81-96), specificity was moderate (57%; 95% CI: 45-69), positive predictive value was high (76%; 95% CI: 64-86), and negative predictive value was high (80%; 95% CI: 60-93). For walking ability 6 months after stroke, sensitivity was classified as moderate (54%; 95% CI: 47-61), specificity was high (81%; 95% CI: 61-92), positive predictive value was high (87%; 95% CI: 70-96), and negative predictive value was low (42%; 95% CI: 50-73). CONCLUSIONS This study provided 2 simple equations that predict walking ability 3 and 6 months after stroke. This represents an important step to accurately identify individuals, who are at high risk of walking dependence early after stroke.
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Affiliation(s)
| | | | | | - Jordana de Paula Magalhães
- Graduate Program in Rehabilitation Sciences, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | | | | | - Iza Faria-Fortini
- Department of Occupational Therapy, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.
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Ackerley S, Smith MC, Jordan H, Stinear CM. Biomarkers of Motor Outcomes After Stroke. Phys Med Rehabil Clin N Am 2024; 35:259-276. [PMID: 38514217 DOI: 10.1016/j.pmr.2023.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2024]
Abstract
Predicting motor outcomes after stroke based on clinical judgment alone is often inaccurate and can lead to inefficient and inequitable allocation of rehabilitation resources. Prediction tools are being developed so that clinicians can make evidence-based, accurate, and reproducible prognoses for individual patients. Biomarkers of corticospinal tract structure and function can improve prediction tool performance, particularly for patients with initially moderate to severe motor impairment. Being able to make accurate predictions for individual patients supports rehabilitation planning and communication with patients and families.
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Affiliation(s)
- Suzanne Ackerley
- School of Sport and Health Sciences, University of Central Lancashire, Preston, PR1 2HE, UK
| | - Marie-Claire Smith
- Department of Exercise Sciences, University of Auckland, Private Bag 92019, Auckland 1023, New Zealand
| | - Harry Jordan
- Department of Medicine, University of Auckland, Private Bag 92019, Auckland 1023, New Zealand
| | - Cathy M Stinear
- Department of Medicine, University of Auckland, Private Bag 92019, Auckland 1023, New Zealand.
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3
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Kwakkel G, Stinear C, Essers B, Munoz-Novoa M, Branscheidt M, Cabanas-Valdés R, Lakičević S, Lampropoulou S, Luft AR, Marque P, Moore SA, Solomon JM, Swinnen E, Turolla A, Alt Murphy M, Verheyden G. Motor rehabilitation after stroke: European Stroke Organisation (ESO) consensus-based definition and guiding framework. Eur Stroke J 2023; 8:880-894. [PMID: 37548025 PMCID: PMC10683740 DOI: 10.1177/23969873231191304] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/08/2023] Open
Abstract
PURPOSE To propose a consensus-based definition and framework for motor rehabilitation after stroke. METHODS An expert European working group reviewed the literature, attaining internal consensus after external feedback. FINDINGS Motor rehabilitation is defined as a process that engages people with stroke to benefit their motor function, activity capacity and performance in daily life. It is necessary for people with residual motor disability whose goal is to enhance their functioning, independence and participation. Motor rehabilitation operates through learning- and use-dependent mechanisms. The trajectory of motor recovery varies across patients and stages of recovery. Early behavioral restitution of motor function depends on spontaneous biological mechanisms. Further improvements in activities of daily living are achieved by compensations. Motor rehabilitation is guided by regular assessment of motor function and activity using consensus-based measures, including patient-reported outcomes. Results are discussed with the patient and their carers to set personal goals. During motor rehabilitation patients learn to optimize and adapt their motor, sensory and cognitive functioning through appropriately dosed repetitive, goal-oriented, progressive, task- and context-specific training. Motor rehabilitation supports people with stroke to maximize health, well-being and quality of life. The framework describes the International Classification of Functioning, Disability and Health in the context of stroke, describes neurobiological mechanisms of behavioral restitution and compensation, and summarizes recommendations for clinical assessment, prediction tools, and motor interventions with strong recommendations from clinical practice guidelines (2016-2022). CONCLUSIONS This definition and framework may guide clinical educators, inform clinicians on current recommendations and guidelines, and identify gaps in the evidence base.
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Affiliation(s)
- Gert Kwakkel
- Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam Neuroscience, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, IL, USA
- Department Acquired Brain Injuries, Amsterdam Rehabilitation Research Centre, Reade, Amsterdam, The Netherlands
| | - Cathy Stinear
- Department of Medicine, Waipapa Taumata Rau University of Auckland, Aotearoa, New Zealand
| | - Bea Essers
- Department of Rehabilitation Sciences, KU Leuven – University of Leuven, Leuven, Belgium
| | - Maria Munoz-Novoa
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Meret Branscheidt
- Department of Neurology, University Hospital of Zurich, and Cereneo Center for Neurology and Rehabilitation, Vitznau, Switzerland
| | - Rosa Cabanas-Valdés
- Department of Physiotherapy, Faculty of Medicine and Health Science, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Sandra Lakičević
- Department of Neurology, Stroke Unit, University Hospital Mostar, Mostar, Bosnia and Herzegovina
| | - Sofia Lampropoulou
- Physiotherapy Department, School of Health Rehabilitation Sciences, University of Patras, Rio, Greece
| | - Andreas R Luft
- Department of Neurology, University Hospital of Zurich, and Cereneo Center for Neurology and Rehabilitation, Vitznau, Switzerland
| | - Philippe Marque
- Service de médecine physique et réadaptation, CHU de Toulouse, Toulouse, France
| | - Sarah A Moore
- Department of Sport, Exercise and Rehabilitation, Faculty of Health and Life Science, Northumbria University, Newcastle upon Tyne, UK
- Stroke Research Group, Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - John M Solomon
- Centre for Comprehensive Stroke Rehabilitation and Research, Manipal Academy of Higher Education, Manipal, Karnataka, India
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Eva Swinnen
- Rehabilitation Research Group, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Andrea Turolla
- Department of Biomedical and Neuromotor Sciences, Alma Mater University of Bologna, Bologna, Italy
- Unit of Occupational Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Margit Alt Murphy
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Occupational Therapy and Physiotherapy, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Geert Verheyden
- Department of Rehabilitation Sciences, KU Leuven – University of Leuven, Leuven, Belgium
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Sommer B, Haas M, Karrer S, Jörger M, Graf E, Huber M, Baumgartner D, Bansi J, Kool J, Bauer C. The Effect on Muscle Activity of Reaching Beyond Arm's Length on a Mobile Seat: A Pilot Study for Trunk Control Training for People After Stroke. Arch Rehabil Res Clin Transl 2023; 5:100289. [PMID: 38163026 PMCID: PMC10757194 DOI: 10.1016/j.arrct.2023.100289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2024] Open
Abstract
Objective This pilot study compared muscle activity during lateral reaching tasks between mobile and stable sitting using a novel therapy chair in people after stroke and healthy controls. Design Observational pilot study. Setting This study was conducted in a rehabilitation center for people after stroke and at the university's movement laboratory for healthy participants. Participants A total of eleven people after stroke and fifteen healthy people (N=26) took part. Interventions Lateral reaching exercises to the ipsilateral and contralateral sides were performed on a mobile and a stable seat. Main Outcome Measure Muscular activity of the multifidus, erector spinae and external oblique was measured bilaterally. A within-subject linear mixed model was applied to analyze the effects of seat condition, task, muscle side, and group. Results A seat condition effect was found for the multifidus and external oblique that was dependent on the muscle side and task. During ipsilateral reaching, the activity of the multifidi decreased for people after stroke on the mobile seat, while increasing for healthy participants. The erector spinae showed no condition effect. Decreased activity of the external oblique was found for both groups on the mobile seat. Conclusions Mobile sitting influences muscular activity. However, these preliminary results should be further investigated in order to generate recommendations for rehabilitation.
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Affiliation(s)
- Bettina Sommer
- School of Health Sciences, Zurich University of Applied Sciences, Winterthur, Switzerland
| | - Michelle Haas
- School of Health Sciences, Zurich University of Applied Sciences, Winterthur, Switzerland
| | - Samuel Karrer
- School of Health Sciences, Zurich University of Applied Sciences, Winterthur, Switzerland
| | - Matthias Jörger
- School of Health Sciences, Zurich University of Applied Sciences, Winterthur, Switzerland
| | - Eveline Graf
- School of Health Sciences, Zurich University of Applied Sciences, Winterthur, Switzerland
| | - Martin Huber
- School of Health Sciences, Zurich University of Applied Sciences, Winterthur, Switzerland
| | - Daniel Baumgartner
- School of Engineering, Zurich University of Applied Sciences, Winterthur, Switzerland
| | - Jens Bansi
- Physiotherapy Department, Valens Rehabilitation Centre, Valens, Switzerland
- OST, University of Applied Sciences of Eastern Switzerland, St. Gallen, Switzerland
| | - Jan Kool
- Physiotherapy Department, Valens Rehabilitation Centre, Valens, Switzerland
| | - Christoph Bauer
- School of Health Sciences, Zurich University of Applied Sciences, Winterthur, Switzerland
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Alt Murphy M, Al-Shallawi A, Sunnerhagen KS, Pandyan A. Early prediction of upper limb functioning after stroke using clinical bedside assessments: a prospective longitudinal study. Sci Rep 2022; 12:22053. [PMID: 36543863 PMCID: PMC9772392 DOI: 10.1038/s41598-022-26585-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 12/16/2022] [Indexed: 12/24/2022] Open
Abstract
Early and accurate prediction of recovery is needed to assist treatment planning and inform patient selection in clinical trials. This study aimed to develop a prediction algorithm using a set of simple early clinical bedside measures to predict upper limb capacity at 3-months post-stroke. A secondary analysis of Stroke Arm Longitudinal Study at Gothenburg University (SALGOT) included 94 adults (mean age 68 years) with upper limb impairment admitted to stroke unit). Cluster analysis was used to define the endpoint outcome strata according to the 3-months Action Research Arm Test (ARAT) scores. Modelling was carried out in a training (70%) and testing set (30%) using traditional logistic regression, random forest models. The final algorithm included 3 simple bedside tests performed 3-days post stroke: ability to grasp, to produce any measurable grip strength and abduct/elevate shoulder. An 86-94% model sensitivity, specificity and accuracy was reached for differentiation between poor, limited and good outcome. Additional measurement of grip strength at 4 weeks post-stroke and haemorrhagic stroke explained the underestimated classifications. External validation of the model is recommended. Simple bedside assessments have advantages over more lengthy and complex assessments and could thereby be integrated into routine clinical practice to aid therapy decisions, guide patient selection in clinical trials and used in data registries.
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Affiliation(s)
- Margit Alt Murphy
- grid.8761.80000 0000 9919 9582Department of Clinical Neuroscience, Rehabilitation Medicine, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden ,grid.1649.a000000009445082XDepartment of Occupational Therapy and Physiotherapy, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Ahmad Al-Shallawi
- grid.510463.50000 0004 7474 9241The Administrative Technical College of Mosul, Northern Technical University, Mosul, Nineveh Iraq
| | - Katharina S. Sunnerhagen
- grid.8761.80000 0000 9919 9582Department of Clinical Neuroscience, Rehabilitation Medicine, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Anand Pandyan
- grid.17236.310000 0001 0728 4630Faculty of Health and Social Science, Bournemouth University, Bournemouth, UK
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