Prognostic value of motor evoked potentials in motor function recovery of upper limb after stroke. Action observation for upper limb function after stroke: evidence-based review of randomized controlled trials Predicting health related quality of life 6 months after stroke: the role of anxiety and upper limb dysfunction Generalizability of the Maximum Proportional Recovery Rule to Visuospatial Neglect Early Poststroke The PREP algorithm predicts potential for upper limb recovery after stroke. Prediction of Upper Limb Recovery, General Disability, and Rehabilitation Status by Activity Measurements Assessed by Accelerometers or the Fugl-Meyer Score in Acute Stroke The Role of Caregiver Involvement in Upper-Limb Treatment in Individuals With Subacute Stroke Predicting functional outcome and survival after acute ischemic stroke Focal Muscle Vibration and Progressive Modular Rebalancing with neurokinetic facilitations in post- stroke recovery of upper limb. Functional recovery of the paretic upper limb after stroke: who regains hand capacity? Are Work Disability Prevention Interventions Effective for the Management of Neck Pain or Upper Extremity Disorders? A Systematic Review by the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration Comparing unilateral and bilateral upper limb training: The ULTRA-stroke program design Long term effects of intensity of upper and lower limb training after stroke: a randomised trial Electroacupuncture may help motor recovery in chronic stroke survivors: a pilot study.
OBJECTIVE To determine the prognostic value of clinical assessment and motor evoked potentials for upper limb strength and functional recovery after acute stroke , and to establish the possible use of motor evoked potentials in rehabilitation . DESIGN A prospect i ve study . SUBJECTS Fifty-two patients with hemiparesis were enrolled one month post-stroke ; 38 patients concluded the study at 12 months . METHODS Motor evoked potentials were recorded at baseline and after one month .  Upper limb muscular strength ( Medical Research Council Scale , MRC ) and functional tests ( Frenchay Arm Test , Barthel Index ) were used as dependent outcome variables 12 months later . Motor evoked potentials were classified as present or absent . Predictive values of motor evoked potentials and MRC were evaluated . RESULTS At 12 months , patients with baseline recordable motor evoked potentials showed a good functional recovery ( positive predictive value 94 % ) . The absence of motor evoked potentials did not exclude muscular strength recovery ( negative predictive value 95 % ) . Motor evoked potentials had a higher positive predictive value than MRC only in patients with MRC < 2 . CONCLUSION Motor evoked potentials could be a supportive tool to increase the prognostic accuracy of upper limb motor and functional outcome in hemiparetic patients , especially those with severe initial paresis ( MRC < 2 ) and /or with motor evoked potentials absent in the post-stroke acute phase [ Purpose ] The purpose of this study was to suggest evidence d information about action observation to improve upper limb function after stroke . [ Methods ] A systematic review of r and omized controlled trials involving adults aged 18 years or over and including descriptions of action observation for improving upper limb function  was undertaken . Electronic data bases were search ed , including MEDLINE , CINAHL , and PEDro ( the Physiotherapy Evidence Data base ) , for articles published between 2000 to 2014 . Following completion of the search es , two review ers independently assessed the trials and extracted data using a data extraction form . The same two review ers independently documented the method ological quality of the trials by using the PEDro scale . [ Results ] Five r and omized controlled trials were ultimately included in this review , and four of them ( 80 % ) reported statistically significant effects for motor recovery of upper limb using action observation intervention in between groups . [ Conclusion ] This review of the literature presents evidence attesting to the benefits conferred on stroke patints result ing from participation in an action observation intervention . The body of literature in this field is growing steadily . Further work needs to be done to evaluate the evidence for different conditions after stroke and different duration of intervention Purpose : This study examined the role of anxiety and upper limb dysfunction , amongst other variables , as predictors of health related quality of life ( HRQOL ) 6 months after stroke . Method : Participants : Stroke survivors ( n = 85 ) who had previously participated in a r and omised controlled trial of a physiotherapy intervention .  Dependent variable : HRQOL – Nottingham Health Profile ( NHP ) . Predictor variables : Mood – Hospital Depression and Anxiety Scale ; Upper Limb Functioning - Action Research Arm Test ; Rivermead Motor Assessment ; Activities of Daily Living – Modified Barthel Index ; Clinical and demographic factors . Results : Anxiety and depression significantly predicted 49 % of variance in overall HRQOL ( p < 0.05 ) , but only anxiety significantly predicted NHP pain ( 13 % variance , p < 0.001 ) , emotional reactions ( 41 % variance , p < 0.001 ) , sleep ( 19 % variance , p = 0.02 ) and social isolation ( 23 % variance , p = 0.02 ) . Depression and anxiety together significantly predicted 30 % variance in energy level ( p < 0.001 ) . UL motor impairment and activities of daily living predicted 36 % of variance in NHP physical activity score ( p < 0.001 ) . Conclusions : This study indicates that where anxiety is assessed , it appears more important in determining HRQOL than depression . UL impairment and ADL independence predicted perceived physical activity . Management strategies for anxiety and therapy for UL recovery long after stroke onset are likely to benefit perceived HRQOL . Implication s for Rehabilitation Anxiety is a major predictor of quality of life six months after stroke . Post-stroke anxiety should be routinely assessed in rehabilitation . Appropriate management strategies for anxiety should occur during rehabilitation with follow-up into the chronic post-stroke period . Upper limb impairment is a stronger predictor of perceptions of physical activity than independence in activities daily living six months after stroke . Rehabilitation of the upper limb should continue into the chronic post-stroke period Background and objective . Proportional recovery of upper-extremity motor function and aphasia after stroke may suggest common mechanisms for spontaneous neurobiological recovery . This study aim ed to investigate if the proportional recovery rule also applies to visuospatial neglect ( VSN ) in right-hemispheric first-ever ischemic stroke patients and explored the possible common underlying mechanisms . Methods . Patients with upper-limb paresis and VSN were included . Recovery defined as the change in  Letter Cancellation Test ( LCT ) score at ~8 days and 6 months poststroke . Potential recovery defined as LCTmax-LCTinitial = 20 − LCTinitial . Hierarchical clustering separated fitters and nonfitters of the prediction rule . A cutoff value on LCTmax-LCTinitial was determined . The change in LCT and Fugl-Meyer Assessment Upper Extremity was expressed as a percentage of the total possible score to investigate the communality of proportional recovery . Results . Out of 90 patients , 80 displayed proportional recovery of VSN ( ie , “ fitters , ” 0.97 ; 95 % CI = 0.82 - 1.12 ) . All patients who did not follow the prediction rule for VSN ( ie , ” nonfitters ” ) had ≥15 missing O ’s at baseline and failed to show proportional recovery of the upper limb . Conclusions . This study shows that the proportional recovery rule also applies to patients with VSN poststroke . Patients who fail to show proportional recovery of VSN are the same patients who fail to show proportional recovery of the upper limb . These findings support the idea of common intrahemispheric mechanisms underlying spontaneous neurobiological recovery in the first months poststroke . Future studies should investigate the prognostic clinical and neurobiological markers of these subgroups Stroke is a leading cause of adult disability and the recovery of motor function is important for independence in activities of daily living . Predicting motor recovery after stroke in individual patients is difficult . Accurate prognosis would enable realistic rehabilitation goal - setting and more efficient allocation of re sources . The aim of this study was to test and refine an algorithm for predicting the potential for recovery of upper limb function after stroke . Forty participants were prospect ively enrolled within 3 days of ischaemic stroke . First ,  shoulder abduction and finger extension strength  were grade d 72 h after stroke onset to compute a shoulder abduction and finger extension score . Secondly , transcranial magnetic stimulation was used to assess the functional integrity of descending motor pathways to the affected upper limb . Third , diffusion-weighted magnetic resonance imaging was used to assess the structural integrity of the posterior limbs of the internal capsules . Finally , these measures were combined in the PREP algorithm for predicting an individual 's potential for upper limb recovery at 12 weeks , measured with the Action Research Arm Test . A cluster analysis was used to independently group patients according to Action Research Arm Test score at 12 weeks , for comparison with predictions from the PREP algorithm . There was excellent correspondence between the cluster analysis of Action Research Arm Test score at 12 weeks and predictions made with the PREP algorithm . The algorithm had positive predictive power of 88 % , negative predictive power of 83 % , specificity of 88 % and sensitivity of 73 % . This study provides preliminary data in support of the PREP algorithm for the prognosis of upper limb recovery in individual patients .  PREP may enable tailored planning of rehabilitation and more accurate stratification of patients in clinical trials Objective This study investigated the clinical predictive value of the Fugl-Meyer Assessment ( FMA ) arm score and the upper limb activity assessed by accelerometers in patients with hemiparesis after acute stroke . Design The prospect i ve cohort ( n = 129 ) was recruited from a general hospital ; activity variables and FMA score at intake were related to the FMA , the modified Rankin Scale , and rehabilitation status after 3 mos of follow-up . The prediction model was based on binary logistic regression . Results Although the FMA score at intake has the best overall predictive value for all three outcome measures ( FMA3 , 87.6 % ; modified Rankin Scale , 85.3 % ; RS , 73.6 % ) , the activity of the impaired arm as assessed by the accelerometer has the best predictive value to determine patients who are at risk for continued disability ( modified Rankin Scale score 1 , 95.1 % ) . The most difficult outcome measure for prediction is the rehabilitation status ; specifically , the patients who went home are predicted imprecisely . The ratio variable is the least accurate predictor of all tested variables . Conclusions The  FMA arm score at intake is the best predictor for arm recovery and general disability . The activity of the impaired arm is an excellent predictor for prolonged disability and is an alternative to the FMA score when it is impossible to score the FMA in the acute phase of stroke Background Initial severity of upper-limb motor impairment and exercise intensity are important predictors of improved upper-limb function during stroke rehabilitation . Initial severity of motor impairment , however , is not modifiable by rehabilitation , and increased one-on-one treatment is not always feasible . Alternative methods to increase intensity and improve upper-limb function are needed . Objective The purpose of this study was to examine  caregiver involvement in upper-limb treatment as a method to improve upper-limb function . Design This study was a secondary analysis of a multi-site r and omized controlled trial for upper-limb recovery during subacute inpatient stroke rehabilitation . Methods Data from 50 individuals with subacute stroke who were r and omly assigned to the experimental group ( upper-limb exercise )  were used for the analysis . Outcome variables were measured at baseline and at completion of the 4-week intervention . Group comparisons between participants with caregiver support and participants without caregiver support were done using an analysis of variance . Using the Fugl-Meyer Upper-Limb Motor Impairment Scale and time spent in treatment ( intensity ) as covariates , a multivariate regression analysis was performed to determine the additive value of caregiver support on upper-limb function , as measured by change scores on the Chedoke Arm and H and Activity Inventory and the Motor Activity Log . Results Group comparisons revealed that participants with caregiver support had improved upper-limb function compared with those without caregiver support and were more likely to increase the amount of time spent doing exercise . The multiple regression analysis showed that Fugl-Meyer score , treatment intensity , and caregiver support were significant predictors of upper-limb improvement ( R2=.240–.292 ) . In the regression models , caregiver support accounted for 5 % to 9 % of upper-limb improvement . Limitations Support was coded as a dichotomous variable , and thus the degree of support or qualitative nature of support was not captured . Conclusions Involvement of caregivers was a determinant of improved upper-limb function over and above initial severity of motor impairment and exercise intensity . Further research is needed to determine the optimal qualitative and quantitative elements of caregiver involvement in stroke rehabilitation in order to maximize results Abstract . Objective : Disability and mortality represent the most relevant clinical outcome after acute ischemic stroke . However , vali date d and comprehensive prognostic models for recovery have not been developed . An accurate model including all previously suggested independent outcome predictors could improve the design and analysis of clinical trials . We therefore developed prognostic models for functional dependence and death after 100 days in a large cohort of stroke patients . Methods : From the German Stroke Data base , 1754 prospect ively collected records of patients with acute ischemic stroke were used for the development of prognostic models . Intubated patients and patients with low functional status before stroke were excluded . Functional independence was defined as a Barthel Index ≥95 after 100 days . Prognostic factors assessable within 72 hours after admission were identified by a systematic literature review . The final models of binary logistic regression analyses were internally vali date d and calibrated . Results : The result ing cross-vali date d and calibrated models correctly classified more than 80 % of the patients and yielded the following prognostic factors for functional independence : Age , right and left arm paresis at admission , NIH-Stroke Scale at admission , Rankin Scale 48–72 hours later , gender , prior stroke , diabetes , fever , lenticulostriate infa rct ion , neurological complications . The following variables were identified as prognostic factors for death : Age , NIH-Stroke Scale at admission , and fever . Conclusions : Our work gives an important insight into prognostic factors after acute ischemic stroke and presents predictive models with high prognostic accuracy . Together with a prospect i ve validation study , currently underway , we hence hope to improve the prediction of functional outcome after ischemic stroke BACKGROUND Stroke is one of the leading causes for disability worldwide . Exercise therapy is a key element of stroke rehabilitation but no evidence are present in literature . Moreover recently focal muscle vibrationis described as a useful therapeutic approach in the post stroke recovery . In this study the efficacy of the vibration therapy in association to progressive modular re balancing rehabilitative approach has been evaluated and compared to the conventional therapy alone and associated to the muscle vibration . METHODS A pilot r and omized controlled trial , using a pragmatic triple-blind , parallel-group study design in chronic stroke patients upper limb function . RESULTS Functional outcomes result ed increased in the group treated with vibration therapy and in particular in the group associated to progressive modular rebalancing approach . CONCLUSION The combining neurophysiologically-based rehabilitative technique and vibration therapy may improve functional recovery in chronic stroke patients OBJECTIVE To describe recovery of upper limb capacity after stroke during  inpatient rehabilitation  based on the Stroke Upper Limb Capacity Scale ( SULCS ) . DESIGN Prospect i ve observational study . SETTING Inpatient department of a rehabilitation center . PARTICIPANTS Patients with stroke ( N=299 ) admitted to a specialized stroke rehabilitation center . INTERVENTION Not applicable . MAIN OUTCOME MEASURES Upper limb capacity was assessed at the start and end of the rehabilitation phase with the SULCS ( range , 0 - 10 ) . The following demographic and clinical characteristics were registered : age , sex , side of stroke , stroke type , time since stroke , and length of stay in the rehabilitation center . RESULTS On admission , 125 patients had no h and capacity ( SULCS score , 0 - 3 ) , 58 had basic h and capacity ( SULCS score , 4 - 7 ) , and 116 had advanced h and capacity ( SULCS score , 8 - 10 ) . Of the patients without initial h and capacity , 41 % regained some h and capacity ( SULCS score , ≥4 ) at discharge . Of these , patients with SULCS scores of 2 and 3 had 29 and 97 times greater chance of regaining some h and capacity compared with patients with an initial SULCS score of 0 , respectively . Of the patients with initial basic h and capacity , 78 % regained advanced h and capacity at discharge . The SULCS score on admission explained 51 % of the SULCS score variance at discharge , while time since stroke was negatively associated with upper limb recovery , explaining an additional 7 % of the SULCS score variance at discharge . CONCLUSIONS Even patients with minimal proximal shoulder and elbow control of the upper paretic limb on admission in a rehabilitation center have a fair chance of regaining some h and capacity in the long-term after stroke , whereas patients without such proximal arm control have a much poorer prognosis for regaining h and capacity Abstract Purpose We conducted a systematic review to critically appraise and synthesize literature on the effectiveness of work disability prevention ( WDP ) interventions in workers with neck pain , whiplash-associated disorders ( WAD ) , or upper extremity disorders . Methods We search ed electronic data bases from 1990 to 2012 . R and om pairs of independent review ers critically appraised eligible studies using the Scottish Intercollegiate Guidelines Network criteria . Scientifically admissible studies were summarized and synthesized following best- evidence synthesis methodology . Results Of the 6,359 articles retrieved , 16 r and omized controlled trials were eligible for critical appraisal and five were admissible . We found that a return-to-work coordination program ( including workplace-based work hardening ) was superior to clinic-based work hardening for persistent rotator cuff tendinitis . Workplace high-intensity strength training and workplace advice had similar outcomes for neck and shoulder pain . Mensendieck/Cesar postural exercises and strength and fitness exercises had similar outcomes for non-specific work-related upper limb complaints . Adding a brief job stress education program to a workplace ergonomic intervention was not beneficial for persistent upper extremity symptoms . Adding computer-prompted work breaks to ergonomic adjustments and workplace education benefited workers ’ recovery from recent work-related neck and upper extremity complaints . Conclusions At present , no firm conclusions can be drawn regarding the effectiveness of WDP interventions for managing neck pain , WAD , and upper extremity disorders . Our review suggests a return-to-work coordination program is more effective than clinic-based work hardening . Also , adding computer-prompted breaks to ergonomic and workplace interventions benefits workers ’ recovery . The current quality of evidence does not allow for a definitive evaluation of the effectiveness of ergonomic interventions Background About 80 % of all stroke survivors have an upper limb paresis immediately after stroke , only about a third of whom ( 30 to 40 % ) regain some dexterity within six months following conventional treatment programs . Of late , however , two recently developed interventions - constraint-induced movement therapy ( CIMT ) and bilateral arm training with rhythmic auditory cueing ( BATRAC ) - have shown promising results in the treatment of upper limb paresis in chronic stroke patients . The ULTRA-stroke ( acronym for Upper Limb TRaining After stroke ) program was conceived to assess the effectiveness of these interventions in subacute stroke patients and to examine how the observed changes in sensori-motor functioning relate to changes in stroke recovery mechanisms associated with peripheral stiffness , interlimb interactions , and cortical inter- and intrahemispheric networks . The present paper describes the design of this single-blinded r and omized clinical trial ( RCT ) , which has recently started and will take several years to complete . Methods / Design Sixty patients with a first ever stroke will be recruited . Patients will be stratified in terms of their remaining motor ability at the distal part of the arm ( i.e. , wrist and finger movements ) and r and omized over three intervention groups  receiving modified CIMT , modified BATRAC , or an equally intensive ( i.e. , dose-matched ) conventional treatment program for 6 weeks . Primary outcome variable is the score on the Action Research Arm test ( ARAT ) , which will be assessed before , directly after , and 6 weeks after the intervention . During those test sessions all patients will also undergo measurements aim ed at investigating the associated recovery mechanisms using haptic robots and magneto-encephalography ( MEG ) . Discussion ULTRA-stroke is a 3-year translational research program which aims ( 1 ) to assess the relative effectiveness of the three interventions , on a group level but also as a function of patient characteristics , and ( 2 ) to delineate the functional and neurophysiological changes that are induced by those interventions .The outcome on the ARAT together with information about changes in the associated mechanisms will provide a better underst and ing of how specific therapies influence neurobiological changes , and which post-stroke conditions lend themselves to specific treatments . Trial Registration The ULTRA-stroke program is registered at the Netherl and s Trial Register ( NTR , http://www.trialregister.nl , number NTR1665 ) Objective : To assess long term effects at 1 year after stroke in patients who participated in an upper and lower limb intensity training programme in the acute and subacute rehabilitation phases . Design : A three group r and omised controlled trial with repeated measures was used . Method : One hundred and one patients with a primary middle cerebral artery stroke were r and omly allocated to one of three groups for a 20 week rehabilitation programme with an emphasis on ( 1 ) upper limb function , ( 2 ) lower limb function or ( 3 ) immobilisation with an inflatable pressure splint ( control group ) . Follow up assessment s within and between groups were compared at 6 , 9 , and 12 months after stroke . Results : No statistically significant effects were found for treatment assignment from 6 months onwards . At a group level , the significant differences in efficacy demonstrated at 20 weeks after stroke in favour of the lower limb remained . However , no significant differences in functional recovery between groups were found for Barthel index ( BI ) , functional ambulation categories (FAC),action research arm test ( ARAT ) , comfortable and maximal walking speed , Nottingham health profile part 1(NHP-part 1 ) , sickness impact profile-68 ( SIP-68 ) , and Frenchay activities index ( FAI ) from 6 months onwards . At an individual subject level a substantial number of patients showed improvement or deterioration in upper limb function ( n=8 and 5 , respectively ) and lower limb function ( n=19 and 9 , respectively ) . Activities of daily living ( ADL ) scores showed that five patients deteriorated and four improved beyond the error threshold from 6 months onwards . In particular , patients with some but incomplete functional recovery at 6 months are likely to continue to improve or regress from 6 months onwards . Conclusions : On average patients maintained their functional gains for up to 1 year after stroke after receiving a 20 week upper or lower limb function training programme . However , a significant number of patients with incomplete recovery showed improvements or deterioration in dexterity , walking ability , and ADL beyond the error threshold Past studies have suggested that acupuncture may reduce spasticity in stroke survivors . We do not know , however , whether acupuncture may enhance the effect of  strength training on motor function . This study compared upper-limb motor functional improvement in chronic stroke survivors who received a combination of  acupuncture and strength training with that of subjects who received strength training alone .  A total of 10 chronic stroke patients with moderate or severe wrist muscle spasticity were recruited for this study . The study used a crossover design with a r and om order of either combined electroacupuncture and strength training or strength training alone . Each subject received one of the two types of treatment twice a week for the first 6 weeks and switched to the other for another 6 weeks . Quantitative measurements of wrist spasticity , active wrist extension range of motion , isometric wrist strength , and clinical evaluation with Fugl-Meyer ( FM ) upper-limb motor scores were conducted before and after either treatment . After the combined treatment , the quantitative spasticity level , active wrist extension range of motion ( increased by a mean of 16.3 degrees ) , and FM upper-limb motor score ( increased by a mean of 4.9 points ) changed significantly ( p < 0.01 ) but no significant changes were noted in isometric wrist strength . The strength training alone result ed in no significant changes to any measured variable . The results of the current study indicate that the combined acupuncture and strength training treatment reduced muscle spasticity and may have improved motor function for chronic stroke survivors with moderate or severe muscle spasticity
The most important predictive factors for upper limb recovery following stroke appears to the initial severity of motor impairment or function
Objective : To systematic ally review and summarize the current available literature on prognostic variables relating to upper limb recovery following stroke .
To identify which , if any variables predict upper limb recovery following stroke .