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PLoS One. 2018 Jan 12;13(1):e0189279. doi: 10.1371/journal.pone.0189279. eCollection 2018.

Is the proportional recovery rule applicable to the lower limb after a first-ever ischemic stroke?

Veerbeek JM1,2,3,4,5, Winters C1,2,3, van Wegen EEH1,2,3, Kwakkel G1,2,3,6,7.

Author information

1
Department of Rehabilitation Medicine, VU University Medical Center, Amsterdam, The Netherlands.
2
Amsterdam Movement Sciences, Amsterdam, the Netherlands.
3
Amsterdam Neuroscience, Amsterdam, the Netherlands.
4
Division of Vascular Neurology and Neurorehabilitation, University of Zurich, Zurich, Switzerland.
5
Cereneo, Center for Neurology and Rehabilitation, Vitznau, Switzerland.
6
Rehabilitation Research Center, Reade, Amsterdam, the Netherlands.
7
Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, Illinois, United States of America.

Abstract

OBJECTIVE:

To investigate (a) the applicability of the proportional recovery rule of spontaneous neurobiological recovery to motor function of the paretic lower extremity (LE); and (b) the presence of fitters and non-fitters of this prognostic rule poststroke. When present, the clinical threshold for fitting nor non-fitting would be determined, as well as within-subject generalizability to the paretic upper extremity (UE).

METHODS:

Prospective cohort study in which the Fugl-Meyer Assessment (FMA)-LE and FMA-UE were measured <72 hours and 6 months poststroke. Predicted maximum potential recovery was defined as [FMA-LEmax-FMA-LEinitial = 34 -FMA-LEinitial]. Hierarchical clustering in 202 first-ever ischemic stroke patients distinguished between fitting and not fitting the rule. Descriptive statistics determined whether fitters and non-fitters for LE were the same persons as for UE.

RESULTS:

175 (87%) patients fitted the FMA-LE recovery rule. The observed average improvement of the fitters was ~64% of the predicted maximum potential recovery. In the non-fitter group, the maximum initial FMA-LE score was 13 points. Fifty-one out of 78 patients (~65%) who scored below the identified 14-point threshold at baseline fitted the FMA-LE rule. Non-fitters were more severely affected than fitters. All non-fitters of the FMA-LE rule did also not fit the proportional recovery rule for FMA-UE.

CONCLUSIONS:

Proportional recovery seems to be consistent within subjects across LE and UE motor impairment at the hemiplegic side in first-ever ischemic hemispheric stroke subjects. Future studies should investigate prospectively distinguishing between fitters and not-fitters within the subgroup of patients who have initial low FMA-LE scores. Subsequently, patients could be stratified based on fitting or not fitting the recovery rule as this would impact rehabilitation management and trial design.

PMID:
29329286
PMCID:
PMC5766096
DOI:
10.1371/journal.pone.0189279
[Indexed for MEDLINE]
Free PMC Article

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