Article

Spontaneous neurological recovery after stroke is a
poorly understood process.
The aim of the present article was to test the
proportional recovery model for the upper extremity poststroke and to identify
clinical characteristics of patients who do not fit this model. METHODS: A change
in the Fugl-Meyer Assessment Upper Extremity score (FMA-UE) measured within 72
hours and at 6 months poststroke served to define motor recovery. Recovery on
FMA-UE was predicted using the proportional recovery model: DeltaFMA-UEpredicted
= 0.7.(66 - FMA-UEinitial) + 0.4. Hierarchical cluster analysis on 211 patients
was used to separate nonfitters (outliers) from fitters, and differences between
these groups were studied using clinical determinants measured within 72 hours
poststroke. Subsequent logistic regression analysis served to predict patients
who may not fit the model. RESULTS: The majority of patients (~70%; n = 146)
showed a fixed proportional upper extremity motor recovery of about 78%; 65
patients had substantially less improvement than predicted. These nonfitters had
more severe neurological impairments within 72 hours poststroke (P values <.01).
Logistic regression analysis revealed that absence of finger extension, presence
of facial palsy, more severe lower extremity paresis, and more severe type of
stroke as defined by the Bamford classification were significant predictors of
not fitting the proportional recovery model. CONCLUSIONS: These results confirm
in an independent sample that stroke patients with mild to moderate initial
impairments show an almost fixed proportional upper extremity motor recovery.
Patients who will most likely not achieve the predicted amount of recovery were
identified using clinical determinants measured within
72 hours poststroke.
CI - (c) The Author(s) 2014.

Langue : ANGLAIS