Outcome and time course of recovery in stroke. Part II: Time course of recovery. The copenhagen stroke study

Jørgensen, Henrik; Nakayama, Hirofumi; Raaschou, Hans Otto; Vive-Larsen, Jørgen; Støier, Mogens; Olsen, Tom Skyhøj

doi:10.1016/s0003-9993(95)80568-0

Cited by 828 publications

(551 citation statements)

References 21 publications

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“…Given that the individuals in the present study were in the sub-acute stages of stroke recovery, variability may have been further increased due to the large changes in motor recovery occurring in the weeks after stroke. 24,25 Furthermore, participants did not use their usual gait aid during the testing, which may have resulted in an increased number of atypical APAs. Only trials without a gait aid were included in the present analysis due to complications with the calculation of COP when a gait aid is present.…”

Section: Absent Apasmentioning

confidence: 99%

Atypical anticipatory postural adjustments during gait initiation among individuals with sub-acute stroke

et al. 2017

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Anticipatory postural adjustments, executed prior to gait initiation, help preserve lateral stability when stepping. Atypical patterns of anticipatory activity prior to gait initiation may occur in individuals with unilateral impairment (e.g., stroke). This study aimed to determine the prevalence, correlates, and consequences of atypical anticipatory postural adjustment patterns prior to gait initiation in a sub-acute stroke population. Forty independently-ambulatory individuals with subacute stroke stood on two force plates and initiated gait at a self-selected speed. Medio-lateral centre of pressure displacement was calculated and used to define anticipatory postural adjustments (shift in medio-lateral centre of pressure >10 mm from baseline). Stroke severity, motor recovery, and functional balance and mobility status were also obtained. Three patterns were identified: single (typical), absent (atypical), and multiple (atypical) anticipatory postural adjustments. Thirty-five percent of trials had atypical anticipatory postural adjustments (absent and multiple). Frequency of absent anticipatory postural adjustments was negatively correlated with walking speed. Multiple anticipatory postural adjustments were more prevalent when leading with the non-paretic than the paretic limb. Trials with multiple anticipatory postural adjustments had longer duration of anticipatory postural adjustment and time to foot-off, and shorter unloading time than trials with single anticipatory postural adjustments. A high prevalence of atypical anticipatory control prior to gait initiation was found in individuals with stroke. Temporal differences were identified with multiple anticipatory postural adjustments, indicating altered gait initiation. These findings provide insight into postural control during gait initiation in individuals with sub-acute stroke, and may inform interventions to improve ambulation in this population.

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Section: Absent Apasmentioning

confidence: 99%

Atypical anticipatory postural adjustments during gait initiation among individuals with sub-acute stroke

et al. 2017

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“…Although most functional recovery poststroke happens in the first few months,17 recovery beyond 6 months does occur,18 but there are few published data on the relationship between early mRS and long‐term disability. Clarifying the time course of evolution of disability and mortality, relative to 3‐month mRS, should inform the optimal durations of both clinical follow‐up in acute stroke trials and data collection on service use, care costs, and utilities for cost‐effectiveness analyses.…”

Section: Introductionmentioning

confidence: 99%

Time Course of Evolution of Disability and Cause‐Specific Mortality After Ischemic Stroke: Implications for Trial Design

Ganesh

Luengo-Fernández

Wharton

et al. 2017

JAHA

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BackgroundOutcome in stroke trials is often based on a 3‐month modified Rankin scale (mRS). How 3‐month mRS relates to longer‐term outcomes will depend on late recovery, delayed stroke‐related deaths, recurrent strokes, and nonstroke deaths. We evaluated 3‐month mRS and death/disability at 1 and 5 years in a population‐based cohort study.Methods and ResultsIn 3‐month survivors of ischemic stroke (Oxford Vascular Study; 2002‐2014), we related 3‐month mRS to disability (defined as mRS >2) at 1 and 5 years and/or death rates (age/sex adjusted). Accrual of disability and index‐stroke‐related and nonstroke deaths in each poststroke year was categorized according to 3‐month mRS. Among 1606 patients with acute ischemic stroke, 181 died within 3 months, but 126 index‐stroke‐related deaths and 320 other deaths occurred during the subsequent 4866 patient‐years of follow‐up up to 5 years. Although 69/126 (54.8%) post‐3‐month index‐stroke‐related deaths occurred after 1 year, mRS>2 at 1 year strongly predicted these deaths (adjusted hazard ratio=21.94, 95%CI 7.88‐61.09, P<0.0001). Consequently, a 3‐month mRS >2 was a strong independent predictor of death at both 1 year (adjusted hazard ratio=6.67, 95%CI 4.16‐10.69, P<0.0001) and 5 years (adjusted hazard ratio=2.93, 95%CI 2.38‐3.60, P<0.0001). Although mRS improved by ≥1 point from 3 months to 1 year in 317/1266 (25.0%) patients with 3‐month mRS ≥1, improvement in mRS after 1 year was limited (improvement by ≥1 point: 91/858 [10.6%]; improvement to mRS ≤2: 13/353 [3.7%]).ConclusionsOur results reaffirm use of the 3‐month mRS outcome in stroke trials. Although later recovery does occur, extending follow‐up to 1 year would capture most long‐term stroke‐related disability. However, administrative mortality follow‐up beyond 1 year has the potential to demonstrate translation of early disability gains into additional reductions in long‐term mortality without much erosion by non‐stroke‐related deaths.

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“…3, 5-8 9 Similarly, severity, is also related to the early clinical course, with patients with severe stroke more likely to experience deterioration. 10 In addition, recovery is observed later in severe stroke 11 and it has been postulated that the extent of intrinsic cerebral damage is reflected not only by the degree of impairment, but also in the length of time to improvement after stroke. 12 The importance of clinical history and examination, for evaluating stroke patients is well recognised, 13 and stroke can be classified into four clinical syndromes, which have distinct natural histories: total anterior circulation syndrome (TACS), partial anterior circulation syndrome (PACS), lacunar syndrome (LACS) and posterior circulation syndrome (POCS).…”

Section: Introductionmentioning

confidence: 99%

Stroke severity, early recovery and outcome are each related with clinical classification of stroke: Data from the ‘Tinzaparin in Acute Ischaemic Stroke Trial’ (TAIST)

Sprigg

Gray

Bath

et al. 2007

Journal of the Neurological Sciences

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Outcome and time course of recovery in stroke. Part II: Time course of recovery. The copenhagen stroke study

Cited by 828 publications

References 21 publications

Atypical anticipatory postural adjustments during gait initiation among individuals with sub-acute stroke

Atypical anticipatory postural adjustments during gait initiation among individuals with sub-acute stroke

Time Course of Evolution of Disability and Cause‐Specific Mortality After Ischemic Stroke: Implications for Trial Design

Stroke severity, early recovery and outcome are each related with clinical classification of stroke: Data from the ‘Tinzaparin in Acute Ischaemic Stroke Trial’ (TAIST)

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