Recovery and Prediction of Bimanual Hand Use After Stroke

Abstract

Objective:To determine similarities and differences in key predictors of recovery of bimanual hand use and unimanual motor impairment after stroke.Method:In this prospective longitudinal study n = 89 first-ever stroke patients with arm paresis, were assessed at 3 weeks, 3 and 6 months after stroke onset. Bimanual activity performance was assessed with the Adult Assisting Hand Assessment Stroke (Ad-AHA), unimanual motor impairment with the Fugl-Meyer Assessment (FMA). Candidate predictors included shoulder abduction and finger extension measured by the corresponding FMA-items (FMA-SAFE, range 0-4) and sensory and cognitive impairment. MRI was used to measure weighted corticospinal tract lesion load (wCST-LL) and resting-state interhemispheric functional connectivity (FC).Results:Initial Ad-AHA performance was poor but improved over time in all (mild-severe) impairment subgroups. Ad-AHA correlated with FMA at each time-point (r>0.88, p<0.001) and recovery trajectories were similar. In patients with moderate-severe initial FMA, FMA-SAFE was the strongest predictor of Ad-AHA outcome (R2 = 0.81) and degree of recovery (R2 = 0.64). Two-point discrimination explained additional variance in Ad-AHA outcome (R2 = 0.05). Repeated analyses without FMA-SAFE identified wCST-LL and cognitive impairment as additional predictors. A wCST-LL above 5.5cc strongly predicted low-to-minimal FMA/Ad-AHA recovery (≤10/20p, specificity = 0.91). FC only explained some additional variance to FMA-SAFE in unimanual recovery.Conclusion:Although recovery of bimanual activity depends on the extent of CST injury and initial sensory and cognitive impairments, FMA-SAFE captures most of the variance explained by these mechanisms. FMA-SAFE, a straightforward clinical measure, strongly predicts bimanual recovery.Classification of Evidence:This study provides Class I evidence that the FMA-SAFE predicts bimanual recovery after stroke.

Determinants of Different Aspects of Upper-Limb Activity after Stroke

“…Secondly, persons with a hemorrhagic stroke would have a lower magnitude ratio. In contrast, previous literature showed a greater improvement in UL activity capacity in patients with a hemorrhagic stroke [ 36 ] and a better recovery of bimanual hand use [ 37 ]. As we did not consider lesion volume and exact lesion location, it might be that the lesion volume was higher and more often located in the UL (sub)cortical area in persons with a hemorrhagic, left-hemispheric lesion, resulting in lower UL activity outcomes.…”

“…A second factor that might have been relevant is ADL dependence, as higher dependence in ADL was associated with lower activity ratios in a chronic stroke sample [ 16 ]. Thirdly, sensory function may also play a role as it was previously shown to be a significant predictor for bimanual hand use in the chronic phase post stroke [ 37 ]. Lastly, in a small group of 20 patients with chronic stroke, lower attention and arousal predicted low affected UL activity above and beyond sensorimotor impairment [ 39 ].…”

Performance Comparison of Different Neuroimaging Methods for Predicting Upper Limb Motor Outcomes in Patients after Stroke

“…A recent study suggested that a 3-week CST-wLL was the strongest predictor of the ability to grasp and control finger forces 6 months poststroke [ 26 ]. A CST‐wLL > 5.5 cc strongly predicted low-to-minimal recovery in unimanual motor impairment and bimanual activity performance (specificity: 0.91) [ 27 ].…”

Tools for Assessing the Function of the Upper Extremity in Patients with Stroke: the Prognostic Role of Finger Extension

“…Таким чином, збереження розгинання пальців кисті є важливим предиктором функціонального відновлення [18]. На жаль існуючі методи оцінки моторної функції руки не дозволяють повноцінно кількісно оцінити функцію екстензорів пальців кисті у хворих, які перенесли гостре порушення мозкового кровообігу.…”