Recovery and Prediction of Dynamic Precision Grip Force Control After Stroke

Abstract

Background and Purpose— Dexterous object manipulation, requiring generation and control of finger forces, is often impaired after stroke. This study aimed to describe recovery of precision grip force control after stroke and to determine clinical and imaging predictors of 6-month performance. Methods— Eighty first-ever stroke patients with varying degrees of upper limb weakness were evaluated at 3 weeks, 3 months, and 6 months after stroke. Twenty-three healthy individuals of comparable age were also studied. The Strength-Dexterity test was used to quantify index finger and thumb forces during compression of springs of varying length in a precision grip. The coordination between finger forces (CorrForce), along with Dexterity-score and Repeatability-score, was calculated. Anatomical magnetic resonance imaging was used to calculate weighted corticospinal tract lesion load (wCST-LL). Results— CorrForce, Dexterity-score, and Repeatability-score in the affected hand were dramatically lower at each time point compared with the less-affected hand and the control group, even in patients with mild motor impairment according to Fugl-Meyer assessment. Improved performance over time occurred in CorrForce and Dexterity-score but not in Repeatability-score. The Fugl-Meyer assessment hand subscale, sensory function, and wCST-LL best predicted CorrForce and Dexterity-score status at 6 months (R 2 =0.56 and 0.87, respectively). wCST-LL explained substantial variance in CorrForce (R 2 =0.34) and Dexterity-score (R 2 =0.50) at 6 months; two-point discrimination and Fugl-Meyer score accounted for considerable additional variance. Absence of recovery in CorrForce was predicted by wCST-LL >4 cc and in Dexterity-score by wCST-LL >6 cc. Conclusions— Findings highlight persisting deficits in the ability to grasp and control finger forces after stroke. wCST-LL was the strongest predictor of performance at 6 months, but early two-point discrimination and Fugl-Meyer score had substantial additional predictive value. Registration— URL: https://www.clinicaltrials.gov . Unique identifier: NCT02878304.

Recovery of Apraxia of Speech and Aphasia in Patients With Hand Motor Impairment After Stroke

“…This pattern was also apparent in severely impaired patients. Neither recovery ratio nor severity of impairment co-varied with lesion volume, coherent with recent reports on hand motor recovery (60).…”

Recovery and Prediction of Bimanual Hand Use After Stroke

“…The ROC analysis further showed that a lesion load > 5.5 cc was highly predictive of both poor bimanual and unimanual recovery (figure 4). Feng, Wang, Chhatbar, Doughty, Landsittel, Lioutas, Kautz and Schlaug 36 also reported that a wCST-LL >5.5 cc in the acute phase, was a strong predictor of unimanual motor recovery (FMA-UE outcome score >25) at three months and Pennati, Plantin, Carment, Roca, Baron, Pavlova, Borg and Lindberg 7 found that wCST-LL >6cc indicated absence of recovery of dynamic precision grip. The present findings show that a similar wCST-LL threshold (>5.5 cc) is also a strong predictor of bimanual hand recovery.…”

Self-perceived functioning and disability after randomized conventional and electromechanically-assisted gait training in subacute stroke: A 6 months follow-up

“…In addition, the degree of corticospinal tract damage according to brain imaging and transcranial magnetic stimulation has predictive value for recovery of movement function in the upper extremity after stroke [45,164,165] but corresponding studies have not yet consistently shown its importance for recovery of lower extremity movement function, gait outcomes and for predicting recovery of independent walking [50,[166][167][168]. In future studies, including data on brain structure and function together with a larger sample size may enable subgroup analysis and provide insight in who will benefit the most from EAGT and conventional gait training respectively.…”