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Published on: March 28, 2018
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Characterizing upper extremity motor behavior in the first week after stroke.
Jessica Barth1, Shashwati Geed1,2, Abigail Mitchell1
1MedStar National Rehabilitation Network, Washington, District of Columbia, United States of America.
Plos One
|August 11, 2020
Summary
Early after stroke, patients use their non-paretic upper extremity (UE) more, potentially hindering recovery. This overuse, alongside reduced overall UE movement, suggests early interventions are crucial for stroke motor recovery.
Area of Science:
- Neuroscience
- Rehabilitation Medicine
- Biomedical Engineering
Background:
- Animal models show early post-lesion flux in sensorimotor function.
- Rodent studies indicate training the less affected limb can impair recovery of the more affected limb.
- This study investigates if similar compensatory behaviors occur in humans early after stroke.
Purpose of the Study:
- To examine spontaneous upper extremity (UE) behaviors in stroke patients within the first week post-stroke.
- To determine if early UE movement patterns could impede clinical motor recovery.
- To identify distinct constructs for accurate UE motor assessment post-stroke.
Main Methods:
- Prospective observational study of 25 stroke patients (4.5 ±1.8 days post-stroke) and 12 controls.
- Utilized accelerometry to measure UE movement quantity and bilateral/unilateral use.
- Assessed motor function using Upper-Extremity Fugl-Meyer (UEFM), Action Research Arm Test (ARAT), and Shoulder Abduction/ Finger Extension Test (SAFE).
Main Results:
- Stroke patients showed reduced total paretic UE movement (44% less bilateral use) compared to controls.
- Unilateral use of the non-paretic UE increased by 77% early after stroke.
- Exploratory factor analysis revealed motor performance and quantity of movement as independent constructs.
Conclusions:
- Early after stroke, movement shifts to overuse of the non-paretic UE, potentially leading to learned non-use.
- Skill acquisition in the non-paretic limb may impede recovery of the paretic limb.
- Accurate UE motor assessment requires evaluating both motor performance and quantity of movement for developing early, behaviorally-based stroke treatments.
