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Arm Motor Recovery After Ischemic Stroke: A Focus on Clinically Distinct Trajectory Groups
Danielle K Kline1, David J Lin, Alison Cloutier
1Department of Physical Therapy (D.K.K., M.P.-F., T.J.K.) and Center for Interprofessional Studies and Innovation (A.B.F.), MGH Institute of Health Professions, Boston, Massachusetts; Center for Neurotechnology and Neurorecovery, Department of Neurology (D.J.L., A.C., K.S., L.R.H.), Divisions of Neurocritical Care and Stroke, Department of Neurology (D.J.L., L.R.H.), Department of Physical Therapy (K.P.), and Department of Occupational Therapy (J.R.), Massachusetts General Hospital, Boston; VA RR&D Center for Neurotechnology and Neurorecovery, Providence, Rhode Island (L.R.H.); and School of Engineering, Brown University, Providence, Rhode Island (L.R.H.).
Stroke survivors can be grouped by arm motor recovery rates, aiding discharge planning. Early identification of recovery trajectories, like Fast, Extended, or Limited, helps tailor patient care.
Area of Science:
- Neurorehabilitation
- Stroke Recovery
- Motor Function Assessment
Background:
- Arm function recovery poststroke is highly variable.
- Current models lack prediction of recovery rates, complicating discharge planning.
- Novel approach to define recovery groups based on arm motor recovery trajectories poststroke.
Purpose of the Study:
- Define recovery groups based on arm motor recovery trajectories.
- Explore between-group differences in baseline characteristics and therapy hours.
- Associate baseline characteristics with group membership.
Main Methods:
- Retrospective cohort analysis of 40 participants post-ischemic stroke.
- Arm recovery trajectory groups defined using Fugl-Meyer Assessment Upper Extremity (FMA-UE) and minimal clinically important difference (MCID).
- Assessed participants at 1 week, 6 weeks, 3 months, and 6 months.
Main Results:
- Three recovery trajectory groups identified: Fast (n=19), Extended (n=12), and Limited (n=9).
- Baseline FMA-UE, NIH Stroke Scale, and Barthel Index associated with group membership.
- Fast Recovery group received fewer therapy hours post-6 weeks; no difference between Extended and Limited groups.
Conclusions:
- Clinically relevant recovery trajectory groups defined using FMA-UE MCID.
- Baseline impairment, stroke severity, and functional dependence predict recovery trajectory.
- Stratifying patients by recovery trajectory early poststroke can guide discharge planning.
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