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Recovery and Prediction of Bimanual Hand Use After Stroke
Jeanette Plantin1, Marion Verneau2, Alison K Godbolt2
1From the Department of Clinical Sciences (J.P., A.K.G., G.V.P., E.L., J.B., P.G.L.), Karolinska Institutet, Danderyd University Hospital, Stockholm, Sweden; Institut de Psychiatrie et Neurosciences de Paris (M.V., J.-C.B., P.G.L.), Inserm U1266, Paris, France; Division of Rehabilitation Medicine (B.J.), Danderyd University Stockholm; Department of Women's and Children's Health (L.K.S.), Karolinska Institutet, Stockholm, Sweden; and Department of Neurology (J.-C.B.), Hôpital Sainte-Anne, Université de Paris, France. jeanette.plantin@ki.se.
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, 89 patients with first-ever stroke with arm paresis were assessed at 3 weeks and 3 and 6 months after stroke onset. Bimanual activity performance was assessed with the Adult Assisting Hand Assessment Stroke (Ad-AHA), and unimanual motor impairment was assessed 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 to severe initial FMA, FMA-SAFE score was the strongest predictor of Ad-AHA outcome (R 2 = 0.81) and degree of recovery (R 2 = 0.64). Two-point discrimination explained additional variance in Ad-AHA outcome (R 2 = 0.05). Repeated analyses without FMA-SAFE score identified wCST-LL and cognitive impairment as additional predictors. A wCST-LL >5.5 cm3 strongly predicted low to minimal FMA/Ad-AHA recovery (≤10 and 20 points respectively, specificity = 0.91). FC explained some additional variance to FMA-SAFE score only in unimanual recovery.
Conclusion:
Although recovery of bimanual activity depends on the extent of corticospinal tract injury and initial sensory and cognitive impairments, FMA-SAFE score captures most of the variance explained by these mechanisms. FMA-SAFE score, a straightforward clinical measure, strongly predicts bimanual recovery.
Clinicaltrialsgov Identifier:
NCT02878304.
Classification Of Evidence:
This study provides Class I evidence that the FMA-SAFE score predicts bimanual recovery after stroke.
