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Prediction of functional outcomes in stroke patients: the role of motor patterns according to limb synergies

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Abstract

Background and aims

To address the relationships among motor patterns evaluated according to the limb synergies and functional outcomes in stroke patients and clarify which motor pattern was the most important predictor of functional outcomes.

Methods

The study was conducted on 208 patients with primary diagnosis of stroke admitted for in-hospital rehabilitation. At entry, the Fugl-Meyer Scale was administered to assess motor function according to limb synergies. Pearson’s correlation was used to assess the relationship between variables, and backward stepwise regression analysis was used to identify the outcome determinants. Final functional independence measure (FIM) scores and length of in-hospital stay were the outcome measures.

Results

At the end of rehabilitation, motor-FIM scores of patients with extensor and flexor synergies, mixing synergies, and no dependence from the synergies were higher than those of no movements and flexor synergy. Multivariate regression analysis showed that extensor synergy of upper limb was an independent predictor of final motor-FIM, personal care and mobility, extensor synergy of lower limb of locomotion, while mixing synergies of upper limb was an independent predictor of length of in-hospital stay.

Conclusions

In stroke rehabilitation, the patients’ motor patterns according to the synergies strongly relate with functional outcomes and are important outcome predictors.

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References

  1. Shelton FD, Volpe BT, Reding M (2001) Motor impairment as a predictor of functional recovery and guide to rehabilitation treatment after stroke. Neurorehabil Neural Repair 15:229–237

    Article  CAS  PubMed  Google Scholar 

  2. Duncan PW, Min Lai S, Keighley J (2000) Defining post-stroke recovery: implications for design and interpretation of drug trials. Neuropharmacology 39:835–841

    Article  CAS  PubMed  Google Scholar 

  3. Twitchell TE (1951) The restoration of motor function following hemiplegia in man. Brain 74:443–480

    Article  CAS  PubMed  Google Scholar 

  4. Li KY, Lin KC, Wang TN, Wu CY, Huang YH, Ouyang P (2012) Ability of three motor measures to predict functional outcomes reported by stroke patients after rehabilitation. NeuroRehabilitation 30:267–275

    PubMed  Google Scholar 

  5. Massie CL, Fritz S, Malcolm MP (2011) Elbow extension predicts motor impairment and performance after stroke. Rehabil Res Pract 2011:381978

    PubMed Central  PubMed  Google Scholar 

  6. Katrak P, Bowring G, Conroy P, Chilvers M, Poulos R, McNeil D (1998) Predicting upper limb recovery after stroke: the place of early shoulder and hand movement. Arch Phys Med Rehabil 79:758–761

    Article  CAS  PubMed  Google Scholar 

  7. Nijland RH, van Wegen EE, Harmeling-van der Wel BC, Kwakkel G (2010) Presence of finger extension and shoulder abduction within 72 hours after stroke predicts functional recovery: early prediction of functional outcome after stroke: the EPOS cohort study. Stroke 41:745–750

    Article  PubMed  Google Scholar 

  8. Welmer AK, Holmqvist LW, Sommerfeld DK (2006) Hemiplegic limb synergies in stroke patients. Am J Phys Med Rehabil 85:112–119

    Article  PubMed  Google Scholar 

  9. Pandian S, Arya KN (2012) Pandiani relation between the upper extremity synergistic movement components and its implication for motor recovery in poststroke hemiparesis. Top Stroke Rehabil 19:545–555

    Article  PubMed  Google Scholar 

  10. Brunnström S (1970) Movement Therapy in Hemiplegia: a neuropsychological approach. Harper and Row, New York

    Google Scholar 

  11. Dipietro L, Krebs HI, Fasoli SE, Volpe BT, Stein J, Bever C, Hogan N (2007) Changing motor synergies in chronic stroke. J Neurophysiol 98:757–768

    Article  CAS  PubMed  Google Scholar 

  12. Hartman-Maier A, Soroker N, Ring H, Katz N (2002) Awareness of deficits in stroke rehabilitation. J Rehabil Med 34:158–164

    Article  Google Scholar 

  13. Fugl-Meyer AR (1980) Post-stroke hemiplegia assessment of physical properties. Scand J Rehabil Med Suppl 7:85–93

    CAS  PubMed  Google Scholar 

  14. Luzzati C, Wilmes K, De Bleser R (1991) Aachener Aphasie Test (AAT). Organizzazioni Speciali, Firenze

    Google Scholar 

  15. Fullerton KJ, McSherry RW (1986) Albert’s test: a neglected test of perceptual neglect. Lancet 1:430–432

    Article  CAS  PubMed  Google Scholar 

  16. Bisiach E, Vallar G, Perani D, Papagno C, Berti A (1986) Unawareness of disease following lesions of the right hemisphere: anosognosia of hemiplegia and anosognosia for hemianopsia. Neuropsychologia 24:471–482

    Article  CAS  PubMed  Google Scholar 

  17. Parmelee PA, Thuras PD, Katz IR, Lawton MP (1995) Validation of the cumulative illness rating scale in a geriatric residential population. J Am Geriatr Soc 43:130–137

    Article  CAS  PubMed  Google Scholar 

  18. Brott T, Adams HP, Olinger CP et al (1989) Measurements of acute cerebral infarction: a clinical examination scale. Stroke 20:864–870

    Article  CAS  PubMed  Google Scholar 

  19. Collin C, Wade D (1990) Assessing motor impairment after stroke: a pilot reliability study. J Neurol Neurosurg Psychiatry 53:576–579

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  20. Granger CV, Cotter AC, Hamilton BB, Fiedler RC (1993) Functional assessment: a study of persons after stroke. Arch Phys Med Rehabil 74:133–138

    CAS  PubMed  Google Scholar 

  21. Adler A (1964) The Bobath method in the treatment of cerebral palsy. Harefuah 66:62–63

    CAS  PubMed  Google Scholar 

  22. Wee JYM, Hopman WM (2005) Stroke impairment predictors of discharge destination in stroke rehabilitation. Am J Phys Med Rehabil 84:604–612

    Article  PubMed  Google Scholar 

  23. Denti L, Agosti M, Franceschini M (2008) Outcome predictors of rehabilitation for first stroke in the elderly. Eur J Phys Rehabil Med 44:3–11

    CAS  PubMed  Google Scholar 

  24. Chang JJ, Sung YT, Lin YT (1990) The relationship between early motor stage and hand function recovery six months after stroke. Gaoxiong Yi Xue Ke Xue Za Zhi 6:38–44

    CAS  PubMed  Google Scholar 

  25. Kawahira K, Shimodozono M, Etoh S, Kamada K, Noma T, Tanaka N (2010) Effects of intensive repetition of a new facilitation technique on motor functional recovery of the hemiplegic upper limb and hand. Brain Inj 24:1202–1213

    Article  PubMed Central  PubMed  Google Scholar 

  26. Hsu AL, Tang PF, Jan MH (2003) Analysis of impairments influencing gait velocity and asymmetry of hemiplegic patients after mild to moderate stroke. Arch Phys Med Rehabil 84:1185–1193

    Article  PubMed  Google Scholar 

  27. Bohannon RW (2007) Knee extension strength and body weight determine sit-to-stand independence after stroke. Physiother Theory Pract 23:291–297

    Article  PubMed  Google Scholar 

  28. Bohannon RW, Andrews AW (1990) Correlation of knee extensor muscle torque and spasticity with gait speed in patients with stroke. Arch Phys Med Rehabil 71:330–333

    CAS  PubMed  Google Scholar 

  29. Saunders DH, Greig CA, Young A, Mead GE (2008) Association of activity limitations and lower-limb explosive extensor power in ambulatory people with stroke. Arch Phys Med Rehabil 89:677–683

    Article  PubMed  Google Scholar 

  30. Gialanella B, Prometti P (2009) Rehabilitation length of stay in patients suffering from aphasia after stroke. Top Stroke Rehabil 16:437–444

    Article  PubMed  Google Scholar 

  31. McClure JA, Salter K, Meyer M, Foley N, Kruger H, Teasell R (2011) Predicting length of stay in patients admitted to stroke rehabilitation with high levels of functional independence. Disabil Rehabil 33:2356–2361

    Article  PubMed  Google Scholar 

  32. Franchignoni FP, Tesio L, Ricupero C, Martino MT (1997) Trunk control test as an early predictor of stroke rehabilitation outcome. Stroke 28:1382–1385

    Article  CAS  PubMed  Google Scholar 

  33. Duarte E, Marco E, Muniesa JM, Belmonte R, Diaz P, Tejero M, Escalada F (2002) Trunk control test as a functional predictor in stroke patients. J Rehabil Med 34:267–272

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgments

The authors thank Dr Laura Comini for the critical revision and editing of the manuscript. The research was not supported by Pharmaceutical Companies. The research was supported by institutional funding.

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical standards

The Ethics Committee of our Institution approved the study protocol and informed consent and all patients gave their written informed consent to participate. The study was conducted in accordance with the principles of the Declaration of Helsinki.

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Authors and Affiliations

  1. Operative Unit for Recovery and Functional Rehabilitation, Scientific Institute of Lumezzane, “Salvatore Maugeri” Foundation, IRCCS, Via G. Mazzini 129, 25065, Lumezzane, BS, Italy

    Bernardo Gialanella & Raffaele Santoro

Authors
  1. Bernardo Gialanella
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  2. Raffaele Santoro
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Correspondence to Bernardo Gialanella.

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Gialanella, B., Santoro, R. Prediction of functional outcomes in stroke patients: the role of motor patterns according to limb synergies. Aging Clin Exp Res 27, 637–645 (2015). https://doi.org/10.1007/s40520-015-0322-7

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  • DOI: https://doi.org/10.1007/s40520-015-0322-7

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