Characterizing upper extremity motor behavior in the first week after stroke.
Accelerometry
/ methods
Aged
Female
Humans
Male
Middle Aged
Motor Activity
/ physiology
Motor Skills
/ physiology
Movement
/ physiology
Outcome Assessment, Health Care
Paresis
/ physiopathology
Prospective Studies
Recovery of Function
/ physiology
Stroke
/ physiopathology
Stroke Rehabilitation
/ methods
Time Factors
United States
Upper Extremity
/ physiology
Journal
PloS one
ISSN: 1932-6203
Titre abrégé: PLoS One
Pays: United States
ID NLM: 101285081
Informations de publication
Date de publication:
2020
2020
Historique:
received:
07
08
2019
accepted:
15
06
2020
entrez:
11
8
2020
pubmed:
11
8
2020
medline:
29
9
2020
Statut:
epublish
Résumé
Animal models of brain recovery identify the first days after lesioning as a time of great flux in sensorimotor function and physiology. After rodent motor system lesioning, daily skill training in the less affected forelimb reduces skill acquisition in the more affected forelimb. We asked whether spontaneous human motor behaviors of the less affected upper extremity (UE) early after stroke resemble the animal training model, with the potential to suppress clinical recovery. This prospective observational study used a convenience sample of patients (n = 25, mean 4.5 ±1.8) days after stroke with a wide severity range; Controls were hospitalized for non-neurological conditions (n = 12). Outcome measures were Accelerometry, Upper-Extremity Fugl-Meyer (UEFM), Action Research Arm Test (ARAT), Shoulder Abduction/ Finger Extension Test (SAFE), NIH Stroke Scale (NIHSS). Accelerometry indicated total paretic UE movement was reduced compared to controls, primarily due to a 44% reduction of bilateral UE use. Unilateral paretic movement was unchanged. Thus, movement shifted early after stroke; bilateral use was reduced and unilateral use of the non-paretic UE was increased by 77%. Low correlations between movement time and motor performance prompted an exploratory factor analysis (EFA) revealing a 2-component solution; motor performance tests load on one component (motor performance) whereas accelerometry-derived variables load on a second orthogonal component (quantity of movement). Early after stroke, spontaneous overall UE movement is reduced, and movement shifts to unilateral use of the non-paretic UE. Two mechanisms that could influence motor recovery may already be in place 4.5 ± 1.8 days post stroke: (1) the overuse of the less affected UE, which could set the stage for learned non-use and (2) skill acquisition in the non-paretic limb that could impede recovery. Accurate UE motor assessment requires two independent constructs: motor performance and quantity of movement. These findings provide opportunities and measurement methods for studies to develop new behaviorally-based stroke recovery treatments that begin early after onset.
Sections du résumé
BACKGROUND
Animal models of brain recovery identify the first days after lesioning as a time of great flux in sensorimotor function and physiology. After rodent motor system lesioning, daily skill training in the less affected forelimb reduces skill acquisition in the more affected forelimb. We asked whether spontaneous human motor behaviors of the less affected upper extremity (UE) early after stroke resemble the animal training model, with the potential to suppress clinical recovery.
METHODS
This prospective observational study used a convenience sample of patients (n = 25, mean 4.5 ±1.8) days after stroke with a wide severity range; Controls were hospitalized for non-neurological conditions (n = 12). Outcome measures were Accelerometry, Upper-Extremity Fugl-Meyer (UEFM), Action Research Arm Test (ARAT), Shoulder Abduction/ Finger Extension Test (SAFE), NIH Stroke Scale (NIHSS).
RESULTS
Accelerometry indicated total paretic UE movement was reduced compared to controls, primarily due to a 44% reduction of bilateral UE use. Unilateral paretic movement was unchanged. Thus, movement shifted early after stroke; bilateral use was reduced and unilateral use of the non-paretic UE was increased by 77%. Low correlations between movement time and motor performance prompted an exploratory factor analysis (EFA) revealing a 2-component solution; motor performance tests load on one component (motor performance) whereas accelerometry-derived variables load on a second orthogonal component (quantity of movement).
CONCLUSIONS
Early after stroke, spontaneous overall UE movement is reduced, and movement shifts to unilateral use of the non-paretic UE. Two mechanisms that could influence motor recovery may already be in place 4.5 ± 1.8 days post stroke: (1) the overuse of the less affected UE, which could set the stage for learned non-use and (2) skill acquisition in the non-paretic limb that could impede recovery. Accurate UE motor assessment requires two independent constructs: motor performance and quantity of movement. These findings provide opportunities and measurement methods for studies to develop new behaviorally-based stroke recovery treatments that begin early after onset.
Identifiants
pubmed: 32776927
doi: 10.1371/journal.pone.0221668
pii: PONE-D-19-22340
pmc: PMC7416933
doi:
Types de publication
Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, Non-P.H.S.
Langues
eng
Sous-ensembles de citation
IM
Pagination
e0221668Déclaration de conflit d'intérêts
The authors have declared that no competing interests exist.
Références
Curr Neurol Neurosci Rep. 2010 May;10(3):158-66
pubmed: 20425030
Curr Neurol Neurosci Rep. 2019 Feb 20;19(3):13
pubmed: 30788609
J Neurol Phys Ther. 2015 Apr;39(2):111-8
pubmed: 25742378
Behav Neurosci. 2010 Feb;124(1):124-132
pubmed: 20141287
Int Rehabil Med. 1987;8(4):166-70
pubmed: 2440825
Pediatr Emerg Care. 2013 Jan;29(1):17-20
pubmed: 23283256
Acta Neurol Scand. 2003 May;107(5):369-81
pubmed: 12713530
Top Stroke Rehabil. 2009 Jul-Aug;16(4):237-53
pubmed: 19740730
J Rehabil Med. 2011 Mar;43(4):299-304
pubmed: 21347506
Stroke. 2000 Mar;31(3):662-7
pubmed: 10700501
Arch Phys Med Rehabil. 2012 Nov;93(11):1975-81
pubmed: 22465403
Brain. 2012 Aug;135(Pt 8):2527-35
pubmed: 22689909
Neurorehabil Neural Repair. 2009 May;23(4):313-9
pubmed: 19118128
JAMA. 2018 Feb 27;319(8):820-821
pubmed: 29486016
Phys Ther. 1983 Oct;63(10):1606-10
pubmed: 6622535
Neurorehabil Neural Repair. 2015 Nov-Dec;29(10):969-78
pubmed: 25896988
Am J Phys Med Rehabil. 2014 Mar;93(3):245-52
pubmed: 24398579
N Engl J Med. 2005 Apr 21;352(16):1677-84
pubmed: 15843670
J Stroke Cerebrovasc Dis. 2015 Feb;24(2):274-83
pubmed: 25533758
Stroke. 1988 Nov;19(11):1354-8
pubmed: 3188120
Curr Opin Neurol. 2003 Dec;16(6):699-704
pubmed: 14624079
Stroke. 2017 Apr;48(4):1011-1019
pubmed: 28280137
Stroke. 2011 May;42(5):1482-8
pubmed: 21474812
Front Neural Circuits. 2017 Feb 21;11:7
pubmed: 28270752
Occup Ther Int. 2009;16(3-4):175-89
pubmed: 19504501
J Exp Anal Behav. 1994 Mar;61(2):281-93
pubmed: 8169577
J Neuroeng Rehabil. 2019 Dec 4;16(1):153
pubmed: 31801569
Neurology. 2006 Oct 10;67(7):1189-94
pubmed: 17030751
J Neurol Neurosurg Psychiatry. 1988 Dec;51(12):1481-8
pubmed: 3221214
J Speech Lang Hear Res. 2008 Feb;51(1):S225-39
pubmed: 18230848
J Mot Behav. 2017 May-Jun;49(3):312-328
pubmed: 27589010
Arch Phys Med Rehabil. 2005 Jul;86(7):1498-501
pubmed: 16003690
J Neurol Phys Ther. 2007 Jun;31(2):56-63
pubmed: 17558358
Int J Rehabil Res. 1981;4(4):483-92
pubmed: 7333761
Curr Opin Neurol. 2008 Feb;21(1):76-82
pubmed: 18180655
Arch Phys Med Rehabil. 2011 Sep;92(9):1437-42
pubmed: 21878214
Rehabil Psychol. 2009 Nov;54(4):398-403
pubmed: 19929121
Nat Rev Neurosci. 2017 May;18(5):267-280
pubmed: 28331232
Circulation. 2018 Mar 20;137(12):e67-e492
pubmed: 29386200
Pain. 2001 Jan;89(2-3):295-300
pubmed: 11291631
Stroke. 2010 Apr;41(4):745-50
pubmed: 20167916
J Rehabil Res Dev. 2013;50(9):1213-22
pubmed: 24458962
J Hand Ther. 2013 Apr-Jun;26(2):104-14;quiz 115
pubmed: 22975740
PLoS One. 2014 Jul 28;9(7):e103135
pubmed: 25068258
Brain. 2000 May;123 ( Pt 5):940-53
pubmed: 10775539
Curr Opin Neurol. 2013 Dec;26(6):609-16
pubmed: 24136129
Exp Neurol. 2008 Mar;210(1):172-81
pubmed: 18054917
Scand J Rehabil Med. 1975;7(1):13-31
pubmed: 1135616
Neurorehabil Neural Repair. 2013 Jun;27(5):439-47
pubmed: 23353185
Rheumatol Rehabil. 1979 Feb;18(1):43-8
pubmed: 424667
J Rehabil Res Dev. 2003 Jan-Feb;40(1):1-8
pubmed: 15150715
Exp Neurol. 2017 Jan;287(Pt 3):384-394
pubmed: 26874223
Arch Phys Med Rehabil. 2006 Oct;87(10):1340-5
pubmed: 17023243
Stroke. 1989 Jul;20(7):864-70
pubmed: 2749846
Arch Phys Med Rehabil. 2001 Jan;82(1):14-9
pubmed: 11239280
J Rehabil Res Dev. 2013;50(8):1099-106
pubmed: 24458895
Ann Clin Transl Neurol. 2017 Oct 24;4(11):811-820
pubmed: 29159193
Arch Phys Med Rehabil. 2006 Dec;87(12):1605-10
pubmed: 17141640
Arch Phys Med Rehabil. 2015 May;96(5):854-61
pubmed: 25497517