Motor recovery of the ipsilesional upper limb in subacute stroke

Abstract

Objective: To investigate the time-related changes in motor performance of the ipsilesional upper limb in subacute poststroke patients by using clinical and kinematic assessments.

Design: Observational, longitudinal, prospective, monocentric study.

Setting: Physical medicine and rehabilitation department.

Participants: Stroke patients (n=19; mean age, 62.9y) were included less than 30 days after a first unilateral ischemic/hemorrhagic stroke. The control group was composed of age-matched, healthy volunteers (n=9; mean age, 63.1y).

Interventions: Clinical and kinematic assessments were conducted once a week during 6 weeks and 3 months after inclusion. Clinical measures consisted of Fugl-Meyer Assessment, Box and Block Test (BBT), Nine-Hole Peg Test (9HPT), and Barthel Index. We used a 3-dimensional motion recording system during a reach-to-grasp task to analyze movement smoothness, movement time, and peak velocity of the hand. Healthy controls performed both clinical (BBT and 9HPT) and kinematic evaluation within a single session.

Main outcome measures: BBT and 9HPT.

Results: Recovery of ipsilesional upper arm capacities increased over time and leveled off after a 6-week period of rehabilitation, corresponding to 9 weeks poststroke. At study discharge, patients demonstrated similar ipsilesional clinical scores to controls but exhibited less smooth reaching movements. We found no effect of the hemispheric side of the lesion on ipsilesional motor deficits.

Conclusions: Our findings provide evidence that ipsilesional motor capacities remain impaired at least 3 months after stroke, even if clinical tests fail to detect the impairment. Focusing on this lasting ipsilesional impairment through a more detailed kinematic analysis could be of interest to understand the specific neural network underlying ipsilesional upper-limb impairment.

Keywords: 9HPT; BBT; Box and Block Test; FMA; Fugl-Meyer Assessment; Ipsilateral; Kinematics; LHD; NVP; Nine-Hole Peg Test; RHD; Reach-to-grasp; Recovery; Rehabilitation; Stroke; UL; analysis of variance with repeated measures; left hemisphere damaged; number of velocity peaks; rANOVA; right hemisphere damaged; upper limb.