Variability in Motor and Language Recovery during the Acute Stroke Period

Abstract

Background: Most stroke recovery occurs by 90 days after onset, with proportional recovery models showing an achievement of about 70% of the maximal remaining recovery. Little is known about recovery during the acute stroke period. Moreover, data are described for groups, not for individuals. In this observational cohort study, we describe for the first time the daily changes of acute stroke patients with motor and/or language deficits over the first week after stroke onset.

Methods: Patients were enrolled within 24-72 h after stroke onset with upper extremity hemiparesis, aphasia, or both, and were tested daily until day 7 or discharge with the upper-extremity Fugl-Meyer Assessment of Motor Recovery after Stroke, the Boston Naming Test, and the comprehension domain from the Western Aphasia Battery. Discharge scores, and absolute and proportional changes were examined using t-tests for pairwise comparisons and linear regression to determine relative contributions of initial impairment, lesion volume, and age to recovery over this period.

Results: Thirty-four patients were enrolled: 19 had motor deficits alone, 8 had aphasia alone, and 7 had motor and language deficits. In a group analysis, statistically significant changes in absolute scores were found in the motor (p < 0.001) and comprehension (p < 0.001) domains but not in naming. Day-by-day recovery curves for individual patients displayed wide variation with comparable initial impairment. Proportional recovery calculations revealed that, on average, patients achieved less than 1/3 of their potential recovery by the time of discharge. Multivariate regression showed that the amount of variance accounted for by initial severity, age, and lesion volume in this early time period was not significant for motor or language domains.

Conclusions: Over the first week after stroke onset, recovery of upper extremity hemiparesis and aphasia were not predictable on the basis of initial impairment, lesion volume, or age. In addition, patients only achieved about 1/3 of their remaining possible recovery based on the anticipated 70% proportion found at 90 days. These findings suggest that the complex interaction between poststroke structural repair, regeneration, and functional reorganization during the first week after stroke has yet to be elucidated.

Keywords: Acute stroke; Aphasia; Motor impairment; Stroke recovery.

Fig. 1

Mean scores on the upper-extremity (UE) FM test (a), mean scores on the BNT (b), and mean scores on the comprehension subtest of the WAB (c) as a function of days since stroke onset. Error bars denote 1 SD above and below the mean.

Fig. 2

Daily scores for individual patients with initial FM scores of 0-22 (a), 23-44 (b), and 45-60 (c), roughly comparable to baseline function in the severe, moderate, and mild ranges, respectively. UE = Upper extremity.

Fig. 3

Daily scores for individual patients with initial comprehension (a) and naming (b) deficits. There were 5 individuals with baseline scores of 0 who demonstrated no recovery over the acute stroke period.