Clinical Predictors for Upper Limb Recovery after Stroke Rehabilitation: Retrospective Cohort Study

Abstract

After stroke, recovery of upper limb (UL) motor function is enhanced by a high dose of rehabilitation and is supposed to be supported by attentive functions. However, their mutual influence during rehabilitation is not well known yet. The aim of this retrospective observational cohort study was to investigate the association between rehabilitation dose and motor and cognitive functions, during UL motor recovery. Inpatients with first unilateral stroke, without time restrictions from onset, and undergoing at least 15 h of rehabilitation were enrolled. Data on dose and modalities of rehabilitation received, together with motor and cognitive outcomes before and after therapy, were collected. Fugl-Meyer values for the Upper Extremity were the primary outcome measure. Logistic regression models were used to detect any associations between UL motor improvement and motor and cognitive-linguistic features at acceptance, regarding dose of rehabilitation received. Thirty-five patients were enrolled and received 80.57 ± 30.1 h of rehabilitation on average. Manual dexterity, level of independence and UL motor function improved after rehabilitation, with no influence of attentive functions on motor recovery. The total amount of rehabilitation delivered was the strongest factor (p = 0.031) influencing the recovery of UL motor function after stroke, whereas cognitive-linguistic characteristics were not found to influence UL motor gains.

Keywords: clinical prediction; motor recovery; stroke; upper limb.

Figure 1

Dose of rehabilitation of the Responders and Non-Responders for FMA-UE. Boxplot of outcomes by Responders and Non-Responders; TOT-UL: total amount of rehabilitation specific for the UL (hours of UL technologies and OT); TOT-NUL: total hours of rehabilitation non-specific for the UL (hours of LL technologies); TOT: total amount of rehabilitation (hours); CT: conventional therapy.