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Recovery and Prediction of Bimanual Hand Use After Stroke

Abstract : Objective: To determine similarities and differences in key predictors of recovery of bimanual hand use and unimanual motor impairment after stroke. Method: In this prospective longitudinal study n = 89 first-ever stroke patients with arm paresis, were assessed at 3 weeks, 3 and 6 months after stroke onset. Bimanual activity performance was assessed with the Adult Assisting Hand Assessment Stroke (Ad-AHA), unimanual motor impairment with the Fugl-Meyer Assessment (FMA). Candidate predictors included shoulder abduction and finger extension measured by the corresponding FMA-items (FMA-SAFE, range 0-4) and sensory and cognitive impairment. MRI was used to measure weighted corticospinal tract lesion load (wCST-LL) and resting-state interhemispheric functional connectivity (FC). Results: Initial Ad-AHA performance was poor but improved over time in all (mild-severe) impairment subgroups. Ad-AHA correlated with FMA at each time-point (r>0.88, p<0.001) and recovery trajectories were similar. In patients with moderate-severe initial FMA, FMA-SAFE was the strongest predictor of Ad-AHA outcome (R2 = 0.81) and degree of recovery (R2 = 0.64). Two-point discrimination explained additional variance in Ad-AHA outcome (R2 = 0.05). Repeated analyses without FMA-SAFE identified wCST-LL and cognitive impairment as additional predictors. A wCST-LL above 5.5cc strongly predicted low-to-minimal FMA/Ad-AHA recovery (≤10/20p, specificity = 0.91). FC only explained some additional variance to FMA-SAFE in unimanual recovery. Conclusion: Although recovery of bimanual activity depends on the extent of CST injury and initial sensory and cognitive impairments, FMA-SAFE captures most of the variance explained by these mechanisms.FMA-SAFE, a straightforward clinical measure, strongly predicts bimanual recovery. Classification of Evidence: This study provides Class I evidence that the FMA-SAFE predicts bimanual recovery after stroke.
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Submitted on : Friday, June 18, 2021 - 3:57:56 PM
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Plantin et al. Neurology. 2021...
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Jeanette Plantin, Marion Verneau, Alison Godbolt, Gaia Pennati, Evaldas Laurencikas, et al.. Recovery and Prediction of Bimanual Hand Use After Stroke. Neurology, American Academy of Neurology, 2021, pp.Published Ahead of Print. ⟨10.1212/wnl.0000000000012366⟩. ⟨inserm-03264834⟩

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