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Journal Articles Neurology Year : 2021

Recovery and Prediction of Bimanual Hand Use After Stroke


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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Dates and versions

inserm-03264834 , version 1 (18-06-2021)



Jeanette Plantin, Marion Verneau, Alison Kate Godbolt, Gaia Valentina Pennati, Evaldas Laurencikas, et al.. Recovery and Prediction of Bimanual Hand Use After Stroke. Neurology, 2021, pp.Published Ahead of Print. ⟨10.1212/wnl.0000000000012366⟩. ⟨inserm-03264834⟩


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