UE Interventions Following Stroke Flashcards
1
Q
Statistics of UE involvement in stroke
A
- 85% if individuals show an initial deficit in the UE
- All 3-6 mo post-stroke 55-75% have difficulty with dexterous tasks
- 56% report marked hemiparesis 5 yrs post-stroke
2
Q
Impact of poor UE recovery following stroke
A
- Associated with low level of subjective well-being
- Associated with poorer ratings of health related QOL
- > 50% are only able to function by developing compensatory strategies using the uninvolved UE
3
Q
Vascular reasons for poor UE recovery
A
- UE is supplied by the biggest cerebral artery
- MCA stroke is most common
4
Q
Anatomical reasons for poor UE recovery
A
- Redundant nerve supply in LE vs UE
- Reticulospinal fibers mostly connecting muscles for postural control & locomotion
5
Q
Biomechanics reasons. for poor UE recovery
A
- Torque= Force X Lever arm
6
Q
Functional reasons for poor UE recovery
A
- Bipedal mobility matters most to patients: most salient activity that needs to be recovered
- ADLs can compensate using non-paretic UE
7
Q
Independence in ADLs post-stroke is predicted by
A
- Age
- Stroke severity(NIH stroke scale)
- UE paresis
8
Q
Prediction tools for UE recovery after stroke
A
- NIHSS (0-42)
- Orpington Prognostic scale (score 1.6 – 6.8)
- Proportional recovery model (based on FM-UE scores measured 24-72 h and approximately 3 or 6 months after stroke)
- ARAT (Action Research Arm test) - 19-item tool for testing reach, grasp, transport, release
- PREP model (Predicting REcovery Potential)
9
Q
NIHSS grading scale
A
- 0 = no stroke sx
- 1-4 = minor stroke
- 5-15 = moderate stroke
- 16-20 = moderate to severe stroke
- 21-42 = severe stroke
10
Q
Describe the PREP model
A
- Algorithm that predicts functional recovery of UE at 3 months
- Algorithm is based on the evidence that sparing of descending white matter pathways is related to better recovery of upper limb function after stroke
- Good predictive value - specificity 88% and sensitivity 73%
- But needs neurophysiological and neuroimaging assessment tools, which may or may not be available in your clinic
- Each element of the algorithm allows for the sequential categorization of UE recovery potential
11
Q
PREP model grading scale
A
- Complete = potential to return to normal
or near-normal hand and arm function within 12 weeks - Notable = Potential to be using affected hand and arm in most activities of daily living within 12 weeks, though normal function is unlikely
- Limited = Potential to have some movement in affected hand and arm within 12 weeks, but it is unlikely to be used functionally for activities of daily living
- None = minimal movement in affected hand and arm, with little improvement at 12 weeks
12
Q
What is transcranial magnetic stimulation
A
- Assess integrity of corticospinal tracts by stimulating M1 motor cortex using electromagnetic pulses, which elicits MEPs (Motor evoked potential) on muscles (for eg, Extensor Carpi Radialis)
13
Q
How is the structural integrity of the posterior limb of the internal capsule quantified by MRI
A
- quantified by calculating an asymmetry index from the mean fractional anisotropy values
14
Q
Describe PREP-2. algorithm
A
- Does not need MRI, instead uses NIHSS to predict UE recovery at 3 mo post-stroke
- If you do not have TMS score, you still can make some predictions
- If patient’s SAFE score is >5, you don’t need TMS to predict recovery
-If patient’s SAFE score is < 5: if NIHSS is <7, then recovery could be good<>limited; If NIHSS is >7, then can be Good or poor, but you can lean more towards poor
15
Q
Slide 16
A
