Functional Prognosis Post Stroke---A Longitudinal Study

The main purpose of this project is to follow up the long-term recovery course of stroke patients at the body, person, and social levels. Specific aims of this project are five-fold: (1) to determine the recovery course of stroke patients on clinical and biomechanical measures (e.g., kinematic measures) at multiple dimensions; (2) to study the time course of recovery related to initial stroke severity; (3) to understand how the kinematic data on both upper arms afford additional insights into functional prognosis above and beyond the clinical scales; (4) to investigate the recovery course of the ipsilesional limb manifested by neurological and kinematic measures; (5) to examine the impact of time course of recovery on the responsiveness of both upper extremities to environmental changes. The neurological scales used to examine the neurological impairments involved the Scandinavian Neurological Stroke Scale (SSS) and National Institute Health Stroke Scale (NIHSS). The NIHSS is simple to use and highly sensitive to predict activities of daily living (ADL) and higher levels of physical function. The Fugl-Meyer (FM) Scale is a well-validated comprehensive evaluation of impairment in hemiparesis, and includes sections to evaluate upper/lower extremity function, sensation and range of motion. The sophisticated motion analysis such as kinematic analysis system (descriptions of the spatio-temporal characteristics of movements) might be necessary to capture the fine differences in patient??s performance. The FIM is the most widely accepted functional assessment measure in the rehabilitation community and demonstrated good reliability, validity, and precision to detect meaningful changes. One of the most widely used instruments to measure HRQOL is the Short From-36 (SF-36), a general health status measure that generates a profile covering physical functioning, role-physical, general health, social functioning, role-emotional, and mental health. Participants received all clinical and laboratory evaluations within one week and were followed up after one, three, six, twelve, and sixteen months of stroke. Generally speaking, the results of initial evaluations showed that motor performance of upper extremity is poorer than that of lower extremity. Half of the participants revealed sensory impairment or less. Performance on activities of daily living ranged from total dependence to moderate dependence. Patients also showed high movement time, great total displacement, and low peak velocity. Higher functional context elicited better kinematic performance than tasks with lower functional meanings. Functional independence is related to multiple factors including severity of neurological impairments and motor recovery. The more severe the neurological impairment after stroke onset, the lower the level of functional independence. Upper extremity paresis as assessed by the SSS is also associated with functional ability. In patients with mild UE paresis, function showed recovery within one month whereas functional recovery for patients with severe UE paresis appeared within two months. Paralysis of the lower extremities is relevant to walking function and mobility. If neurological status regarding lower extremity motor function improved quickly in the first week, walking and mobility abilities recovered better within one year. Age is an impeding factor for rehabilitation outcome. Age played an influential role in independence of activities of daily living but not in neurological recovery. One possible explanation is that aged patients with stroke poorly develop compensatory strategies. Accordingly, intervention planning should incorporate compensatory skills training. Sex is related to functional prognosis but not survival r

Project ID:PG9303-1453
External Project ID:NHRI-EX93-9103EC