Generalizability of the Maximum Proportional Recovery Rule to Visuospatial Neglect Early Poststroke

Caroline Winters, Erwin E.H. van Wegen*, Andreas Daffertshofer, Gert Kwakkel

*Corresponding author for this work

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Abstract

Background and objective. Proportional recovery of upper-extremity motor function and aphasia after stroke may suggest common mechanisms for spontaneous neurobiological recovery. This study aimed to investigate if the proportional recovery rule also applies to visuospatial neglect (VSN) in right-hemispheric first-ever ischemic stroke patients and explored the possible common underlying mechanisms. Methods. Patients with upper-limb paresis and VSN were included. Recovery defined as the change in Letter Cancellation Test (LCT) score at ∼8 days and 6 months poststroke. Potential recovery defined as LCTmax-LCTinitial = 20 â' LCTinitial. Hierarchical clustering separated fitters and nonfitters of the prediction rule. A cutoff value on LCTmax-LCTinitial was determined. The change in LCT and Fugl-Meyer Assessment Upper Extremity was expressed as a percentage of the total possible score to investigate the communality of proportional recovery. Results. Out of 90 patients, 80 displayed proportional recovery of VSN (ie, "fitters," 0.97; 95% CI = 0.82-1.12). All patients who did not follow the prediction rule for VSN (ie, "nonfitters") had ≥15 missing O's at baseline and failed to show proportional recovery of the upper limb. Conclusions. This study shows that the proportional recovery rule also applies to patients with VSN poststroke. Patients who fail to show proportional recovery of VSN are the same patients who fail to show proportional recovery of the upper limb. These findings support the idea of common intrahemispheric mechanisms underlying spontaneous neurobiological recovery in the first months poststroke. Future studies should investigate the prognostic clinical and neurobiological markers of these subgroups.

Original languageEnglish
Pages (from-to)334-342
Number of pages9
JournalNeurorehabilitation and Neural Repair
Volume31
Issue number4
Early online date13 Dec 2016
DOIs
Publication statusPublished - Apr 2017

Funding

The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: The research leading to these results has received funding from the Royal Dutch Society of Physical Therapy, supported by the EXPLICIT-stroke grant from the Netherlands Organization for Health Research and Development (ZonMw; Grant No. 89000001) and the European Research Council under the European Union's Seventh Framework Programme (FP/2007-2013)/ERC Grant Agreement n. 291339-4D-EEG.

FundersFunder number
Netherlands Organization for Health Research and Development
Royal Dutch Society of Physical Therapy
European Research Council291339-4D-EEG
ZonMw89000001
Seventh Framework ProgrammeFP/2007-2013

    Keywords

    • prognosis
    • stroke
    • upper extremity
    • visuospatial neglect

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