Michael A Dimyan1,2,3, Stacey Harcum1, Elsa Ermer1,2, Amy F Boos2,4, Susan S Conroy1, Fang Liu5, Linda B Horn6, Huichun Xu7, Min Zhan8, Hegang Chen8, Jill Whitall6, George F Wittenberg1,2,3,4,6,9. 1. VA Maryland Health Care System, Baltimore VA Medical Center, Baltimore, MD, USA. 2. Department of Neurology, University of Maryland School of Medicine, Baltimore, MD, USA. 3. Geriatrics Research, Education and Clinical Center and Maryland Exercise and Robotics Center of Excellence, Veterans Affairs Medical Center, Older Americans Independence Center, University of Maryland School of Medicine, Baltimore, MD, USA. 4. Department of Neurology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA. 5. Rehab & Neural Engineering Labs, Department of Physical Medicine & Rehabilitation, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA. 6. Department of Physical Therapy and Rehabilitation Science, University of Maryland School of Medicine, Baltimore, MD, USA. 7. Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA. 8. Department of Epidemiology and Preventative Medicine, University of Maryland School of Medicine, Baltimore, MD, USA. 9. Geriatrics Research, Education and Clinical Center, Human Engineering Research Laboratory, VA Maryland Health Care System, Pittsburgh, PA, USA.
Abstract
BACKGROUND: Repetitive task practice reduces mean upper extremity motor impairment in populations of patients with chronic stroke, but individual response is highly variable. A method to predict meaningful reduction in impairment in response to training based on biomarkers and other data collected prior to an intervention is needed to establish realistic rehabilitation goals and to effectively allocate resources. OBJECTIVES: To identify prognostic factors and better understand the biological substrate for reductions in arm impairment in response to repetitive task practice among patients with chronic (≥6 months) post-stroke hemiparesis. METHODS: The intervention is a form of repetitive task practice using a combination of robot-assisted therapy and functional arm use in real-world tasks. Baseline measures include the Fugl-Meyer Assessment, Wolf Motor Function Test, Action Research Arm Test, Stroke Impact Scale, questionnaires on pain and expectancy, MRI, transcranial magnetic stimulation, kinematics, accelerometry, and genomic testing. RESULTS: Mean increase in FM-UE was 4.6 ± 1.0 SE, median 2.5. Approximately one-third of participants had a clinically meaningful response to the intervention, defined as an increase in FM ≥ 5. The selected logistic regression model had a receiver operating curve with AUC = .988 (Std Error = .011, 95% Wald confidence limits: .967-1) showed little evidence of overfitting. Six variables that predicted response represented impairment, functional, and genomic measures. CONCLUSION: A simple weighted sum of 6 baseline factors can accurately predict clinically meaningful impairment reduction after outpatient intensive practice intervention in chronic stroke. Reduction of impairment may be a critical first step to functional improvement. Further validation and generalization of this model will increase its utility in clinical decision-making.
BACKGROUND: Repetitive task practice reduces mean upper extremity motor impairment in populations of patients with chronic stroke, but individual response is highly variable. A method to predict meaningful reduction in impairment in response to training based on biomarkers and other data collected prior to an intervention is needed to establish realistic rehabilitation goals and to effectively allocate resources. OBJECTIVES: To identify prognostic factors and better understand the biological substrate for reductions in arm impairment in response to repetitive task practice among patients with chronic (≥6 months) post-stroke hemiparesis. METHODS: The intervention is a form of repetitive task practice using a combination of robot-assisted therapy and functional arm use in real-world tasks. Baseline measures include the Fugl-Meyer Assessment, Wolf Motor Function Test, Action Research Arm Test, Stroke Impact Scale, questionnaires on pain and expectancy, MRI, transcranial magnetic stimulation, kinematics, accelerometry, and genomic testing. RESULTS: Mean increase in FM-UE was 4.6 ± 1.0 SE, median 2.5. Approximately one-third of participants had a clinically meaningful response to the intervention, defined as an increase in FM ≥ 5. The selected logistic regression model had a receiver operating curve with AUC = .988 (Std Error = .011, 95% Wald confidence limits: .967-1) showed little evidence of overfitting. Six variables that predicted response represented impairment, functional, and genomic measures. CONCLUSION: A simple weighted sum of 6 baseline factors can accurately predict clinically meaningful impairment reduction after outpatient intensive practice intervention in chronic stroke. Reduction of impairment may be a critical first step to functional improvement. Further validation and generalization of this model will increase its utility in clinical decision-making.
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Authors: Iris F Groeneveld; Paulien H Goossens; Inke van Braak; Stéphanie van der Pas; Jorit J L Meesters; Radha D Rambaran Mishre; Henk J Arwert; Thea P M Vliet Vlieland Journal: Ann Phys Rehabil Med Date: 2018-07-24
Authors: Christel Rushing; Anuradha Bulusu; Herbert I Hurwitz; Andrew B Nixon; Herbert Pang Journal: Comput Biol Med Date: 2014-12-09 Impact factor: 4.589
Authors: Christopher J L Murray; Charles Atkinson; Kavi Bhalla; Gretchen Birbeck; Roy Burstein; David Chou; Robert Dellavalle; Goodarz Danaei; Majid Ezzati; A Fahimi; D Flaxman; Sherine Gabriel; Emmanuela Gakidou; Nicholas Kassebaum; Shahab Khatibzadeh; Stephen Lim; Steven E Lipshultz; Stephanie London; Michael F MacIntyre; A H Mokdad; A Moran; Andrew E Moran; Dariush Mozaffarian; Tasha Murphy; Moshen Naghavi; C Pope; Thomas Roberts; Joshua Salomon; David C Schwebel; Saeid Shahraz; David A Sleet; Jerry Abraham; Mohammed K Ali; Charles Atkinson; David H Bartels; Kavi Bhalla; Gretchen Birbeck; Roy Burstein; Honglei Chen; Michael H Criqui; Eric L Ding; E Ray Dorsey; Beth E Ebel; Majid Ezzati; S Flaxman; A D Flaxman; Diego Gonzalez-Medina; Bridget Grant; Holly Hagan; Howard Hoffman; Nicholas Kassebaum; Shahab Khatibzadeh; Janet L Leasher; John Lin; Steven E Lipshultz; Rafael Lozano; Yuan Lu; Leslie Mallinger; Mary M McDermott; Renata Micha; Ted R Miller; A A Mokdad; A H Mokdad; Dariush Mozaffarian; Mohsen Naghavi; K M Venkat Narayan; Saad B Omer; Pamela M Pelizzari; David Phillips; Dharani Ranganathan; Frederick P Rivara; Thomas Roberts; Uchechukwu Sampson; Ella Sanman; Amir Sapkota; David C Schwebel; Saeid Sharaz; Rupak Shivakoti; Gitanjali M Singh; David Singh; Mohammad Tavakkoli; Jeffrey A Towbin; James D Wilkinson; Azadeh Zabetian; Jerry Abraham; Mohammad K Ali; Miriam Alvardo; Charles Atkinson; Larry M Baddour; Emelia J Benjamin; Kavi Bhalla; Gretchen Birbeck; Ian Bolliger; Roy Burstein; Emily Carnahan; David Chou; Sumeet S Chugh; Aaron Cohen; K Ellicott Colson; Leslie T Cooper; William Couser; Michael H Criqui; Kaustubh C Dabhadkar; Robert P Dellavalle; Daniel Dicker; E Ray Dorsey; Herbert Duber; Beth E Ebel; Rebecca E Engell; Majid Ezzati; David T Felson; Mariel M Finucane; Seth Flaxman; A D Flaxman; Thomas Fleming; Mohammad H Forouzanfar; Greg Freedman; Michael K Freeman; Emmanuela Gakidou; Richard F Gillum; Diego Gonzalez-Medina; Richard Gosselin; Hialy R Gutierrez; Holly Hagan; Rasmus Havmoeller; Howard Hoffman; Kathryn H Jacobsen; Spencer L James; Rashmi Jasrasaria; Sudha Jayarman; Nicole Johns; Nicholas Kassebaum; Shahab Khatibzadeh; Qing Lan; Janet L Leasher; Stephen Lim; Steven E Lipshultz; Stephanie London; Rafael Lozano; Yuan Lu; Leslie Mallinger; Michele Meltzer; George A Mensah; Catherine Michaud; Ted R Miller; Charles Mock; Terrie E Moffitt; A A Mokdad; A H Mokdad; A Moran; Mohsen Naghavi; K M Venkat Narayan; Robert G Nelson; Casey Olives; Saad B Omer; Katrina Ortblad; Bart Ostro; Pamela M Pelizzari; David Phillips; Murugesan Raju; Homie Razavi; Beate Ritz; Thomas Roberts; Ralph L Sacco; Joshua Salomon; Uchechukwu Sampson; David C Schwebel; Saeid Shahraz; Kenji Shibuya; Donald Silberberg; Jasvinder A Singh; Kyle Steenland; Jennifer A Taylor; George D Thurston; Monica S Vavilala; Theo Vos; Gregory R Wagner; Martin A Weinstock; Marc G Weisskopf; Sarah Wulf Journal: JAMA Date: 2013-08-14 Impact factor: 56.272