International Journal of Current Research and Review
ISSN: 2231-2196 (Print)ISSN: 0975-5241 (Online)
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IJCRR - 11(1), January, 2019

Pages: 06-09

Date of Publication: 10-Jan-2019


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Relationship & Comparison between Post-Stroke Motor Recovery and Functional Recovery \? An Observational Study

Author: Ashish Kakkad, Priyanshu V. Rathod

Category: Healthcare

Abstract:Aims and Objectives: This study explored relationship between post-stroke motor recovery and functional recovery in Gujarat, India.
Patients, Materials and Methods: This Study involved 67 (48 males and 19 females) individuals diagnosed of stroke by Neurophysician or General Physician with less than 6 months of post stroke duration. Fugl Meyer Motor Assessment Score was (total of upper extremity and lower extremity sub score) was used to assess their post-stroke motor recovery. Their functional recovery was assessed using the Modified Barthel Index. They were assessed on the same day for Fugl-Meyer Motor Assessment as well as Modified Barthel Index. Data were analyzed using the Pearson's Moment Correlation and Students' paired t-test at p =0.05.
Results: Patients' mean age was 57.52\? 13.1 years ranging between 17 years and 80 years. Their motor recovery had direct positive relationship (r=0.791, p=0.00) with their functional recovery but there was significant difference (t=13.16, p=0.00) between motor recovery and functional recovery. Mean score of motor recovery by total of Fugl-Meyer Upper extremity & Lower extremity subscore is 54.79 (54.79%) of total 100 score. Mean score of functional recovery by Modified Barthel Index was 14.06 (70.3%) of total 20 score.
Conclusion: Though Motor recovery has positive impact on the functional recovery in stroke survivors, motor recovery and functional recovery may differ significantly where functional recovery may exceed than motor recovery.

Keywords: Stroke, Stroke rehabilitation, Recovery of function

Full Text:

Introduction

World Health Organization (WHO) defines stroke as a clinical syndrome characterized by rapidly developing clinical symptoms and/or signs of focal and at times global loss of cerebral function, with symptoms lasting more than 24 hours or leading to death, with no apparent cause other than that of vascular origin.1,2

Stroke is classified into two types. Ischemic stroke is the most common type affecting about 67-80% of individuals with stroke2,3 and results when a clot or block impairs blood flow, depriving the brain of essential oxygen and nutrients, leading to disruption of cellular metabolism, injury and death of tissues. Hemorrhagic stroke occurs when blood vessels rupture, causing leakage of blood in and around brain. It may occur due to increase in intracranial pressure or restriction of distal blood flow.1 Central Venous Sinus Thrombosis (CVST) is the presence of acute thrombosis (a blood clot) in the dural venous in sinuses, which drain blood from the brain. Symptoms may include headache, abnormal vision, any of the symptoms of stroke such as weakness of the face and limbs on the side of the body and seizures.4

Stroke is a global health problem. It is second commonest cause of death and fourth leading cause of disability worldwide.5 In developed countries, stroke is the first leading cause of disability, second leading cause of death.5 It makes an important concern not only for the physiotherapists but for the entire rehabilitation team.

The incidence of stroke rises rapidly with increasing age. In India, the overall prevalence rate for stroke lies between 84 – 262 per 100,000 in rural area and between 334 – 424 per 100,000 in urban areas.6 After the age of 55 years, the risk of stroke doubles every 10 years; two thirds of all strokes occurring in people older than the age of 65 years.7 The incidence of stroke is about 1.25 times greater for males than female.8

Katherine J. Sullivan et al did a study “Fugl-Meyer Assessment of Sensorimotor Function after Stroke Standardized Training Procedure for Clinical Practice and Clinical Trials” in 2011 to find out reliability of the same score and found that intra-rater reliability for the expert rater was high for the motor and sensory scores (range, 0.95–1.0). Inter-rater agreement (intraclass correlation coefficient, 2, 1) between expert and therapist raters was high for the motor scores (total, 0.98; upper extremity, 0.99; lower extremity, 0.91) and sensory scores (total, 0.93; light touch, 0.87; proprioception, 0.96). 9

Ohura T et al in 2017, found validity and reliability for Modified Barthel Index in study on stroke patients. ICC for inter-rater reliability for first session was 0.99. For intra rater reliability, mean value of ICC was 0.99 for individual task, inter rate kw coefficients for the first session ranged from 0.77 to 0.94 with intra-rater kw coefficients from 0.85 to 0.96. They concluded with strong criterion related validity against the Barthel Index, with higher reliabilities. Scoring system is convenient tool allowing anyone to assess activity of daily life.10

Stroke- related physical disability diminishes quality of daily living, place care burden on families, and increase need for long-term institutionalization11,12

Recovery after stroke occurs in two phases: neurological or functional. Neurological recovery occurs as a result of brain repair and reorganization while functional recovery depends on many factors including extent of motor affectation and the quality of rehabilitation13. Although neurological recovery may peak within the first three months of stroke; functional recovery continues with improvement in the recoveries of specific functions like mobility and social participation.13 Neurological recovery includes motor recovery, sensory recovery and also balance recovery. Functional recovery describes dependency of individual in activity of daily life. Another dimension to be taken into consideration is Quality of life which is individual perception of his/her position in life in the context of the culture and value system in which they live and in relation to their goals, expectations, standards, and concern.14

Recent studies have shown that Stroke has negative impact on both the functional recovery and quality of life of stroke survivors. Quality of life of stroke survivors increases with improvement in functional recovery.14 Stroke has impact on both the motor recovery and functional recovery in individuals who have survived stroke episode but the relationship between motor recovery and functional recovery in stroke has not been clearly explained. However, the relationship between these differential shifts in neurological recovery and functional recovery among stroke survivors has not been well explored. Therefore, this study explored the relationship between post-stroke motor recovery and functional recovery in stroke survivors within first 6 months of post stroke duration.

Methods

This study was ethically approved by a RK University, Gujarat. This study involved 67 consecutively recruited stroke survivors diagnosed of stroke by Neurophysician or General physician as per selection criteria as follows:

Inclusion criteria:

1. All stroke patients who are willing to participate

2. Both male & female stroke patients

3. Mini mental scale examination score >2415

4. Duration of stroke varies from discharge from hospital up to 6 months16

Exclusion criteria:

1. Stroke patients who are not cooperative.

2. Stroke patients who have auditory &/or visual deficits.

3. Stroke patients who do not have proper medical records.

4. Patients having another neurological deficit with stroke.

Oral as well as written consent was taken by patient &/or relative from those who were willing to participate. All subjects were explained about the study and were assessed for different demographic data as well as for motor as well as functional recovery by Fugl-Meyer Motor Assessment Score and Modified Barthel Index Score respectively. Fugl-Meyer Motor Assessment scale was used to assess their post stroke motor recovery. And Modified Barthel Index was used to assess functional recovery of stroke patients. Both of these scales were assessed on the same day for particular patients. They were also interviewed for demographic characteristics (age, gender, body mass index, side of body affected), clinical variables (length of coma, length of hospitalization, hypertension, diabetes and other co-morbidities) and history (addiction history, transient ischemic attack history, family history).

Data was summarized using mean and standard deviation, frequency. Data were analyzed using the Pearson’s correlation for relationship between motor recovery and functional recovery and paired t-test for comparison between motor recovery and functional recovery of participants.

Results

Study included 67 stroke patients. Mean age of the participants was 57.52±13.1 years with majority (92.53%) between 17 and 80 years. Total 19 (28.36%) females and 48 (71.64%) males were included in study. The left side of the body was affected in 35 (52.23%) of the participants while right side of body was affected in 32 (47.76%) patients. Out of the participants who took part in the study, 57 had ischemic stroke (85.07%) while 10 (14.93%) had hemorrhagic stroke. Positive family history of stroke was found in 5 (7.46%) patients. 13 (19.4%) patients themselves had history of transient ischemic attack or stroke in past and had stroke another time. Total 19 (28.36%) patients were diagnosed with hypertension as co-morbidity while 30 (44.75%) patients were diagnosed with diabetes. 29 (43.28%) patients had at least one of the addictions of tobacco, alcohol or smoking.

Data was checked for plausibility and cleaned. The kolmogrov-smirnov test was used to analyze normal distribution assumption of outcomes measures and was found normally distributed. Pearson correlation test was applied to find out relation between Fugl-Meyer Motor Assessment Score and Modified Barthel Index Score. By this test, r value found was 0.791 (n=67, p=0.00). Paired student’s t-test was applied to compare Fugl-Meyer Motor Assessment Score and Modified Barthel Index Score. By this test, t value found was 13.161 (n=67, df=66, p=0.00)

Discussion

From the results, it is observed that motor recovery has positive impact on functional recovery which suggests that with motor recovery, functional performance also improves of stroke patient as the time passes. It is also found that there is significant difference between motor recovery and functional recovery suggesting that motor recovery and functional recovery may happen at different rate. From mean value, it can be observed that functional recovery exceed than motor recovery. Motor performance accounts recovery of affected side only which is limited to neurological recovery only. Functional performance may also include contribution from normal side also to compensate for completion of task along with affected side of body. By this reason, functional recovery may exceed than motor recovery. Although, stroke had been shown to have negative impact on both the motor recovery and functional recovery in stroke survivors, the relationship between motor recovery and functional recovery after stroke has not been clearly delineated. The result of this study shows that improved motor recovery results in improved functional recovery in individuals who have had an episode of stroke. This means that if effort is geared towards functional recovery rather than motor activity, there will be remarkable reduction in the dependency in activity of daily living. Even with less motor recovery, by efforts patient can be given advantage of more functional recovery which is more required for patient. This is a wake-up call for clinicians involved in stroke rehabilitation to plan goals that will improve various aspects of life of stroke survivors and tailored those activities that will improve societal integration and reduce activity limitation and participation restriction.14

Anthea Rhoda et al. (2014) conducted a similar type study. In this study, total of 73 patients from the two separate studies were matched for age at stroke onset, gender, and initial motor functioning. Motor and functional recoveries were assessed at baseline, two and six months post stroke using the Rivermead Motor Assessment Scale and the Barthel Index (BI) respectively. Significant difference between motor and functional recovery was found.17 Lucca Nannetti et al. (2004) also conducted a study to compare motor and functional recovery on 170 post stroke depression patients. They found post stroke depression does not influence motor and functional recovery suggesting that depression is not affecting recovery.18

Limitations of this study include small size and only one time assessment was taken. Undiagnosed co-morbidities can also influence findings. Future studies can target on longitudinal follow-up for all stroke patients with more sample size.

Conclusion

The findings of this study support the fact that motor recovery had positive impact on functional outcome in stroke survivors. But functional recovery may exceed the motor recovery. Therefore, rehabilitation of stroke patient should not be only focus on the motor recovery but also on functional recovery training equally or even more.

Acknowledgement

Authors acknowledge the immense help received from the scholars whose articles are cited and included in references of this manuscript. The authors are also grateful to authors / editors / publishers of all those articles, journals and books from where the literature for this article has been reviewed and discussed.

Funding

Self

Conflict of interest

None

References:

  1. Carr JH, Shepherd RB. Neurological Rehabilitation Optimizing Motor Recovery. 2nd edition. Churchill Livingstone; 2010.

  2. http://www.worldneurologyonline.com/article/implications-of-the-ahaasa updateddefinition-of-stroke-for-the-21st-century

  3. O?Sullivan SB, Schmitz TJ. Physical Rehabilitation. 5th edition. New Delhi: Jaypee Brothers; 2007.

  4. Stam J (2005). "Thrombosis of the cerebral veins and sinuses". N. Engl.                       J. Med. 352 (17):1791–8. PMID 15858188. doi:10.1056/NEJMra042354 (Cited on 2017 March 4)

  5. Manjari Tripathi, Deepti Vibha. Stroke in Young. Indi SAGE – Hindwawi Access to research article ID 368629, 6 pgs.

  6. Jeyaraj  Durai  Pandian,  Paulin  Sudhan.  Stroke  Epidemiology  and Stroke care services in Indian Journal of stroke 2013; 15 (3) : 128-134.

  7. Darcy    Umphred    A.    Neurological    Rehabilitation.    5th    edition. Philadelphia: Elsevier Publication; 2007.

  8. American Heart Association. Heart Disease And Stroke Statistical-2014 Update. Circulation 2014.

  9. Sullivan  KJ, Tilson  JK, Cen  SY  et  al.  Fugl-Meyer  assessment  of sensorimotor function after stroke: standardized training procedure for clinical practice and clinical trials. Stroke. 2011 Feb; 42 (2): 427-32

  10. Ohura T. et al. Validity and reliability of a recovery evaluation tool based on the Modified Barthel index for stroke patients. BMC Med Res Methodol. 2017

  11. Stineman MG, Maislin G, Fiedler RC Granger CV. A prediction Model for functional recovery in stroke. Stroke 1997; 28: 550 – 556.

  12. Gbiri CA and Akinpelu AO. Pattern of post-stroke func- tional recovery among stroke survivors in the first 12 months. Nigerian Quarterly Journal of Hospital Medi- cine. 2011; 21(3): 16-24

  13. Teasell RW, Foley NC, Bhogal SK. Recovery post – stroke. Evidence-Based Reviewed of Stroke Rehabilita- tion. Topics in Stroke Rehabilitation 2004; 10(1):29-58

  14. Gbiri CA and Akinpelu AO. Relationship between post-stroke functional recovery and quality of life among Nigerian stroke survivors. The Nigerian Postgraduate Medical Journal, Vol. 20, No. 1 March, 2013

  15. Folstein MF, Folstein SE, McHugh PR: “Mini-mental state: A practical method for grading the cognitive state of patients for the clinician.” J Psychiatr Res 1975;12:189-198.

  16. Henk T. Henrich et al. Motor recovery after stroke: a systemic review of literature: Arch Physical Med Rehabil. 2012; 82:1629-38

  17. Anthea Rhoda, Mario Smith1, Koen Putman et al. Motor and functional recovery after stroke: a comparison between rehabilitation settings in a developed versus a developing country. BMC Health Services Research 2014, 14:82

  18. Luca Nannetti, Matteo Paci, Jacopo Pasquini et al. Motor and functional recovery in patients with post-stroke depression. Disability and Rehabilitation, 2005; 27(4): 170–175

Announcements

Dr. Pramod Kumar Manjhi joined Editor-in-Chief since July 2021 onwards

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SCOPUS indexing: 2014, 2019 to 2021


Awards, Research and Publication incentive Schemes by IJCRR

Best Article Award: 

One article from every issue is selected for the ‘Best Article Award’. Authors of selected ‘Best Article’ are rewarded with a certificate. IJCRR Editorial Board members select one ‘Best Article’ from the published issue based on originality, novelty, social usefulness of the work. The corresponding author of selected ‘Best Article Award’ is communicated and information of award is displayed on IJCRR’s website. Drop a mail to editor@ijcrr.com for more details.

Women Researcher Award:

This award is instituted to encourage women researchers to publish her work in IJCRR. Women researcher, who intends to publish her research work in IJCRR as the first author is eligible to apply for this award. Editorial Board members decide on the selection of women researchers based on the originality, novelty, and social contribution of the research work. The corresponding author of the selected manuscript is communicated and information is displayed on IJCRR’s website. Under this award selected women, the author is eligible for publication incentives. Drop a mail to editor@ijcrr.com for more details.

Emerging Researcher Award:

‘Emerging Researcher Award’ is instituted to encourage student researchers to publish their work in IJCRR. Student researchers, who intend to publish their research or review work in IJCRR as the first author are eligible to apply for this award. Editorial Board members decide on the selection of student researchers for the said award based on originality, novelty, and social applicability of the research work. Under this award selected student researcher is eligible for publication incentives. Drop a mail to editor@ijcrr.com for more details.


Best Article Award

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A Study by Gainneos PD et al. entitled "A Comparative Evaluation of the Levels of Salivary IgA in HIV Affected Children and the Children of the General Population within the Age Group of 9 – 12 Years – A Cross-Sectional Study" is awarded Best Article of Vol 13 issue 05 Special issue on Recent Advances in Dentistry for better Oral Health
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A Study by Chen YY and Ghazali SRB entitled "Lifetime Trauma, posttraumatic stress disorder Symptoms and Early Adolescence Risk Factors for Poor Physical Health Outcome Among Malaysian Adolescents" is awarded Best Article of Vol 13 issue 04 Special issue on Current Updates in Plant Biology to Medicine to Healthcare Awareness in Malaysia
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A Study by Mohita Ray et al. entitled "Accuracy of Intra-Operative Frozen Section Consultation of Gastrointestinal Biopsy Samples in Correlation with the Final Histopathological Diagnosis" is awarded Best Article for Vol 13 issue 01
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A Study by Sindhu Priya E S et al. entitled "Neuroprotective activity of Pyrazolone Derivatives Against Paraquat-induced Oxidative Stress and Locomotor Impairment in Drosophila melanogaster" is awarded Best Article for Vol 12 issue 23
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A Study by Ghaffar UB et al. entitled "Correlation between Height and Foot Length in Saudi Population in Majmaah, Saudi Arabia" is awarded Best Article for Vol 12 issue 21
A Study by Siti Sarah Binti Maidin entitled "Sleep Well: Mobile Application to Address Sleeping Problems" is awarded Best Article for Vol 12 issue 20
A Study by Avijit Singh"Comparison of Post Operative Clinical Outcomes Between “Made in India” TTK Chitra Mechanical Heart Valve Versus St Jude Mechanical Heart Valve in Valve Replacement Surgery" is awarded Best Article for Vol 12 issue 19
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A Study by Jabbar Desai et al. entitled "Prevalence of Obstructive Airway Disease in Patients with Ischemic Heart Disease and Hypertension" is awarded Best Article for Vol 12 issue 17
A Study by Juna Byun et al. entitled "Study on Difference in Coronavirus-19 Related Anxiety between Face-to-face and Non-face-to-face Classes among University Students in South Korea" is awarded Best Article for Vol 12 issue 16
A Study by Sudha Ramachandra & Vinay Chavan entitled "Enhanced-Hybrid-Age Layered Population Structure (E-Hybrid-ALPS): A Genetic Algorithm with Adaptive Crossover for Molecular Docking Studies of Drug Discovery Process" is awarded Best article for Vol 12 issue 15
A Study by Varsha M. Shindhe et al. entitled "A Study on Effect of Smokeless Tobacco on Pulmonary Function Tests in Class IV Workers of USM-KLE (Universiti Sains Malaysia-Karnataka Lingayat Education Society) International Medical Programme, Belagavi" is awarded Best article of Vol 12 issue 14, July 2020
A study by Amruta Choudhary et al. entitled "Family Planning Knowledge, Attitude and Practice Among Women of Reproductive Age from Rural Area of Central India" is awarded Best Article for special issue "Modern Therapeutics Applications"
A study by Raunak Das entitled "Study of Cardiovascular Dysfunctions in Interstitial Lung Diseas epatients by Correlating the Levels of Serum NT PRO BNP and Microalbuminuria (Biomarkers of Cardiovascular Dysfunction) with Echocardiographic, Bronchoscopic and HighResolution Computed Tomography Findings of These ILD Patients" is awarded Best Article of Vol 12 issue 13 
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A Study by Muhammet Lutfi SELCUK and Fatma entitled "Distinction of Gray and White Matter for Some Histological Staining Methods in New Zealand Rabbit's Brain" is awarded best article for  Vol 12 issue 11
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A Study by Ilona Gracie De Souza & Pavan Kumar G. entitled "Effect of Releasing Myofascial Chain in Patients with Patellofemoral Pain Syndrome - A Randomized Clinical Trial" is awarded best article for  Vol 12 issue 08
A Study by Virendra Atam et. al. entitled "Clinical Profile and Short - Term Mortality Predictors in Acute Stroke with Emphasis on Stress Hyperglycemia and THRIVE Score : An Observational Study" is awarded best article for  Vol 12 issue 07
A Study by K. Krupashree et. al. entitled "Protective Effects of Picrorhizakurroa Against Fumonisin B1 Induced Hepatotoxicity in Mice" is awarded best article for issue Vol 10 issue 20
A study by Mithun K.P. et al "Larvicidal Activity of Crude Solanum Nigrum Leaf and Berries Extract Against Dengue Vector-Aedesaegypti" is awarded Best Article for Vol 10 issue 14 of IJCRR
A study by Asha Menon "Women in Child Care and Early Education: Truly Nontraditional Work" is awarded Best Article for Vol 10 issue 13
A study by Deep J. M. "Prevalence of Molar-Incisor Hypomineralization in 7-13 Years Old Children of Biratnagar, Nepal: A Cross Sectional Study" is awarded Best Article for Vol 10 issue 11 of IJCRR
A review by Chitra et al to analyse relation between Obesity and Type 2 diabetes is awarded 'Best Article' for Vol 10 issue 10 by IJCRR. 
A study by Karanpreet et al "Pregnancy Induced Hypertension: A Study on Its Multisystem Involvement" is given Best Paper Award for Vol 10 issue 09

List of Awardees

A Study by Ese Anibor et al. "Evaluation of Temporomandibular Joint Disorders Among Delta State University Students in Abraka, Nigeria" from Vol 13 issue 16 received Emerging Researcher Award


A Study by Alkhansa Mahmoud et al. entitled "mRNA Expression of Somatostatin Receptors (1-5) in MCF7 and MDA-MB231 Breast Cancer Cells" from Vol 13 issue 06 received Emerging Researcher Award


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Disclaimer: International Journal of Current Research and Review (IJCRR) provides platform for researchers to publish and discuss their original research and review work. IJCRR can not be held responsible for views, opinions and written statements of researchers published in this journal.



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International Journal of Current Research and Review (IJCRR) provides platform for researchers to publish and discuss their original research and review work. IJCRR can not be held responsible for views, opinions and written statements of researchers published in this journal

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