Variability in Motor and Language Recovery during the Acute Stroke Period.
BACKGROUND
Most stroke recovery occurs by 90 days after onset, with proportional recovery models showing an achievement of about 70% of the maximal remaining recovery. Little is known about recovery during the acute stroke period. Moreover, data are described for groups, not for individuals. In this observational cohort study, we describe for the first time the daily changes of acute stroke patients with motor and/or language deficits over the first week after stroke onset.


METHODS
Patients were enrolled within 24-72 h after stroke onset with upper extremity hemiparesis, aphasia, or both, and were tested daily until day 7 or discharge with the upper-extremity Fugl-Meyer Assessment of Motor Recovery after Stroke, the Boston Naming Test, and the comprehension domain from the Western Aphasia Battery. Discharge scores, and absolute and proportional changes were examined using t-tests for pairwise comparisons and linear regression to determine relative contributions of initial impairment, lesion volume, and age to recovery over this period.


RESULTS
Thirty-four patients were enrolled: 19 had motor deficits alone, 8 had aphasia alone, and 7 had motor and language deficits. In a group analysis, statistically significant changes in absolute scores were found in the motor (p < 0.001) and comprehension (p < 0.001) domains but not in naming. Day-by-day recovery curves for individual patients displayed wide variation with comparable initial impairment. Proportional recovery calculations revealed that, on average, patients achieved less than 1/3 of their potential recovery by the time of discharge. Multivariate regression showed that the amount of variance accounted for by initial severity, age, and lesion volume in this early time period was not significant for motor or language domains.


CONCLUSIONS
Over the first week after stroke onset, recovery of upper extremity hemiparesis and aphasia were not predictable on the basis of initial impairment, lesion volume, or age. In addition, patients only achieved about 1/3 of their remaining possible recovery based on the anticipated 70% proportion found at 90 days. These findings suggest that the complex interaction between poststroke structural repair, regeneration, and functional reorganization during the first week after stroke has yet to be elucidated.
Baylor College of Medicine, Houston, Tex., USA.
Lauren E
LE
Dunn
The Richard and Jenny Levine Cerebral Localization Laboratory, Department of Neurology, Columbia University Medical Center, New York, N.Y., USA.
Adam B
AB
Schweber
The Richard and Jenny Levine Cerebral Localization Laboratory, Department of Neurology, Columbia University Medical Center, New York, N.Y., USA.
Daniel K
DK
Manson
The Richard and Jenny Levine Cerebral Localization Laboratory, Department of Neurology, Columbia University Medical Center, New York, N.Y., USA.
Andrea
A
Lendaris
The Richard and Jenny Levine Cerebral Localization Laboratory, Department of Neurology, Columbia University Medical Center, New York, N.Y., USA.
Charlotte
C
Herber
The Richard and Jenny Levine Cerebral Localization Laboratory, Department of Neurology, Columbia University Medical Center, New York, N.Y., USA.
Randolph S
RS
Marshall
The Richard and Jenny Levine Cerebral Localization Laboratory, Department of Neurology, Columbia University Medical Center, New York, N.Y., USA.
Ronald M
RM
Lazar
D061605:Administration, Intravenous; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001037:Aphasia / Q000503:physiopathology; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage; D006760:Hospitalization; D006801:Humans; D007807:Language Tests; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D010291:Paresis / Q000503:physiopathology; D020127:Recovery of Function; D020521:Stroke / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000503:physiopathology*; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage
D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator
Acute stroke; Aphasia; Motor impairment; Stroke recovery