title: Spontaneous Recovery of Upper Extremity Motor Impairment After Ischemic Stroke: Implications for Stem Cell-Based Therapeutic Approaches.
abstract: Preclinical studies suggest that stem cell therapy (SCT) may improve sensorimotor recovery after stroke. Upper extremity motor impairment (UEMI) is common after stroke, often entailing substantial disability. To evaluate the feasibility of post-stroke UEMI as a target for SCT, we examined a selected sample of stroke patients potentially suitable for SCT, aiming to assess the frequency and recovery of UEMI, as well as its relation to activity limitations and participation restrictions. Patients aged 20-75 years with first-ever ischemic stroke, and National Institutes of Health Stroke Scale (NIHSS) scores 1-18, underwent brain diffusion-weighted MRI within 4 days of stroke onset (n = 108). Survivors were followed up after 3-5 years, including assessment with NIHSS, Fugl-Meyer assessment of upper extremity (FMA-UE), modified Rankin Scale (mRS), and Stroke Impact Scale (SIS). UEMI was defined as NIHSS arm/hand score ≥1. UEMI recovery was evaluated with change in NIHSS arm/hand scores between baseline and follow-up. Of 97 survivors, 84 were available to follow-up. Among 76 subjects (of 84) without recurrent stroke, 41 had UEMI at baseline of which 10 had residual UEMI at follow-up. The FMA-UE showed moderate-severe impairment in seven of 10 survivors with residual UEMI. UEMI was correlated to mRS (rs= 0.49, p < 0.001) and the SIS social participation domain (rs= -0.38, p = 0.001). Nearly 25% of the subjects with UEMI at baseline had residual impairment after 3-5 years, whereas about 75% showed complete recovery. Most of the subjects with residual UEMI had moderate-severe impairment, which correlated strongly to dependency in daily activities and social participation restrictions. Our findings suggest that SCT targeting post-stroke UEMI may be clinically valuable with significant meaningful benefits for patients but also emphasize the need of early prognostication to detect patients that will have residual impairment in order to optimize patient selection for SCT.
authors.affiliation: Department of Clinical Sciences Lund, Division of Neurology, Lund University, Lund, Sweden. hossein.delavaran@med.lu.se.|Department of Neurology and Rehabilitation Medicine, Skåne University Hospital, Lund, Sweden. hossein.delavaran@med.lu.se.
authors.forename: Hossein
authors.identifier: 0000-0002-8763-8255
authors.initials: H
authors.lastname: Delavaran
authors.affiliation: Department of Clinical Sciences Lund, Division of Neurology, Lund University, Lund, Sweden.
authors.forename: Joseph
authors.initials: J
authors.lastname: Aked
authors.affiliation: Center for Medical Imaging and Physiology, Skåne University Hospital, Lund, Sweden.
authors.forename: Håkan
authors.initials: H
authors.lastname: Sjunnesson
authors.affiliation: Department of Clinical Sciences Lund, Division of Neurology, Lund University, Lund, Sweden.|Department of Neurology and Rehabilitation Medicine, Skåne University Hospital, Lund, Sweden.|Laboratory of Stem Cells and Restorative Neurology, Lund Stem Cell Center, Lund University, Lund, Sweden.
authors.forename: Olle
authors.initials: O
authors.lastname: Lindvall
authors.affiliation: Department of Clinical Sciences Lund, Division of Neurology, Lund University, Lund, Sweden.|Department of Neurology and Rehabilitation Medicine, Skåne University Hospital, Lund, Sweden.
authors.forename: Bo
authors.initials: B
authors.lastname: Norrving
authors.affiliation: Department of Clinical Sciences Lund, Division of Neurology, Lund University, Lund, Sweden.|Laboratory of Stem Cells and Restorative Neurology, Lund Stem Cell Center, Lund University, Lund, Sweden.
authors.forename: Zaal
authors.initials: Z
authors.lastname: Kokaia
authors.affiliation: Department of Clinical Sciences Lund, Division of Neurology, Lund University, Lund, Sweden.|Department of Neurology and Rehabilitation Medicine, Skåne University Hospital, Lund, Sweden.
authors.forename: Arne
authors.initials: A
authors.lastname: Lindgren
mesh_terms: D000328:Adult; D000368:Aged; D002545:Brain Ischemia / Q000150:complications; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods; D004185:Disability Evaluation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009069:Movement Disorders / Q000000981:diagnostic imaging / Q000209:etiology* / Q000473:pathology; D009460:Neurologic Examination; D011788:Quality of Life / Q000523:psychology; D020127:Recovery of Function / Q000502:physiology*; D012189:Retrospective Studies; D020521:Stroke / Q000150:complications* / Q000000981:diagnostic imaging / Q000209:etiology / Q000523:psychology; D000071939:Stroke Rehabilitation; D034941:Upper Extremity / Q000503:physiopathology*; D055815:Young Adult
keywords: Recovery; Stem cell therapy; Stroke; Upper extremity motor impairment