Does Stroke Rehabilitation Really Matter? Part B: An Algorithm for Prescribing an Effective Intensity of Rehabilitation
Does Stroke Rehabilitation Really Matter? Part B: An Algorithm for Prescribing an Effective Intensity of Rehabilitation
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DOI：
10.1177/1545968317753074
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发表时间：
2018-01-01
影响因子：
4.2
通讯作者：
Corbett, Dale
中科院分区：
文献类型：
--
作者：
Jeffers, Matthew Strider;Karthikeyan, Sudhir;Corbett, Dale
背景。比例恢复规则表明，目前的康复实践可能对中风恢复的影响有限。然而，实现康复所需的适当康复强度仍然未知。啮齿动物和人类恢复生物标志物之间的相似性可能允许确定激活内源性生物恢复过程所需的恢复阈值。目标。我们确定了脑卒中恢复的临床相关生物标志物对功能结局的相对影响。然后，这些生物标记物被用来生成一种算法，该算法规定了恢复功能所需的个性化康复强度。方法。对593只雄性Sprague-Dawley大鼠进行回顾性队列研究，利用多元线性回归方法确定最能预测蒙托亚楼梯到达任务中脑卒中后颗粒回收变化的生物标志物。使用内皮素-1诱导的卒中（n = 49）对这些因素进行前瞻性操作来验证模型。结果。为了可靠地预测中风严重程度的恢复，康复是必要的。随着梗死面积和初始损伤的增加，需要更密集的康复才能恢复。在这个模型中，我们使用脑卒中后初始损伤和梗死体积的生物标志物规定了大鼠实现显著运动恢复所需的每日康复的特定剂量。结论。我们的算法展示了一种个性化的中风康复方法，其中成像和功能表现测量可用于为大鼠开发优化的康复范例，特别是那些有严重损伤的大鼠。在人类患者中探索这种方法可能会增加中风后运动功能丧失恢复的个体比例。
Background. The proportional recovery rule suggests that current rehabilitation practices may have limited ability to influence stroke recovery. However, the appropriate intensity of rehabilitation needed to achieve recovery remains unknown. Similarities between rodent and human recovery biomarkers may allow determination of rehabilitation thresholds necessary to activate endogenous biological recovery processes. Objective. We determined the relative influence that clinically relevant biomarkers of stroke recovery exert on functional outcome. These biomarkers were then used to generate an algorithm that prescribes individualized intensities of rehabilitation necessary for recovery of function. Methods. A retrospective cohort of 593 male Sprague-Dawley rats was used to identify biomarkers that best predicted poststroke change in pellet retrieval in the Montoya staircase-reaching task using multiple linear regression. Prospective manipulation of these factors using endothelin-1-induced stroke (n = 49) was used to validate the model. Results. Rehabilitation was necessary to reliably predict recovery across the continuum of stroke severity. As infarct volume and initial impairment increased, more intensive rehabilitation was required to engage recovery. In this model, we prescribed the specific dose of daily rehabilitation required for rats to achieve significant motor recovery using the biomarkers of initial poststroke impairment and infarct volume. Conclusions. Our algorithm demonstrates an individualized approach to stroke rehabilitation, wherein imaging and functional performance measures can be used to develop an optimized rehabilitation paradigm for rats, particularly those with severe impairments. Exploring this approach in human patients could lead to an increase in the proportion of individuals experiencing recovery of lost motor function poststroke.