Abstract
The aim of the current study was to investigate the longitudinal relationship between improvements of synergism and strength of the upper paretic limb and severity of visuo-spatial neglect during the first 52 weeks post-stroke. The longitudinal association between severity of VSN and motor impairment using Fugl Meyer motor score and Motricity Index of the arm was measured in an intensive repeated measurement design including 18 measurement sessions for each subject. Neglect was assessed using the letter cancellation test applied in a prospective cohort of 101 ischemic, first-ever, hemispheric stroke patients. All time-dependent measures were taken weekly, starting within 14 days post-stroke. From week 10 to 20 biweekly measurements are obtained. The longitudinal relationship of (bi)weekly time on improvement of motor functions and severity of neglect was investigated using random coefficient analysis and trend analyses. Fifty-one of the 101 stroke patients showed neglect at stroke onset. Less improvement of synergism and strength of the upper paretic limb was associated with more severe neglect. This association was most pronounced in the first 10 weeks post-stroke. The seemingly suppressive effect of neglect on upper-limb motor recovery appears to take place mainly during spontaneous neurological recovery of first 10 weeks post-stroke. This finding suggests that damage to large-scale white matter tracts of especially the perceptual-attention networks suppress recovery of other networks at distance in the brain suggesting a common underlying mechanism.
Highlights
Visuospatial neglect (VSN) is a frequent post-stroke disorder [1,2], where patients demonstrate impaired awareness for contralesional stimuli
VSN is linked to poor motor recovery, higher disability, poor responses to rehabilitation services [3], yet the time course of suppressive effects of VSN are largely unknown [4] due to lack of prospective cohort studies satisfying the key methodological criteria for prognostic research according to the STROBE statement [5]
The aim of the current study is to investigate the time course of suppressive effects of VSN on the severity and time course of synergistic motor control (FM-arm) and motor strength (Motricity Index-arm (MI-arm)) of the upper paretic limb in the first year post-stroke are investigated
Summary
Visuospatial neglect (VSN) is a frequent post-stroke disorder [1,2], where patients demonstrate impaired awareness for contralesional stimuli. The aim of the current study is to investigate the time course of suppressive effects of VSN on the severity and time course of synergistic motor control (FM-arm) and motor strength (Motricity Index-arm (MI-arm)) of the upper paretic limb in the first year post-stroke are investigated. We hypothesize that VSN is associated with more motor impairment at stroke onset, and with reduced motor improvement in the first months post-stroke. These suppressive effects will be mainly restricted to the same time-window where spontaneous neurological recovery takes place. These effects of VSN on the time course of motor recovery will be comparable for FM-arm and MI-arm, due to a common underlying suppressive mechanism affecting motor networks that gradual alleviate in time [13]
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