Intense Arm Rehabilitation Therapy Improves the Modified Rankin Scale Score: Association Between Gains in Impairment and Function

Authors

Steven C. Cramer, University of California, Los Angeles
Vu Le, University of California, Irvine
Jeffrey L. Saver, University of California, Los Angeles
Lucy Dodakian, University of California, Irvine
Jill See, University of California, Irvine
Renee Augsburger, University of California, Irvine
Alison McKenzie, Chapman UniversityFollow
Robert J. Zhou, University of California, Irvine
Nina L. Chiu, University of California, Irvine
Jutta Heckhausen, University of California, Irvine
Jessica M. Cassidy, University of California, Irvine
Walt Scacchi, University of California, Irvine
Megan Therese Smith, University of California, Irvine
A. M. Barrett, Kessler Foundation
Jayme Knutson, Case Western Reserve University
Dylan Edwards, Burke Neurological Institute
David Putrino, Burke Medical Research Institute
Kunal Agrawal, University of California, San Diego
Kenneth Ngo, Brooks Rehabilitation
Elliot J. Roth, Northwestern University
David L. Tirschwell, University of Washington
Michelle L. Woodbury, Medical University of South Carolina
Ross Zafonte, Spaulding Rehabilitation Hospital
Wenle Zhao, Medical University of South Carolina
Judith L. Spilker, University of Cincinnati
Steven L. Wolf, Emory University
Joseph P. Broderick, University of Cincinnati
Scott Janis, National Institutes of Health

Document Type

Article

Publication Date

2-15-2021

Abstract

Objective To evaluate the effect of intensive rehabilitation on the modified Rankin Scale (mRS), a measure of activities limitation commonly used in acute stroke studies, and to define the specific changes in body structure/function (motor impairment) most related to mRS gains.

Methods Patients were enrolled >90 days poststroke. Each was evaluated before and 30 days after a 6-week course of daily rehabilitation targeting the arm. Activity gains, measured using the mRS, were examined and compared to body structure/function gains, measured using the Fugl-Meyer (FM) motor scale. Additional analyses examined whether activity gains were more strongly related to specific body structure/function gains.

Results At baseline (160 ± 48 days poststroke), patients (n = 77) had median mRS score of 3 (interquartile range, 2–3), decreasing to 2 [2–3] 30 days posttherapy (p < 0.0001). Similarly, the proportion of patients with mRS score ≤2 increased from 46.8% at baseline to 66.2% at 30 days posttherapy (p = 0.015). These findings were accounted for by the mRS score decreasing in 24 (31.2%) patients. Patients with a treatment-related mRS score improvement, compared to those without, had similar overall motor gains (change in total FM score, p = 0.63). In exploratory analysis, improvement in several specific motor impairments, such as finger flexion and wrist circumduction, was significantly associated with higher likelihood of mRS decrease.

Conclusions Intensive arm motor therapy is associated with improved mRS in a substantial fraction (31.2%) of patients. Exploratory analysis suggests specific motor impairments that might underlie this finding and may be optimal targets for rehabilitation therapies that aim to reduce activities limitations.

Comments

This article was originally published in Neurology, volume 96, issue 14, in 2021. https://doi.org/10.1212/WNL.0000000000011667

Recommended Citation

Cramer SC, Le V, Saver JL, et al. Intense arm rehabilitation therapy improves the modified Rankin Scale score: Association between gains in impairment and function. Neurology. 2021;96(14):e1812-e1822. https://doi.org/10.1212/WNL.0000000000011667

Peer Reviewed

1

Copyright

American Academy of Neurology