Variables Explaining Functional Recovery Following Motor Stroke

Janice L. Hinkle

Disclosures

J Neurosci Nurs. 2006;38(1):6-12. 

In This Article

Abstract and Introduction

Abstract

Few well-designed descriptive studies focus exclusively on patients after motor stroke. This study describes a cohort of participants after motor stroke and assesses the extent to which five key variables explain the variation in functional recovery 3 months after stroke. Prospective data were collected (N = 100) on age, lesion volume, motor strength, cognition, and poststroke function during the acute care hospital admission. Instruments included magnetic resonance imaging (MRI) to provide a measure of lesion volume, the Mini-Mental® State Examination (MMSE™) and the Neurobehavioral Cognitive Status Examination (NCSE) to measure cognitive status, and the National Institute of Health Stroke Scale (NIHSS) to measure motor strength. The Functional Independence Measure (FIM™) was used to measure baseline function and functional recovery 3 months after stroke. Descriptive and hierarchical multiple regression analyses were used to describe the cohort and predict functional recovery. The means for key variables during acute care were 65 (±15) years of age, lesion volume 21.5 (±44.7) cm3, NIHSS 6.34 (±3.55), MMSE 24.38 (±4.82), NCSE 64.33 (±13), and FIM 94.05 (±19.31). Age, cognitive status, and initial function accounted for 42% of the variance in functional recovery 3 months after stroke. Results indicate that neuroscience nurses need to add cognition to their focus during the fast-paced acute phase of care following motor stroke.

Introduction

Approximately 13%-14% of all strokes (Arboix et al., 2001) and 25% of ischemic strokes (Moncayo, Devuyst, van Melle, & Bogousslavsky, 2000) clinically present as pure motor strokes. This type of stroke is characterized as a hemiparesis or hemiplegia that affects the face, arm, and leg equally, although the exact pattern may differ according to the anatomic location of the infarction within the brain (Bronstein, Popovich, & Stewart-Amidei, 1991). Patients with a pure motor stroke have normal sensation, no visual field deficit, and no swallowing or speech impairment (Fisher & Curry, 1965). Areas of the brain commonly associated with a pure motor stroke are the internal capsule and pons (Arboix et al.; Fisher, 1982). These areas are involved in cognition, although cognitive deficits are not included in the definition or description of motor stroke (Bronstein et al.; Donnan, Norrving, Bamford, & Bogousslavsky, 1995).

The stroke rehabilitation and clinical literature suggests the importance of motor strength, lesion volume, age, cognitive status, and poststroke functional level as relevant variables influencing functional recovery following motor stroke. This article reports a study that was conducted to provide clinicians and researchers with baseline data on a unique set of five key variables during acute care and their relationship to functional recovery in a group of motor stroke patients.

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