Variables Explaining Functional Recovery Following Motor Stroke

Janice L. Hinkle


J Neurosci Nurs. 2006;38(1):6-12. 

In This Article

Functional Recovery Following Motor Stroke

The recovery of function during and after stroke rehabilitation has been studied extensively in the general population of stroke patients (Jeffery & Good, 1995; Kelly-Hayes & Paige, 1995). As new therapies and decreasing mortality rates for acute ischemic stroke have come about, so have greater expectations for favorable outcomes and rapid functional recovery following the acute phase of care. According to a recent review of the literature, demographic variables (including age), risk factors, clinical examination findings (including motor strength), laboratory test results, and imaging studies are all variables that affect outcome (mostly mortality) from the acute phase of stroke care (Demchuk & Buchan, 2000). Demchuk and Buchan fail to include motor stroke patients or any cognitive or functional outcome measures in this review.

Motor Strength

Loss of motor strength is the most common deficit after stroke, reported in 88% of patients who have had a stroke (Gresham et al., 1995), and is a predominant feature of motor stroke. However, only one study was found that specifically provided a description of deficits following motor stroke (Libman, Sacco, Shi, Tatemichi, & Mohr, 1992). This study described 62 patients with pure motor stroke and compared them with 280 patients with other types of stroke syndromes. Patients in this study were followed for only 10 days, their functional recovery was not measured, and the study did not include a standardized scale, such as the National Institutes of Health Stroke Scale (NIHSS), to measure motor strength. More recently, the NIHSS was used to predict outcome in the general population of ischemic stroke patients (Baird et al., 2001; Johnston, Connors, Wagner, & Haley, 2003).

Another study assessed the relationship of motor and cognitive abilities to functional performance in 37 patients during stroke rehabilitation (Fong, Chan, & Au, 2001). This study used the Fugl-Meyer Assessment to rate motor strength; however, patients with motor stroke were not assessed as a separate group and the study did not address the acute care period.

Lesion Volume

The National Institute of Neurologic Disorders and Stroke rt-PA trial used lesion volume following ischemic stroke, measured with computed tomography (CT), to predict outcome (Johnston et al., 2003). Technical advances in the last two decades enable clinicians to obtain clearer anatomical images of the brain via magnetic resonance imaging (MRI) compared to CT. Many techniques exist for measuring lesion volume on MRI, and the best method has yet to be determined (Saunders, Clifton, & Brown, 1995). Lesion volume has not been described, nor has its relationship with other variables been explored, during the acute phase of care following motor stoke.


Advancing age is a significant risk factor for stroke in general (Gresham et al., 1995). Approximately 72% of strokes occur in individuals who are at least 65 years of age (Gresham et al.). Age is commonly included in multivariate models for predicting mortality and outcome following stroke (Gladman, Harwood, & Barer, 1992; Johnston et al., 2003). Although age has been acknowledged as a significant factor for mortality and outcome, its influence on functional recovery following motor stroke has not been explored.

Cognitive Status

Initial alterations of cognitive function in patients presenting with motor stroke, while suspected, have not been well documented or researched (Donnan et al., 1995). Two studies used an MMSE score of 24 or lower to document impaired cognitive status in approximately one-third of patients after lacunar infarction. Only a subset of them had a motor stroke (Samuelsson, Soderfeldt, & Olsson, 1996; van Swieten, Staal, Kappelle, Derix, & van Gijn, 1996). Another study used a Chinese version of the NCSE to describe the relationship of motor and cognitive abilities to functional performance in 37 patients during stroke rehabilitation (Fong et al., 2001).

Evans & Bishop (1990) describe poor cognitive status as a predictor of nursing home placement or hospital readmission in the general stroke population. An analysis of the stroke rehabilitation literature leads to the conclusion that cognitive impairment in stroke patients is associated with a less favorable functional recovery (Jeffery & Good, 1995). Additional studies link cognitive decline after stroke to negative functional outcomes in the general stroke population (Tatemichi et al., 1994). Neither the review by Jeffery and Good, nor the study by Tatemichi et al., includes motor stroke.

Functional Outcome

The Functional Independence Measure (FIM™) has been used extensively with patients who have had strokes (Hinkle, 2000). Functional ability at the time of admission is strongly linked to functional recovery in the inpatient stroke rehabilitation literature. For example, total FIM scores for 520 general stroke patients at admission were significantly correlated with total FIM scores at discharge (r = 0.80; Alexander, 1994). Others concur that the admission total FIM score influences the change in the total FIM score during the rehabilitation stay, F (1,374) = 8.39, p = .004 (Ween, Alexander, D'Esposito, & Roberts, 1996b). Fong, Chan, and Au (2001) describe the relationship of motor and cognitive abilities to functional performance in 37 patients during stroke rehabilitation. None of these studies focuses on patients who have had a motor stroke or on functional ability during the acute phase of care.

The reviewed the literature reveals that the acute phase and predictors of recovery following motor stroke have not been well documented or described. The five key variables included in this study were gleaned, for the most part, from the better developed body of literature concerning inpatient rehabilitation following stroke.


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