University of Zurich and University Hospital Zurich, Zurich, Switzerland.
cereneo, Center for Neurology and Rehabilitation, Vitznau, Switzerland.
Neurorehabil Neural Repair. 2019 Nov;33(11):876-887. doi: 10.1177/1545968319872996. Epub 2019 Sep 15.
In 2008, it was proposed that the magnitude of recovery from nonsevere upper limb motor impairment over the first 3 to 6 months after stroke, measured with the Fugl-Meyer Assessment (FMA), is approximately 0.7 times the initial impairment ("proportional recovery"). In contrast to patients with nonsevere hemiparesis, about 30% of patients with an initial severe paresis do not show such recovery ("nonrecoverers"). Hence it was suggested that the proportional recovery rule (PRR) was a manifestation of a spontaneous mechanism that is present in all patients with mild-to-moderate paresis but only in some with severe paresis. Since the introduction of the PRR, it has subsequently been applied to other motor and nonmotor impairments. This more general investigation of the PRR has led to inconsistencies in its formulation and application, making it difficult to draw conclusions across studies and precipitating some cogent criticism. Here, we conduct a detailed comparison of the different studies reporting proportional recovery and, where appropriate, critique statistical methodology. On balance, we conclude that existing data in aggregate are largely consistent with the PRR as a population-level model for upper limb motor recovery; recent reports of its demise are exaggerated, as these excessively focus on the less conclusive issue of individual subject-level predictions. Moving forward, we suggest that methodological caution and new analytical approaches will be needed to confirm (or refute) a systematic character to spontaneous recovery from motor and other poststroke impairments, which can be captured by a mathematical rule either at the population or at the subject level.
2008 年有人提出，用 Fugl-Meyer 评估（FMA）测量，中风后最初 3 至 6 个月非严重上肢运动障碍的恢复程度，其幅度大约是初始损伤的 0.7 倍（“比例恢复”）。与非严重偏瘫患者不同，大约 30%的初始严重弛缓性瘫痪患者不会出现这种恢复（“不可恢复者”）。因此，有人提出比例恢复规则（PRR）是一种自发机制的表现，这种自发机制存在于所有轻度至中度弛缓性瘫痪患者中，但仅存在于部分严重弛缓性瘫痪患者中。自 PRR 引入以来，它随后被应用于其他运动和非运动损伤。对 PRR 的这种更广泛的研究导致了其表述和应用的不一致，使得难以在研究之间得出结论，并引发了一些有说服力的批评。在这里，我们对报告比例恢复的不同研究进行了详细比较，并在适当的情况下对统计方法进行了批评。总的来说，我们的结论是，现有数据在总体上基本符合 PRR 作为上肢运动恢复的人群水平模型；最近关于其消亡的报告被夸大了，因为这些报告过于关注个体主体水平预测这一不太明确的问题。展望未来，我们建议需要采取谨慎的方法和新的分析方法，以确认（或反驳）运动和其他中风后损伤的自发恢复具有系统特征，这种特征可以通过数学规则在人群或个体水平上得到体现。
