Neurocenter Luzerner Kantonsspital Lucerne Switzerland.
Chair for Mathematical Information Science ETH Zurich Zurich Switzerland.
J Am Heart Assoc. 2023 Aug 15;12(16):e030472. doi: 10.1161/JAHA.123.030472. Epub 2023 Aug 10.
Background Laboratory-based assessments have shown that stroke recovery is heterogeneous between patients and affected domains such as motor and language function. However, laboratory-based assessments are not ecologically valid and do not necessarily reflect patients' daily life performance. Therefore, we aimed to give an innovative view on stroke recovery by profiling daily life performance recovery across domains in patients with early subacute stroke and determine their interrelatedness, taking stroke localization into account. Methods and Results Daily life performance was observed at neurorehabilitation admission and weekly thereafter until discharge, using a scale containing 7 daily life domains. Graphical modeling was applied to investigate the conditional independence between recovery of these domains depending on stroke localization. There were 592 patients analyzed. Four clusters of interrelated domains were identified within the first 6 weeks poststroke. The first cluster included recovery in learning and applying knowledge, general tasks and demands, and domestic life. The second cluster comprised recovery in self-care and general tasks and demands. The third cluster included recovery in mobility and self-care; it incorporated interpersonal interactions and relationships in left supratentorial stroke, and learning and applying knowledge in right supratentorial stroke. The final cluster included only communication recovery. Conclusions Daily life recovery dynamics early poststroke show that although impairments in body functions are anatomically determined, their impact on performance is comparable. Second, some, but by no means all, domains show an interrelated recovery. Domains requiring cognitive abilities are especially interrelated and seem to be essential for concomitant recovery in mobility and domestic life.
背景 基于实验室的评估表明，患者之间的卒中恢复存在异质性，且受运动和语言功能等领域的影响。然而，基于实验室的评估并不具有生态效度，不一定能反映患者的日常生活表现。因此，我们旨在通过对早期亚急性期卒中患者的日常生活表现进行跨领域的恢复情况进行分析，提供一种创新性的卒中恢复视角，并考虑到卒中定位，确定它们之间的相互关系。
方法和结果 在神经康复入院时及此后每周进行日常生活表现观察，使用包含 7 个日常生活领域的量表。应用图形建模来研究这些领域的恢复取决于卒中定位的条件独立性。共分析了 592 例患者。在卒中后 6 周内，发现了 4 个相互关联的领域集群。第一个集群包括学习和应用知识、一般任务和需求以及家庭生活方面的恢复。第二个集群包含自我护理和一般任务和需求的恢复。第三个集群包括活动能力和自我护理的恢复；它包括左大脑半球卒中的人际互动和关系，以及右大脑半球卒中的学习和应用知识。最后一个集群仅包含沟通能力的恢复。
结论 卒中后早期日常生活恢复的动态表明，尽管身体功能的损伤在解剖学上是确定的，但它们对表现的影响是相似的。其次，并非所有领域都表现出相互关联的恢复，一些但不是所有的领域都显示出相互关联的恢复。需要认知能力的领域尤其相互关联，似乎对活动能力和家庭生活的同时恢复至关重要。
