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Characterising Arm Recovery in People with Severe Stroke (CARPSS)

The prevalence and severity of stroke related upper limb disability is increasing and the prospect of optimal recovery is poor.

Aims

To address critical gaps in our understanding of motor recovery in people with severe upper limb impairment post stroke, we propose four studies that aim to:

Aim 1: Characterise the longitudinal changes in clinical and neuroanatomical structure and function;

Aim 2: Determine what characteristics define individuals who show significant change in motor function and thus are a recoverer;

Aim 3: Explore the stroke survivor’s perception of meaningful recovery of upper limb function; and

Aim 4: Characterise the physical activity levels of people with severe upper limb disability.

Design: Longitudinal cohort study

Current status: Recruiting from GF Strong Rehabilitation Facility, Vancouver Canada.

Site/s: Department of Physical Therapy, University of British Columbia, Vancouver Canada; Florey Institute for Neuroscience and Mental Health Melbourne Australia; GF Strong Rehabilitation Facility, Vancouver Canada.

Clinical trial registration: ClinicalTrials.gov identifier NCT02464085

Stroke survivors with severe impairment lack early indicators (<7 days post-stroke) of a good prognosis, such as active movement at the shoulder and wrist and integrity of the corticospinal tract. This propagates the clinical belief that this cohort are unlikely to functionally benefit from rehabilitation efforts. However, it is likely that indicators of good potential for recovery – either neuroanatomical or clinical – may present in individuals with severe stroke later, that is beyond the early time-period. Indeed, there is increasing evidence of the potential for ongoing improvements in motor performance in response to intensive interventions that are undertaken 6-months or more post-stroke. This therefore, implies that there is some degree of untapped recovery potential. However, as very few studies have longitudinally explored the potential indicators of recovery in a severe cohort, the dynamic capacity of the severely damaged remains unknown. Thus, there is a need to determine who recovers upper limb function and who does not. In doing so, this study will build the foundations for more personalized health care options for people with severe upper limb disability post stroke.

Design/methods: Longitudinal cohort study of stroke survivors with severe upper limb disability (SAFE <5/10). Assessments will occur at 2-4wks post stroke; 3mths post stroke; 6mths post stroke; and 12 mths post stroke. At each time-point a clinical (including FMA-UL, MAS-UL, REACH, accelerometry, SIS) and neuroimaging (including resting state fMRI and DTI) assessment will be completed.

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