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Lesion Characteristics, NIH Stroke Scale, and Functional Recovery After Stroke

Glymour, M Maria ScD; Berkman, Lisa F. PhD; Ertel, Karen A. MS; Fay, Martha E. MPH; Glass, Thomas A. PhD; Furie, Karen L. MD

American Journal of Physical Medicine & Rehabilitation: September 2007 - Volume 86 - Issue 9 - p 725-733
doi: 10.1097/PHM.0b013e31813e0a32
CME Article • 2007 Series • Number 3: Stroke

Glymour MM, Berkman LF, Ertel KA, Fay ME, Glass TA, Furie KL: Lesion characteristics, NIH stroke scale, and functional recovery after stroke. Am J Phys Med Rehabil 2007;86:725–733.

Objective: We examined the relationships between the National Institute of Health Stroke Scale (NIHSS) and physical, cognitive, and social participation outcomes across subpopulations of stroke survivors on the basis of cortical involvement and lesion lateralization.

Design: Families in Recovery from Stroke Trial participants were classified with respect to lesion lateralization (n = 274) and cortical involvement (n = 158). NIHSS scores (average 13 days after stroke) were used to predict Physical Performance Test times (PPT), limitations in activities of daily living (Augmented Barthel Index (ABI)), Instrumental Activities of Daily Living (IADL), cognitive function, depressive symptoms (Center for Epidemiologic Studies Depression scale [CES-D]), and productive, recreational, self-care, and social role activities 3 and 6 mos later. We compared the relationship between NIHSS and each outcome in stroke subgroups classified by lesion lateralization and cortical involvement.

Results: NIHSS predicted physical performance, activities of daily living, and IADL independence. The association between NIHSS and both PPT and IADLs was less steep for patients with cortical lesions than for patients with exclusively subcortical lesions. NIHSS predicted physical performance, activities of daily living, or IADLs similarly for right- and left-hemisphere strokes, but hemisphere modified the association between NIHSS and CES-D and cognitive measures.

Conclusions: The NIHSS may predict outcomes in subpopulations of stroke survivors with subcortical lesions better than in patients with cortical involvement. NIHSS predicted CES-D in patients with right-sided lesions but not in those with left-sided lesions. In contrast, NIHSS had little association with cognitive outcomes among patients without left-side involvement.

From the Mailman School of Public Health at Columbia University, New York, NY (MMG); Harvard School of Public Health, Boston, Massachusetts (MMG, LFB, KAE, MEF); Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (TAG); and Harvard School of Medicine and Massachusetts General Hospital, Boston, Massachusetts (KLF).

All correspondence and requests for reprints should be addressed to M. Maria Glymour, Department of Epidemiology, Mailman School of Public Health, 722 West 168th Street, Room 1603, New York, NY 10032.

Funded by the National Institute of Neurologic Disorders and Stroke (NS032324).

© 2007 Lippincott Williams & Wilkins, Inc.