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BRIEF COMMUNICATIONS: J. Uy, M. C. Ridding, S. Hillier, P. D. Thompson, and T. S. Miles Does induction of plastic change in motor cortex improve leg function after stroke? Neurology 2003; 61: 982-984 [Abstract] [Full text] [PDF]

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Does induction of plastic change in motor cortex improve leg function after stroke?

Meheroz H Rabadi, MD, MRCPI   (23 March 2004)

Reply to Rabadi

M. C. Ridding   (23 March 2004)

Does induction of plastic change in motor cortex improve leg function after stroke? 23 March 2004
Meheroz H Rabadi, MD, MRCPI, Burke Rehabilitation Hospital 785 Mamaroneck Ave,White Plains, NY 10605 Send Correspondence to journal: Re: Does induction of plastic change in motor cortex improve leg function after stroke? mrabadi{at}burke.org Meheroz H Rabadi, MD, MRCPI	We read with interest the article by Uy et al [1] on motor plasticity and its influence on functional outcome. The study suggested that 4 weeks of daily dual stimulation in chronic, stable, stroke patients showed improvement in electrophysiological (electromyographic activity in tibialis anterior and peroneus longus muscles) and functional (passive and active dorsiflexion and gait characteristics) measures. However, the patient population studied was relatively young, except for one patient who was 78 years old. They also had relatively high discharge total functional independence measure scores (TFIM) (96 and greater), and a high average Rivermead Mobility index (11.3). In contrast, the stroke population that comes for rehabilitation is usually old (70 years and above), with much lower discharge TFIM score (<90). Does the degree of improvement noted in this study by this dual stimulation technique also occur in this stroke population? Did the authors correct for co-variants and degree of improvement noted? Age [2,3,4] and TFIM [5] both have an impact on functional outcome measures. References 1. Uy J, Ridding MC, Hillier S, Thompson PD, Miles TS. Does induction of plastic change in motor cortex improve leg function after stroke? Neurology 2003;61:982-984. 2. Ween JE, Alexander MP, D'Esposito M, Roberts M. Factors predictive of stroke outcome in a rehabilitation setting. Neurology 1996;47:388-392. 3. Nakayama H, Jorgensen HS, Raaschou HO, Olsen TS. The influence of age on stroke outcome. The Copenhagen Stroke Study. Stroke 1994;25:808-813. 4. Bagg S, Pombo AP, Hopman W. Effect of age on functional outcomes after stroke rehabilitation. Stroke 2002;33:179-185. 5. Ween JE, Mernoff ST, Alexander MP. Recovery rates after stroke and their impact on outcome prediction. Neurorehabil Neural Repair 2000;14:229-35.
Reply to Rabadi 23 March 2004
M. C. Ridding, Department of Physiology University of Adelaide, Adelaide, South Australia 5005, Australia Send Correspondence to journal: Re: Reply to Rabadi michael.ridding{at}adelaide.edu.au M. C. Ridding	We thank Dr. Rabadi for his comments on our article. He raises a number of interesting points about the influence of age and baseline functional abilities on the outcome following the dual stimulation paradigm. Unfortunately, we can say very little about these issues. There was no obvious relationship between baseline functional capacity, or age, to outcome following the intervention. However, the sample size was small. It would be useful to explore the influence of these factors in a larger study. Our patients were a sample of convenience recruited locally. No attempt was made to select younger subjects. Therefore the lower age of our patients may reflect regional differences in mean stroke patients age.