Intense Arm Rehabilitation Therapy Improves the Modified Rankin Scale Score: Association Between Gains in Impairment and Function

Steven C. Cramer*, Vu Le, Jeffrey L. Saver, Lucy Dodakian, Jill See, Renee Augsburger, Alison McKenzie, Robert J. Zhou, Nina L. Chiu, Jutta Heckhausen, Jessica M. Cassidy, Walt Scacchi, Megan Therese Smith, A. M. Barrett, Jayme Knutson, Dylan Edwards, David Putrino, Kunal Agrawal, Kenneth Ngo, Elliot J. RothDavid L. Tirschwell, Michelle L. Woodbury, Ross Zafonte, Wenle Zhao, Judith Spilker, Steven L. Wolf, Joseph P. Broderick, Scott Janis

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

8 Scopus citations


Objective To evaluate the effect of intensive rehabilitation on the modified Rankin Scale (mRS), a measure of activities limitation commonly used in acute stroke studies, and to define the specific changes in body structure/function (motor impairment) most related to mRS gains.MethodsPatients were enrolled >90 days poststroke. Each was evaluated before and 30 days after a 6-week course of daily rehabilitation targeting the arm. Activity gains, measured using the mRS, were examined and compared to body structure/function gains, measured using the Fugl-Meyer (FM) motor scale. Additional analyses examined whether activity gains were more strongly related to specific body structure/function gains.ResultsAt baseline (160 ± 48 days poststroke), patients (n = 77) had median mRS score of 3 (interquartile range, 2-3), decreasing to 2 [2-3] 30 days posttherapy (p < 0.0001). Similarly, the proportion of patients with mRS score ≤2 increased from 46.8% at baseline to 66.2% at 30 days posttherapy (p = 0.015). These findings were accounted for by the mRS score decreasing in 24 (31.2%) patients. Patients with a treatment-related mRS score improvement, compared to those without, had similar overall motor gains (change in total FM score, p = 0.63). In exploratory analysis, improvement in several specific motor impairments, such as finger flexion and wrist circumduction, was significantly associated with higher likelihood of mRS decrease.ConclusionsIntensive arm motor therapy is associated with improved mRS in a substantial fraction (31.2%) of patients. Exploratory analysis suggests specific motor impairments that might underlie this finding and may be optimal targets for rehabilitation therapies that aim to reduce activities limitations.Clinical identifier: NCT02360488.Classification of EvidenceThis study provides Class III evidence that for patients >90 days poststroke with persistent arm motor deficits, intensive arm motor therapy improved mRS in a substantial fraction (31.2%) of patients.

Original languageEnglish (US)
Pages (from-to)E1812-E1822
Issue number14
StatePublished - Apr 6 2021
Externally publishedYes

ASJC Scopus subject areas

  • Clinical Neurology


Dive into the research topics of 'Intense Arm Rehabilitation Therapy Improves the Modified Rankin Scale Score: Association Between Gains in Impairment and Function'. Together they form a unique fingerprint.

Cite this