Stinear et al use the PREP algorithm to predict motor recovery of an upper extremity following stroke. The authors are from the University of Auckland and Auckland City Hospital in New Zealand.
PREP = predicting recovery potential
Patient selection: acute stroke
Outcome: prediction of potential for upper limb recovery
Parameters:
(1) shoulder abduction and finger extension MRC muscle strength in affected limb at 72 hours after stroke
(2) motor evoked potentials (MEP) in affected limb by transcranial magnetic stimulation (TMS)
(3) asymmetry index of fractional anisotropy in the posterior limbs of the internal capsules on diffuse-weighted MRI (a measure of functional integrity of the descending motor pathways to the affected upper limb)
SAFE score =
= (strength of shoulder abduction) + (strength of finger extension)
SAFE Score
TMS
Asymmetry Index on MRI
Predicted Outcome
>= 8
NA
NA
complete
< 8
MEP present
NA
notable
< 8
MEP absent
< point of no return
limited
< 8
MEP absent
> point of no return
none
where:
• MRC (Medical Research Council) muscle strength ranges from 0 to 5 (normal). The maximum SAFE score is 10.
• The point of no return on the asymmetry index is 0.15.
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