PREP2 Prediction Categories

 

 

Prediction categories
As you know, there are four PREP2 prediction categories for upper limb functional outcome.

PREP2 predictions are usually delivered in the first 7 days after stroke. The prediction is usually discussed with the patient, and their family when appropriate, and is reinforced by providing written information to the patient. The prediction and its associated information should also be documented in the patient’s clinical notes.

An overview of the four predictions, which patients they are relevant for, and the information that is likely to have been given to the patient and their family is provided below.

Excellent
The patient is likely to make a complete, or near complete, recovery of hand and arm function within 12 weeks. As these patients are often mildly affected, and soon discharged from hospital, they can be prescribed a self-directed hand and arm exercise programme help them reach their potential. The rehabilitation focus is promote normal function.

These patients are:

• • <80 years old with a Day 3 SAFE score of 5 or more
  • 80+ years old with a Day 3 SAFE score of 8 or more

Information given to the patient and their family:

• • Based on our assessments, your hand and arm have the potential to regain very good movement
  • You can expect to be able to use your hand fairly normally for most day to day activities within the next 3 months
  • The focus of your rehabilitation will be on improving your strength, coordination and fine control
  • You will need to practice using your hand and arm to help it improve
  • It’s important to avoid using your other hand to compensate
  • This prediction is based on your current status, and is not a guarantee, as some people recover more or less than expected

Good
The patient is most likely to be using their hand and arm in most day to day activities within 12 weeks. Upper limb rehabilitation is likely to focus on improving function by increasing strength, coordination and fine control. Repetitive practice of movement and everyday tasks should help. The affected hand and arm should be used for safe daily activities, and compensation with the stronger arm should be minimised. The rehabilitation focus is to promote function.

These patients are:

• • 80+ years old with a Day 3 SAFE score of 5,6 or 7
  • Any age with a Day 3 SAFE score < 5 and MEP+ on TMS testing at 3 – 7 days post-stroke

Information given to the patient and their family when TMS testing was not needed:

• • Based on our assessments, your hand and arm have the potential to regain fairly good movement
  • You can expect to be able to use your hand for mostday to day activities within the next 3 months
  • Your hand may still be affected by slowness, weakness or clumsiness
  • The focus of your rehabilitation will be on improving your strength, coordination and fine control
  • You will need to practice using your hand and arm to help improve it
  • It’s important to avoid using your other hand to compensate
  • This prediction is based on your current status, and is not a guarantee, as some people recover more or less than expected

Information given to the patient and their family when TMS testing was used:

• • The TMS assessment shows that the pathways between your brain and your arm are working
  • This means your hand and arm have the potential to regain fairly good movement within the next 3 months
  • You can expect to be able to use your hand for most day to day activities within the next 3 months, though it may still be affected by slowness, weakness or clumsiness
  • The focus of your rehabilitation will shift from helping you regain movement to improving your strength, coordination and fine control
  • You will need to practice using your hand and arm to help improve it
  • It’s important to avoid using your other hand to compensate
  • This prediction is based on your current status, and is not a guarantee, as some people recover more or less than expected

Limited
The patient is likely to have some movement in their hand and arm within 12 weeks. However, activities that use their affected upper hand are likely to require significant modification. They may recover grasp function, but are unlikely to recover useful fine motor control. Upper limb rehabilitation can focus on maintaining and improving strength and flexibility of the affected hand and arm, and helping to adapt day to day activities to incorporate this hand and arm wherever possible. The rehabilitation focus is to promote movement.

These patients are:

• • Day 3 SAFE score < 5, MEP- on TMS testing at 3 – 7 days post-stroke, and Day 3 NIHSS < 7

Information given to the patient and their family:

• • The TMS assessment shows that the pathways between your brain and your arm have been damaged
  • You can expect to regain some arm movement within the next 3 months
  • You might also regain some hand opening and closing, though fine finger control is unlikely
  • You will probably need to use the other hand to help with some activities
  • The focus of your rehabilitation will be on maintaining and improving the strength and flexibility of your hand and arm, and helping you to adapt activities to incorporate this hand and arm wherever possible
  • You will need to practice using your hand and arm to help improve it
  • This prediction is based on your current status, and is not a guarantee, as some people recover more or less than expected

Poor
The patient is likely to have only minimal movement in their affected hand and arm within 12 weeks. Upper limb rehabilitation can focus on prevention of secondary complications, such as pain, spasticity, and shoulder instability, and helping the patient to do everyday activities with the stronger hand and arm. The rehabilitation focus is to promote compensation.

These patients are:

• • Day 3 SAFE score < 5, MEP- on TMS testing at 3 – 7 days post-stroke, and Day 3 NIHSS ≥ 7

Information for the patient and their family:

• • The TMS assessment shows that the pathways between your brain and your arm have been damaged
  • You may regain some movement in your arm within the next 3 months
  • You might be able to use your weaker hand to stabilise objects, but fine finger control is unlikely
  • The focus of your rehabilitation will be on maintaining the flexibility of your hand and arm, preventing shoulder instability or pain, and helping you learn to perform day to day activities with your other hand or both hands where possible
  • This prediction is based on your current status, and is not a guarantee, as some people recover more or less than expected