scholarly journals Dynamic connectivity predicts acute motor impairment and recovery post-stroke

2020 ◽  
Author(s):  
Anna K Bonkhoff ◽  
Anne Rehme ◽  
Lukas Hensel ◽  
Caroline Tscherpel ◽  
Lukas Volz ◽  
...  
Keyword(s):  
Acute Phase ◽  
Resting State ◽  
Prediction Models ◽  
Motor Impairment ◽  
Motor Recovery ◽  
Stroke Recovery ◽  
Integrated Network ◽  
Post Stroke ◽  
Model Based ◽  
Dynamic Connectivity

Objective Thorough assessment of cerebral dysfunction after acute brain lesions is paramount to optimize predicting short- and long-term clinical outcomes. The potential of dynamic resting-state connectivity for prognosticating motor recovery has not been explored so far. Methods We built random forest classifier-based prediction models of acute upper limb motor impairment and recovery after stroke. Predictions were based on structural and resting-state fMRI data from 54 ischemic stroke patients scanned within the first days of symptom onset. Functional connectivity was estimated using both a static and dynamic approach. Individual motor performance was phenotyped in the acute phase and six months later. Results A model based on the time spent in specific dynamic connectivity configurations achieved the best discrimination between patients with and without motor impairments (out-of-sample area under the curve and 95%-confidence interval (AUC±95%-CI): 0.67±0.01). In contrast, patients with moderate-to-severe impairments could be differentiated from patients with mild deficits using a model based on the variability of dynamic connectivity (AUC±95%-CI: 0.83±0.01). Here, the variability of the connectivity between ipsilesional sensorimotor cortex and putamen discriminated the most between patients. Finally, motor recovery was best predicted by the time spent in specific connectivity configurations (AUC±95%-CI: 0.89±0.01) in combination with the initial motor impairment. Here, better recovery was linked to a shorter time spent in a functionally integrated network configuration in the acute phase post-stroke. Interpretation Dynamic connectivity-derived parameters constitute potent predictors of acute motor impairment and post-stroke recovery, which in the future might inform personalized therapy regimens to promote recovery from acute stroke.

scholarly journals Bringing proportional recovery into proportion: Bayesian modelling of post-stroke motor impairment

Brain ◽  
2020 ◽  
Vol 143 (7) ◽  
pp. 2189-2206 ◽  
Author(s):  
Anna K Bonkhoff ◽  
Thomas Hope ◽  
Danilo Bzdok ◽  
Adrian G Guggisberg ◽  
Rachel L Hawe ◽  
...  
Keyword(s):  
Model Comparison ◽  
Motor Impairment ◽  
Synthetic Data ◽  
Motor Recovery ◽  
Stroke Recovery ◽  
Future Research ◽  
Single Subject ◽  
Post Stroke ◽  
Specific Fraction ◽  
Explained Variance

Abstract Accurate predictions of motor impairment after stroke are of cardinal importance for the patient, clinician, and healthcare system. More than 10 years ago, the proportional recovery rule was introduced by promising that high-fidelity predictions of recovery following stroke were based only on the initially lost motor function, at least for a specific fraction of patients. However, emerging evidence suggests that this recovery rule is subject to various confounds and may apply less universally than previously assumed. Here, we systematically revisited stroke outcome predictions by applying strategies to avoid confounds and fitting hierarchical Bayesian models. We jointly analysed 385 post-stroke trajectories from six separate studies—one of the largest overall datasets of upper limb motor recovery. We addressed confounding ceiling effects by introducing a subset approach and ensured correct model estimation through synthetic data simulations. Subsequently, we used model comparisons to assess the underlying nature of recovery within our empirical recovery data. The first model comparison, relying on the conventional fraction of patients called ‘fitters’, pointed to a combination of proportional to lost function and constant recovery. ‘Proportional to lost’ here describes the original notion of proportionality, indicating greater recovery in case of a more severe initial impairment. This combination explained only 32% of the variance in recovery, which is in stark contrast to previous reports of >80%. When instead analysing the complete spectrum of subjects, ‘fitters’ and ‘non-fitters’, a combination of proportional to spared function and constant recovery was favoured, implying a more significant improvement in case of more preserved function. Explained variance was at 53%. Therefore, our quantitative findings suggest that motor recovery post-stroke may exhibit some characteristics of proportionality. However, the variance explained was substantially reduced compared to what has previously been reported. This finding motivates future research moving beyond solely behaviour scores to explain stroke recovery and establish robust and discriminating single-subject predictions.

scholarly journals Recovery of Apraxia of Speech and Aphasia in Patients With Hand Motor Impairment After Stroke

2021 ◽  
Vol 12 ◽  
Author(s):  
Helena Hybbinette ◽  
Ellika Schalling ◽  
Jeanette Plantin ◽  
Catharina Nygren-Deboussard ◽  
Marika Schütz ◽  
...  
Keyword(s):  
Left Hemisphere ◽  
Motor Impairment ◽  
Stroke Recovery ◽  
Similar Amount ◽  
Apraxia Of Speech ◽  
Stroke Patients ◽  
Post Stroke ◽  
Language Functions ◽  
Brain Recovery ◽  
Recovery Mechanisms

Objective: Aphasia and apraxia of speech (AOS) after stroke frequently co-occur with a hand motor impairment but few studies have investigated stroke recovery across motor and speech-language domains. In this study, we set out to test the shared recovery hypothesis. We aimed to (1) describe the prevalence of AOS and aphasia in subacute stroke patients with a hand motor impairment and (2) to compare recovery across speech-language and hand motor domains. In addition, we also explored factors predicting recovery from AOS.Methods: Seventy participants with mild to severe paresis in the upper extremity were assessed; 50% of these (n = 35) had left hemisphere (LH) lesions. Aphasia, AOS and hand motor assessments and magnetic resonance imaging were conducted at 4 weeks (A1) and at 6 months (A2) after stroke onset. Recovery was characterized in 15 participants showing initial aphasia that also had complete follow-up data at 6 months.Results: All participants with AOS and/or aphasia had LH lesions. In LH lesioned, the prevalence of aphasia was 71% and of AOS 57%. All participants with AOS had aphasia; 80% of the participants with aphasia also had AOS. Recovery in aphasia (n = 15) and AOS (n = 12) followed a parallel pattern to that observed in hand motor impairment and recovery correlated positively across speech-language and motor domains. The majority of participants with severe initial aphasia and AOS showed a limited but similar amount of recovery across domains. Lesion volume did not correlate with results from behavioral assessments, nor with recovery. The initial aphasia score was the strongest predictor of AOS recovery.Conclusion: Our findings confirm the common occurrence of AOS and aphasia in left hemisphere stroke patients with a hand motor impairment. Recovery was similar across speech-language and motor domains, even in patients with severe impairment, supporting the shared recovery hypothesis and that similar brain recovery mechanisms are involved in speech-language and motor recovery post stroke. These observations contribute to the knowledge of AOS and its relation to motor and language functions and add information that may serve as a basis for future studies of post stroke recovery. Studies including neuroimaging and/or biological assays are required to gain further knowledge on shared brain recovery mechanisms.

scholarly journals Longitudinal Effects of Lesions on Functional Networks after Stroke

2013 ◽  
Vol 33 (8) ◽  
pp. 1279-1285 ◽  
Author(s):  
Smadar Ovadia-Caro ◽  
Kersten Villringer ◽  
Jochen Fiebach ◽  
Gerhard Jan Jungehulsing ◽  
Elke van der Meer ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Resting State ◽  
Large Scale ◽  
Clinical Symptoms ◽  
Resting State Fmri ◽  
Functional Change ◽  
Stroke Recovery ◽  
Focal Lesion ◽  
Supporting Evidence ◽  
Post Stroke

While ischemic stroke reflects focal damage determined by the affected vascular territory, clinical symptoms are often more complex and may be better explained by additional indirect effects of the focal lesion. Assumed to be structurally underpinned by anatomical connections, supporting evidence has been found using alterations in the functional connectivity of resting-state functional magnetic resonance imaging (fMRI) data in both sensorimotor and attention networks. To assess the generalizability of this phenomenon in a stroke population with heterogeneous lesions, we investigated the distal effects of lesions on a global level. Longitudinal resting-state fMRI scans were acquired at three consecutive time points, beginning during the acute phase (days 1, 7, and 90 post-stroke) in 12 patients after ischemic stroke. We found a preferential functional change in affected networks (i.e., networks containing lesions changed more during recovery when compared with unaffected networks). This change in connectivity was significantly correlated with clinical changes assessed with the National Institute of Health Stroke Scale. Our results provide evidence that the functional architecture of large-scale networks is critical to understanding the clinical effect and trajectory of post-stroke recovery.

scholarly journals Does Cathodal vs. Sham Transcranial Direct Current Stimulation Over Contralesional Motor Cortex Enhance Upper Limb Motor Recovery Post-stroke? A Systematic Review and Meta-analysis

2021 ◽  
Vol 12 ◽  
Author(s):  
Joyce L. Chen ◽  
Ashley Schipani ◽  
Clarissa Pedrini Schuch ◽  
Henry Lam ◽  
Walter Swardfager ◽  
...  
Keyword(s):  
Systematic Review ◽  
Motor Cortex ◽  
Direct Current ◽  
Transcranial Direct Current Stimulation ◽  
Meta Analysis ◽  
Motor Impairment ◽  
Motor Recovery ◽  
Controlled Trials ◽  
Post Stroke ◽  
Cathodal Tdcs

Background: During recovery from stroke, the contralesional motor cortex (M1) may undergo maladaptive changes that contribute to impaired interhemispheric inhibition (IHI). Transcranial direct current stimulation (tDCS) with the cathode over contralesional M1 may inhibit this maladaptive plasticity, normalize IHI, and enhance motor recovery.Objective: The objective of this systematic review and meta-analysis was to evaluate available evidence to determine whether cathodal tDCS on contralesional M1 enhances motor re-learning or recovery post-stroke more than sham tDCS.Methods: We searched OVID Medline, Embase, and the Cochrane Central Register of Controlled Trials for participants with stroke (>1 week post-onset) with motor impairment and who received cathodal or sham tDCS to contralesional M1 for one or more sessions. The outcomes included a change in any clinically validated assessment of physical function, activity, or participation, or a change in a movement performance variable (e.g., time, accuracy). A meta-analysis was performed by pooling five randomized controlled trials (RCTs) and comparing the change in Fugl–Meyer upper extremity scores between cathodal and sham tDCS groups.Results: Eleven studies met the inclusion criteria. Qualitatively, four out of five cross-over design studies and three out of six RCTs reported a significant effect of cathodal vs. sham tDCS. In the quantitative synthesis, cathodal tDCS (n = 65) did not significantly reduce motor impairment compared to sham tDCS (n = 67; standardized mean difference = 0.33, z = 1.79, p = 0.07) with a little observed heterogeneity (I2 = 5%).Conclusions: The effects of cathodal tDCS to contralesional M1 on motor recovery are small and consistent. There may be sub-populations that may respond to this approach; however, further research with larger cohorts is required.

scholarly journals No evidence for motor recovery-related cortical reorganization after stroke using resting-state fMRI

2019 ◽  
Author(s):  
Meret Branscheidt ◽  
Naveed Ejaz ◽  
Jing Xu ◽  
Mario Widmer ◽  
Michelle D. Harran ◽  
...  
Keyword(s):  
Resting State ◽  
Resting State Fmri ◽  
Motor Recovery ◽  
Cortical Reorganization ◽  
Behavioral Recovery ◽  
Brain Areas ◽  
Data Set ◽  
Post Stroke ◽  
Cortical Areas ◽  
One Year

AbstractCortical reorganization has been suggested as mechanism for recovery after stroke. It has been proposed that a form of cortical reorganization (changes in functional connectivity between brain areas) can be assessed with resting-state fMRI. Here we report the largest longitudinal data-set in terms of overall sessions in 19 patients with subcortical stroke and 11 controls. Patients were imaged up to 5 times over one year. We found no evidence for post-stroke cortical reorganization despite substantial behavioral recovery. These results could be construed as questioning the value of resting-state imaging. Here we argue instead that they are consistent with other emerging reasons to challenge the idea of motor recovery-related cortical reorganization post-stroke when conceived as changes in connectivity between cortical areas.

scholarly journals Association between aphasia severity and brain network alterations after stroke assessed using the electroencephalographic phase synchrony index

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Teiji Kawano ◽  
Noriaki Hattori ◽  
Yutaka Uno ◽  
Megumi Hatakenaka ◽  
Hajime Yagura ◽  
...  
Keyword(s):  
Resting State ◽  
Motor Impairment ◽  
Brain Network ◽  
Phase Synchrony ◽  
Beta Band ◽  
Post Stroke ◽  
Expressive Function ◽  
Delta Band ◽  
Network Status ◽  
The Right

AbstractElectroencephalographic synchrony can help assess brain network status; however, its usefulness has not yet been fully proven. We developed a clinically feasible method that combines the phase synchrony index (PSI) with resting-state 19-channel electroencephalography (EEG) to evaluate post-stroke motor impairment. In this study, we investigated whether our method could be applied to aphasia, a common post-stroke cognitive impairment. This study included 31 patients with subacute aphasia and 24 healthy controls. We assessed the expressive function of patients and calculated the PSIs of three motor language-related regions: frontofrontal, left frontotemporal, and right frontotemporal. Then, we evaluated post-stroke network alterations by comparing PSIs of the patients and controls and by analyzing the correlations between PSIs and aphasia scores. The frontofrontal PSI (beta band) was lower in patients than in controls and positively correlated with aphasia scores, whereas the right frontotemporal PSI (delta band) was higher in patients than in controls and negatively correlated with aphasia scores. Evaluation of artifacts suggests that this association is attributed to true synchrony rather than spurious synchrony. These findings suggest that post-stroke aphasia is associated with alternations of two different networks and point to the usefulness of EEG PSI in understanding the pathophysiology of aphasia.

Abstract TP152: Correlation of NIH Stroke Scale and Fugl-Meyer Motor Scales in a Longitudinal Stroke Recovery Study: Implication for Feasibility Survey for Stroke Rehabilitation Trial

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Pratik Chhatbar ◽  
Hernan Bayona ◽  
Gottfried Schlaug ◽  
Wayne Feng
Keyword(s):  
Correlation Coefficient ◽  
Stroke Rehabilitation ◽  
Pearson Correlation ◽  
Motor Impairment ◽  
Stroke Recovery ◽  
Imaging Biomarker ◽  
Correlation Pattern ◽  
Post Stroke ◽  
Feasibility Assessment ◽  
Recovery Study

Introduction: Recruitments of stroke recovery trials have been challenging. NIH stroke scale (NIHSS) has been universally collected in the acute stroke phase, but stroke recovery trials generally use Fugl-Meyer Motor Scale (FMMS) for outcome measure as well as patient selection criteria. The knowledge gap on the relationship between the two scales potentially jeopardize the accuracy of clinical trial recruitment feasibility survey that is based on NIHSS in the acute phase. We aimed to investigate the correlation between the two scales in a longitudinal stroke recovery study. Methods: This is a prospective cohort study (Prediction and Imaging biomarker of Post-stroke Motor Recovery) that enrolled patients with first-ever acute ischemic stroke with various degrees of motor impairment. NIHSS and FMMS were assessed 2-7 days after onset of stroke symptoms as well as at 90 days (± 15 days) post-stroke. Modified Rankin Scale (mRS), Stroke Impact Scale-16 (SIS-16) and Personal Health Questionnaire-9 (PHQ-9) were collected at 90 days (±15 days). Correlation analysis were conducted with Pearson Correlation coefficient. Results: 119 patients met the inclusion criteria and were included in the analysis. NIH Arm scales of 0, 1, 2, 3 and 4 correspond to FM-UE scales at 3 months of 61.1, 59.8, 58.0, 47.3 and 17.0. NIH leg scales of 1, 2, 3 and 4 correspond to FM_LE scales at 3 months of 32.4, 29.8, 27.8, 21.0 and 17.2. The correlation coefficient between of two leg scales is not as good as the two arm scales. (0.76 vs. 0.83). Similarly, mRS of 0, 1, 2, 3, 4 and 5 correspond to FMMS of 99.0, 91.6, 85.5, 51.6, 41.5, 21.6 and SIS-16 of 73.7, 69.6, 64.7, 55.1, 42.8, 25.3. Conclusions: Our data suggest that there is a strong correlation pattern between the NIH arm scale and FM-UE scale, NIH leg scale and FM-LE scale as well as mRS, FMMS, NIHSS and SIS-16. This information is potentially useful to inform the feasibility assessment for future stroke rehabilitation trials done through the NIH Stroke Trials Network.

Abstract 14: Effects of Lesion Laterality on Post-Stroke Motor Performance: An ENIGMA Stroke Recovery Analysis

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Sook-Lei Liew ◽  
Neda Jahanshad ◽  
Lisa Aziz-Zadeh ◽  
Niels Birbaumer ◽  
Michael Borich ◽  
...  
Keyword(s):  
Motor Performance ◽  
Statistical Significance ◽  
Motor Recovery ◽  
Small Sample ◽  
Stroke Recovery ◽  
Intracranial Volume ◽  
Brain Volumes ◽  
Post Stroke ◽  
Small Sample Sizes ◽  
Cortical Regions

The laterality of the lesioned hemisphere is often overlooked in stroke recovery research due to small sample sizes. Here, we used a well-powered dataset from ENIGMA Stroke Recovery (a consortium that harmonizes post-stroke MRIs and behavioral data worldwide; http://enigma.usc.edu) to analyze the effects of left (LHL) versus right (RHL) hemisphere lesions on motor performance. Given the different functional roles of each hemisphere, we hypothesized that the LHL group should show better motor performance, and, consequently, different brain-behavior relationships, compared to the RHL group. Data from over 2000 stroke patients across 20 sites worldwide has been committed. To date, structural T1-weighted MRIs from n=343 (10 sites) have been analyzed (LHL n=174; RHL n=169). ENIGMA protocols extracted volumes of subcortical regions of interest and provided quality control. Regression analyses examined brain volumes as predictors of motor outcomes. Motor scores were combined across scales/sites, with each score expressed as a percentage of the maximum score. Covariates (e.g., age, sex, intracranial volume) and manually marked lesion effects were also modeled. Statistical significance was assessed nonparametrically by permutation. As anticipated, the LHL group had better motor performance compared to the RHL group (t(1,341)=3.07, p=0.0023). In addition, while the combined LHL+RHL analyses showed significant associations between motor scores and volumes of the basal ganglia/lateral ventricles, separate group analyses showed strong associations for the LHL group, but only one association for the RHL group (Table 1). This may suggest that motor recovery following RH lesions is more heterogeneous or relies more on cortical regions/networks that were not assessed here. While further research is needed, these results suggest that laterality of the lesioned hemisphere affects neural patterns related to motor recovery and should be carefully examined.

scholarly journals Targeting GABAC Receptors Improves Post-Stroke Motor Recovery

2021 ◽  
Vol 11 (3) ◽  
pp. 315
Author(s):  
Petra S. van Nieuwenhuijzen ◽  
Kim Parker ◽  
Vivian Liao ◽  
Josh Houlton ◽  
Hye-Lim Kim ◽  
...  
Keyword(s):  
Infarct Size ◽  
Motor Function ◽  
Treatment Options ◽  
Motor Recovery ◽  
Stroke Recovery ◽  
Xenopus Laevis Oocytes ◽  
Reactive Astrogliosis ◽  
Delayed Treatment ◽  
Post Stroke ◽  
Gabac Receptors

Ischemic stroke remains a leading cause of disability worldwide, with limited treatment options available. This study investigates GABAC receptors as novel pharmacological targets for stroke recovery. The expression of ρ1 and ρ2 mRNA in mice were determined in peri-infarct tissue following photothrombotic motor cortex stroke. (R)-4-amino-cyclopent-1-enyl butylphosphinic acid (R)-4-ACPBPA and (S)-4-ACPBPA were assessed using 2-elecotrode voltage electrophysiology in Xenopus laevis oocytes. Stroke mice were treated for 4 weeks with either vehicle, the α5-selective negative allosteric modulator, L655,708, or the ρ1/2 antagonists, (R)-4-ACPBPA and (S)-4-ACPBPA respectively from 3 days post-stroke. Infarct size and expression levels of GAT3 and reactive astrogliosis were determined using histochemistry and immunohistochemistry respectively, and motor function was assessed using both the grid-walking and cylinder tasks. After stroke, significant increases in ρ1 and ρ2 mRNAs were observed on day 3, with ρ2 showing a further increase on day 7. (R)- and (S)-4-ACPBPA are both potent antagonists at ρ2 and only weak inhibitors of α5β2γ2 receptors. Treatment with either L655,708, (S)-4-ACPBPA (ρ1/2 antagonist; 5 mM only), or (R)-4-ACPBPA (ρ2 antagonist; 2.5 and 5 mM) from 3 days after stroke resulted in a significant improvement in motor recovery on the grid-walking task, with L655,708 and (R)-4-ACPBPA also showing an improvement in the cylinder task. Infarct size was unaffected, and only (R)-4-ACPBPA significantly increased peri-infarct GAT3 expression and decreased the level of reactive astrogliosis. Importantly, inhibiting GABAC receptors affords significant improvement in motor function after stroke. Targeting the ρ-subunit could provide a novel delayed treatment option for stroke recovery.

scholarly journals TMS-Induced Central Motor Conduction Time at the Non-Infarcted Hemisphere is Associated with Spontaneous Motor Recovery of the Paretic Upper Limb after Severe Stroke

2021 ◽  
Vol 11 (5) ◽  
pp. 648
Author(s):  
Maurits Hoonhorst ◽  
Rinske Nijland ◽  
Cornelis Emmelot ◽  
Boudewijn Kollen ◽  
Gert Kwakkel
Keyword(s):  
Ischemic Stroke ◽  
Upper Limb ◽  
Normative Data ◽  
Motor Impairment ◽  
Motor Recovery ◽  
Conduction Time ◽  
Stroke Patients ◽  
Severe Stroke ◽  
Central Motor Conduction Time ◽  
Post Stroke

Background: Stroke affects the neuronal networks of the non-infarcted hemisphere. The central motor conduction time (CMCT) induced by transcranial magnetic stimulation (TMS) could be used to determine the conduction time of the corticospinal tract of the non-infarcted hemisphere after a stroke. Objectives: Our primary aim was to demonstrate the existence of prolonged CMCT in the non-infarcted hemisphere, measured within the first 48 h when compared to normative data, and secondly, if the severity of motor impairment of the affected upper limb was significantly associated with prolonged CMCTs in the non-infarcted hemisphere when measured within the first 2 weeks post stroke. Methods: CMCT in the non-infarcted hemisphere was measured in 50 patients within 48 h and at 11 days after a first-ever ischemic stroke. Patients lacking significant spontaneous motor recovery, so-called non-recoverers, were defined as those who started below 18 points on the FM-UE and showed less than 6 points (10%) improvement within 6 months. Results: CMCT in the non-infarcted hemisphere was prolonged in 30/50 (60%) patients within 48 h and still in 24/49 (49%) patients at 11 days. Sustained prolonged CMCT in the non-infarcted hemisphere was significantly more frequent in non-recoverers following FM-UE. Conclusions: The current study suggests that CMCT in the non-infarcted hemisphere is significantly prolonged in 60% of severely affected, ischemic stroke patients when measured within the first 48 h post stroke. The likelihood of CMCT is significantly higher in non-recoverers when compared to those that show spontaneous motor recovery early post stroke.

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