scholarly journals Chronic stroke sensorimotor impairment is related to smaller hippocampal volumes: An ENIGMA analysis

2021 ◽  
Author(s):  
Artemis Zavaliangos-Petropulu ◽  
Bethany Lo ◽  
Miranda R Donnelly ◽  
Nicolas Schweighofer ◽  
Keith Lohse ◽  
...  
Keyword(s):  
Upper Limb ◽  
Hippocampal Volume ◽  
Chronic Stroke ◽  
Stroke Recovery ◽  
Lesion Volume ◽  
Supporting Evidence ◽  
Cross Sectional ◽  
Secondary Degeneration ◽  
Post Stroke ◽  
Sensorimotor Impairment

Persistent sensorimotor impairments after stroke can negatively impact quality of life. The hippocampus is involved in sensorimotor behavior but has not been widely studied within the context of post-stroke upper limb sensorimotor impairment. The hippocampus is vulnerable to secondary degeneration after stroke, and damage to this region could further weaken sensorimotor circuits, leading to greater chronic sensorimotor impairment. The purpose of this study was to investigate the cross-sectional association between non-lesioned hippocampal volume and upper limb sensorimotor impairment in people with chronic stroke. We hypothesized that smaller ipsilesional hippocampal volumes would be associated with worse upper-limb sensorimotor impairment. Cross-sectional T1-weighted brain MRIs were pooled from 357 participants at the chronic stage after stroke (>180 days post-stroke) compiled from 18 research cohorts worldwide in the ENIGMA Stroke Recovery Working Group (age: median = 61 years, interquartile range = 18, range = 23-93; 135 women and 222 men). Sensorimotor impairment was estimated from the Fugl-Meyer Assessment of Upper Extremity scores. Robust mixed-effects linear models were used to test associations between post-stroke sensorimotor impairment and hippocampal volumes (ipsilesional and contralesional separately; Bonferroni-corrected, p-value < 0.025), controlling for age, sex, lesion volume, and lesioned hemisphere. We also performed an exploratory analysis to test whether sex differences influence the relationship between sensorimotor impairment and hippocampal volume. Upper limb sensorimotor impairment was positively associated with ipsilesional (p = 0.005; d = 0.33) but not contralesional (p = 0.96; d = 0.01) hippocampal volume, such that impairment was worse for participants with smaller ipsilesional hippocampal volume. This association remained significant independent of lesion volume or other covariates (p = 0.001; d = 0.36). Evidence indicates an interaction between sensorimotor impairment and sex for both ipsilesional (p = 0.008; d = -0.29) and contralesional (p = 0.006; d = -0.30) hippocampal volumes, whereby women showed progressively worsening sensorimotor impairment with smaller hippocampal volumes compared to men. The present study has identified a novel association between chronic post-stroke sensorimotor impairment and ipsilesional, but not contralesional, hippocampal volume. This finding was not due to lesion size and may be stronger in women. We also provide supporting evidence that smaller hippocampal volume post-stroke is likely a consequence of ipsilesional damage, which could provide a link between vascular disease and other disorders, such as dementia.

Effects of proximal and distal robot-assisted upper limb rehabilitation on chronic stroke recovery

2013 ◽  
Vol 33 (1) ◽  
pp. 33-39 ◽  
Author(s):  
Stefano Mazzoleni ◽  
Patrizio Sale ◽  
Marco Franceschini ◽  
Samuele Bigazzi ◽  
Maria Chiara Carrozza ◽  
...  
Keyword(s):  
Upper Limb ◽  
Chronic Stroke ◽  
Stroke Recovery ◽  
Robot Assisted ◽  
Upper Limb Rehabilitation ◽  
Limb Rehabilitation

Abstract 100: A Simple Bedside Grading Scale Can Effectively Predict Severe Post-stroke Upper-extremity Spasticity

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Hernan F Bayona ◽  
Pratik Y Chhatbar ◽  
Gottfried Schlaug ◽  
Wayne Feng
Keyword(s):  
Upper Limb ◽  
Assessment Tool ◽  
Infarct Volume ◽  
Imaging Biomarker ◽  
Lesion Volume ◽  
Post Stroke ◽  
Severe Spasticity ◽  
Limb Spasticity ◽  
Grading Scale ◽  
Simple Bedside

Introduction: Upper-limb spasticity is a very disabling complication after stroke. There has been no simple clinical standard scale to predict spasticity immediately after stroke. This study aims to develop a simple bedside grading scale with the information collected during the acute phase to predict spasticity at 3 month post-stroke Methods: This is a prospective cohort study (Prediction and Imaging Biomarker of Post-stroke Motor Recovery) of patients with first-ever acute ischemic stroke with various degrees of motor impairment. NIH stroke scale (NIHSS) was assessed 2-7 days after onset of stroke symptoms. Modified Ashworth Spasticity Scale was used as an assessment tool in biceps, wrist flexors and finger flexors at 90 days (± 15 days) and score ≥2 at any muscle was considered as severe spasticity. Infarction volume was measured based on the lesion on MRI/DWI. Independent predictors of upper-limb spasticity at 90 days were identified by multivariate logistic regression. A risk stratification scale was developed with weighting independent predictors based on beta coefficient. Results: One hundred twenty three patients were recruited for this study. Covariates associated with upper-limb spasticity are NIHSS arm score (p<0.0001), sub-cortical location (p=0.004) and lesion volume >65 cc (p=0.025). The proposed grading scale is summation of individual points as followed: NIHSS Arm Score: =4 (2 point), <4 (0 point); infarct location: sub-cortical (1 point), non sub-cortical (0 point); infarct volume: ≥65 cc (1 point), <65cc (0 point). The rates of severe upper limb spasticity for the bedside spasticity scale, in order 0-4, are 8.9%, 29.2%, 65%, 88.7%, 96.2%. In other words, the likelihood of developing severe spasticity increases steadily using the score. Conclusion: A simple bedside grading scale can effectively predict severe post-stroke upper-limb spasticity at 90 days. Validation with an independent external dataset is a planned next step.

scholarly journals β-Oscillations Reflect Recovery of the Paretic Upper Limb in Subacute Stroke

2020 ◽  
Vol 34 (5) ◽  
pp. 450-462 ◽  
Author(s):  
Chih-Wei Tang ◽  
Fu-Jung Hsiao ◽  
Po-Lei Lee ◽  
Yun-An Tsai ◽  
Ya-Fang Hsu ◽  
...  
Keyword(s):  
Motor Function ◽  
Upper Limb ◽  
Primary Motor Cortex ◽  
Hand Movement ◽  
Stroke Recovery ◽  
Stroke Survivors ◽  
Healthy Controls ◽  
Functional Changes ◽  
Post Stroke ◽  
Subacute Stroke

Background. Recovery of upper limb function post-stroke can be partly predicted by initial motor function, but the mechanisms underpinning these improvements have yet to be determined. Here, we sought to identify neural correlates of post-stroke recovery using longitudinal magnetoencephalography (MEG) assessments in subacute stroke survivors. Methods. First-ever, subcortical ischemic stroke survivors with unilateral mild to moderate hand paresis were evaluated at 3, 5, and 12 weeks after stroke using a finger-lifting task in the MEG. Cortical activity patterns in the β-band (16-30 Hz) were compared with matched healthy controls. Results. All stroke survivors (n=22; 17 males) had improvements in action research arm test (ARAT) and Fugl-Meyer upper extremity (FM-UE) scores between 3 and 12 weeks. At 3 weeks post-stroke the peak amplitudes of the movement-related ipsilesional β-band event-related desynchronization (β-ERD) and synchronization (β-ERS) in primary motor cortex (M1) were significantly lower than the healthy controls (p<0.001) and were correlated with both the FM-UE and ARAT scores (r=0.51-0.69, p<0.017). The decreased β-ERS peak amplitudes were observed both in paretic and non-paretic hand movement particularly at 3 weeks post-stroke, suggesting a generalized disinhibition status. The peak amplitudes of ipsilesional β-ERS at week 3 post-stroke correlated with the FM-UE score at 12 weeks (r=0.54, p=0.03) but no longer significant when controlling for the FM-UE score at 3 weeks post-stroke. Conclusions. Although early β-band activity does not independently predict outcome at 3 months after stroke, it mirrors functional changes, giving a potential insight into the mechanisms underpinning recovery of motor function in subacute stroke.

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 The Comparison Of Relationship Of Depression,Cognitive,Motor And Functional Deficities In Chronic Stroke Patients (A Pilot Study)

2017 ◽  
pp. 28
Author(s):  
Amin Ghaffari ◽  
Malahat Akbarfahimi ◽  
Bijan Forough
Keyword(s):  
Pilot Study ◽  
Activities Of Daily Living ◽  
Verbal Memory ◽  
Daily Living ◽  
Cognitive Rehabilitation ◽  
Cross Sectional Study ◽  
Chronic Stroke ◽  
Cross Sectional ◽  
Post Stroke ◽  
Post Stroke Depression

Aim and background: One of the most important psychological disorders that arise after a stroke for people with subsequent depression, which leads to reduced quality of life, optimal rehabilitation failure, loss of cognitive tasks and decrease the recovery process.In this study communication patterns of depression with cognitive, motor and function deficites in people with chronic stroke has been studied.Methods and materials: it is a pilot study of cross-sectional study, 40 patients with chronic stroke (more than 6 months) selected sampling method. depression (Beck Depression Inventory), cognition (attention test TMT-A & B and Wechsler memory), motor (Motorcity index), basic activities of daily living (Barthel scale) and instrumental activities of daily living (Lawton scale) were evaluated.Results: The results of the study revealed a significant positive correlation between post stroke depression with verbal memory(r=./386 ،P<./05), attention(r=./549 ،P<./05), motor status(r=./550 ،P<./05) and independence in activities of daily living(r=./653 ،P<./05)Conclusion: According to the findings, the study of factors affecting  post stroke depression(PSD) clinical and practical aspects are necessary. Cognitive rehabilitation programs with motor rehabilitation can reduce depression in patients with stroke in the direction of independence in activities of daily living and greater participation in society .    

scholarly journals Construct Validity of the Upper-Limb Interlimb Coordination Test in Stroke

2021 ◽  
pp. 154596832110580
Author(s):  
Roni Molad ◽  
Mindy F. Levin
Keyword(s):  
Construct Validity ◽  
Upper Limb ◽  
Cross Correlation ◽  
Functional Limitations ◽  
Correlation Coefficients ◽  
Interlimb Coordination ◽  
Chronic Stroke ◽  
Secondary Outcome ◽  
Cross Sectional ◽  
Coordination Test

Background Coordination impairments are under-evaluated in patients with stroke due to the lack of validated assessments resulting in an unclear relationship between coordination deficits and functional limitations. Objective Determine the construct validity of the new clinical upper-limb (UL) Interlimb Coordination test (ILC2) in individuals with chronic stroke. Methods Thirteen individuals with stroke, ≥40 years, with ≥30° isolated supination of the more-affected (MAff) arm, who could understand instructions and 13 healthy controls of similar age participated in a cross-sectional study. Participants performed synchronous bilateral anti-phase forearm rotations for 10 seconds in 4 conditions: self-paced internally-paced (IP1), fast internally-paced (IP2), slow externally-paced (EP1), and fast externally-paced (EP2). Primary (continuous relative phase-CRP, cross-correlation, lag) and secondary outcome measures (UL and trunk kinematics) were compared between groups. Results Participants with stroke made slower UL movements than controls in all conditions, except EP1. Cross-correlation coefficients were lower (i.e., closer to 0) in stroke in IP1, but CRP and lag were similar between groups. In IP1 and matched-speed conditions (IP1 for healthy and IP2 for stroke), stroke participants used compensatory trunk and shoulder movements. The synchronicity sub-scale and total scores of ILC2 were related to temporal coordination in IP2. Interlimb Coordination test total score was related to greater shoulder rotation of the MAff arm. Interlimb Coordination test scores were not related to clinical scores. Conclusion Interlimb Coordination test is a valid clinical measure that may be used to objectively assess UL interlimb coordination in individuals with chronic stroke. Further reliability testing is needed to determine the clinical utility of the scale.

scholarly journals A Comparison of the Relation of Depression, and Cognitive, Motor and Functional Deficits in Chronic Stroke Patients: A Pilot Study

2017 ◽  
Vol 5 (4) ◽  
pp. 1
Author(s):  
Amin Ghaffari ◽  
Malahat Akbarfahimi ◽  
Bijan Forough
Keyword(s):  
Activities Of Daily Living ◽  
Verbal Memory ◽  
Daily Living ◽  
Cognitive Rehabilitation ◽  
Recovery Process ◽  
Chronic Stroke ◽  
Cross Sectional ◽  
Post Stroke ◽  
Instrumental Activities ◽  
Post Stroke Depression

Aim and background: One of the most important psychological disorders after stroke is depression, which leads to reduced quality of life, optimal rehabilitation failure, loss of cognitive tasks and decrease in the recovery process. In this research, relation between patterns of depression and cognitive, motor and function deficits in people with chronic stroke was studied. Methods and materials: In a pilot cross-sectional study, 40 patients with chronic stroke (more than 6 months) were enrolled. Depression (Beck Depression Inventory), cognition (attention test TMT-A & B and Wechsler memory), motor (Motorcity index), basic activities of daily living (Barthel scale) and instrumental activities of daily living (Lawton scale) were evaluated. Results: The results of the study revealed a significant positive correlation between post stroke depression and verbal memory (r=0.440،P<.05), attention (r=0.615،P<.05), motor function(r-0.368،P<.05), independence in basic activities of daily living (r=0.781،P<.05) and instrumental activities of daily living (r=0.741, P<.05). Conclusion: According to the findings, further studies of factors affecting post stroke depression (PSD) clinical and practical aspects are necessary. Cognitive rehabilitation programs with motor rehabilitation can decrease depression and gain independence in activities of daily living and more participation in society activities.

scholarly journals 4047 EEG as a Predictor of Post-Stroke Recovery: A Systematic Review and Meta-Analysis

2020 ◽  
Vol 4 (s1) ◽  
pp. 71-71
Author(s):  
Amanda Vatinno ◽  
Viswanathan Ramakrishnan ◽  
Annie Simpson ◽  
Heather Bonilha ◽  
Na Jin Seo
Keyword(s):  
Systematic Review ◽  
Clinical Outcome ◽  
Outcome Measure ◽  
Meta Analysis ◽  
Stroke Recovery ◽  
Lesion Volume ◽  
Behavioral Impairment ◽  
Post Stroke ◽  
Prognostic Accuracy ◽  
Clinical Outcome Measure

OBJECTIVES/GOALS: The objective of this study is to perform a systematic review and meta-analysis on the prognostic utility of electroencephalography (EEG) in stroke recovery. METHODS/STUDY POPULATION: A literature search was conducted using three electronic databases, including PubMed, Scopus, and CINAHL. Key search terms were “EEG,” “stroke,” and “rehabilitation”. Only peer-reviewed journal articles published in English that examined the relationship between EEG and a standardized clinical outcome measure(s) at a later time in stroke patients were included. Two independent raters completed data extraction and assessed methodological quality of the studies with the Downs and Black form. A linear meta-regression was performed across subsets of individual studies that utilized a common clinical outcome measure to determine the association between EEG and clinical outcome while adjusting for sample size and study quality. RESULTS/ANTICIPATED RESULTS: 56 papers met the inclusion criteria and were included in the systematic review. The prognostic value of EEG was evidenced at both the acute and chronic stages of stroke. The addition of EEG enhanced prognostic accuracy more than initial clinical assessment scores and/or lesion volume alone. In the meta-analysis, a subset of 10 papers that utilized the National Institutes of Health Stroke Scale (NIHSS) and a subset of 7 papers that utilized the Modified Rankin Scale (MRS) were included. Analysis demonstrated an association between EEG and the subsequent clinical outcome measures. DISCUSSION/SIGNIFICANCE OF IMPACT: Currently, prognosis is largely based on initial behavioral impairment level. However, post-stroke recovery outcomes are heterogeneous despite similar initial clinical presentations. Uncertain prognosis makes it difficult for clinicians to develop personalized treatment plans for patients. Improved prognosis for recovery may guide clinical management for stroke survivors by helping clinicians determine the maximally efficient course of treatment and care. This study suggests that prognostic accuracy may be enhanced using EEG.

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