Abstract 72: A Novel VLSM-CST Lesion Load Model is a Superior Predictor of Motor Outcomes of Acute Stroke Patients

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Jasmine Wang ◽  
Wayne Feng ◽  
Pratik Y Chhatbar ◽  
Gottfried Schlaug
Keyword(s):  
Acute Stroke ◽  
Motor Impairment ◽  
Motor Deficits ◽  
Precentral Gyrus ◽  
Stroke Patients ◽  
Lesion Load ◽  
Days Of Therapy ◽  
Motor Outcome ◽  
Motor Tracts ◽  
Best Fit

Introduction: Lesion load of the Corticospinal Tract (CST-LL) can predict 64% of the variance in 3-months outcome of acute stroke patients. Voxel-based lesion symptom mapping (VLSM) studies have revealed brain voxels associated with motor impairment. A combined VLSM- CST-LL approach may give particular weight to voxels that are both part of an impairment map and the descending motor tracts. Hypothesis: A combined VLSM-wCST-LL model can predict acute motor outcome better than weighted CST-LL alone. Methods: We derived the VLSM map from a group of 50 chronic patients with variable motor deficits relating voxels of patients’ lesions to Upper Extremity Fugl-Meyer (UE-FM) scores. A correction for multiple comparisons was applied at FDR<0.05. Resulting VLSM T-maps were multiplied using our probabilistic CST maps, and then summed to form a canonical VLSM-weighted CST tract. Individual lesion maps from 76 acute stroke patients were overlaid onto the VLSM-weighted CST map to calculate lesion load. Patients were assessed for motor impairment (UE-FM) at baseline and at 3 months. Linear regressions were fit for baseline UE-FM, wCST-LL, and Days-of-Therapy (DoT) to determine predictions of 3-months outcome. A multivariate regression was run using VSLM-weighted CST-LL, controlling for baseline UE-FM and DoT. Age was not a significant regressor. Akaike Information Criterion was run to select the best fit model. Results: The VLSM analysis determined that voxels of lesions in the precentral gyrus, premotor regions, the corona radiata region, and within the descending motor tracts were significantly related to chronic motor impairment. VLSM-CST-LL applied to a group of acute stroke patients with motor impairment predicted 85% of the variance at 3 months motor outcome. AIC results confirmed with 99% certainty that VLSM is the best fit model. Conclusions: VLSM-weighted CST-LL is the superior fit model compared to the weighted CST-LL model for predicting 3 months outcome.

Abstract 2856: Lesion load of Corticospinal Tract and Initial Motor Impairment in the Acute Stroke Phase Predict Motor Impairment 3 Months Post-Stroke

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Wuwei Feng ◽  
Jing Wang ◽  
Evgeny Sidorov ◽  
Christine Holmstedt ◽  
Christopher Doughty ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Stroke ◽  
Corticospinal Tract ◽  
Motor Impairment ◽  
Lesion Size ◽  
Sectional Area ◽  
Lesion Load ◽  
Cross Sectional ◽  
Post Stroke ◽  
Days Of Therapy

Background: We use lesion-mapping techniques in combination with diffusion tensor imaging to quantitatively test the hypothesis that motor impairment 3 months post- stroke is inversely related to the lesion load of the corticospinal tract (CST) in the acute stroke phase. Methods: We prospectively followed up a cohort of 32 patients who presented with their first-ever acute ischemic stroke with various degree of motor deficit , had a MRI during the hospitalization, and had follow-up motor assessments using the Fugl-Meyer Upper Extremity Scale (FM-UE) at 3 months (+/- 2 weeks) after stroke. We calculated a CST-lesion load for each patient by overlaying the patient’s lesion map from diffusion weighted image with a probabilistic DTI tract constructed from 12 age-matched healthy subjects . Both raw and weighted (which accounts for the narrowing of the CST as it descends from the motor cortex to the posterior limb of the internal capsule) were calculated; weighted lesion-loads were calculated by multiplying the lesion-tract overlap on each slice by the ratio of the maximum cross-sectional area of the tract to the cross-sectional area of the tract on that particular slice). A multiple regression is fit to assess the predicted value of CST lesion load (raw or weighted), along with other variables such age, gender, lesion size, initial impairment, days of therapy known to have an possible effect on motor outcome. Results: CST-lesion load and initial motor impairment are found to be significant predictors of upper extremity motor impairment at 3 months post-stroke. Age, gender, lesion size or days of therapy does not have predictive value in our cohort study. The adjusted R² is 0.63 with initial impairment and raw lesion load in the regression model, and is 0.66 with initial impairment and weighted lesion load. Conclusions: Our data shows the degree of motor impairment at 3 months after a first-ever ischemic stroke can be predicted by the overlap of the lesion with the canonical CST derived from age-matched healthy control subjects and the initial motor impairment measured in the acute phase.

Abstract 87: Neuroimaging, Not Clinical Assessment Predicts Post-Stroke Motor Outcome in Severely Impaired Stroke Patients

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Wuwei Feng ◽  
Jing Wang ◽  
Christopher Doughty ◽  
Christine Holmstedt ◽  
Gottfried Schlaug
Keyword(s):  
Clinical Assessment ◽  
Predictive Value ◽  
Motor Impairment ◽  
Stroke Patients ◽  
Lesion Load ◽  
Post Stroke ◽  
Motor Outcome ◽  
Severe Motor ◽  
Stroke Group ◽  
Severe Motor Impairment

Background: Initial motor impairment by clinical assessment and neuroimaging measures of corticospinal tract injury have been shown to predict 3-month motor outcome in mild-to-moderately impaired stroke patients. Clinical assessment alone is good to predict outcome of more severely impaired patients. This study aims to compare clinical assessment with neuroimaging in severely impaired patients. Methods: This study followed 27 first-ever ischemic stroke patients who presented with severe motor impairment at baseline( between 2- 5 days after stroke) which is defined as Upper Extremity Fugl-Meyer (UE-FM) Scale was <=5. Patients will be assessed at 3 months (90 ±14 days) again with UE_FM. A weighted CST lesion load (wCST-LL) was calculated by overlaying each patient’s lesion map on MRI with a probabilistic CST constructed from healthy subjects. A regression analysis was applied to assess the predictive value of wCST-LL and initial motor impairment. Results: Initial motor impairment has no predictive value (p=0.25, R 2 =0.05) while wCST-LL has a strong prediction (p=0.002, R 2 =0.31) for post-stroke motor outcome in this severely impaired stroke group. If wCST is more than 7 cc, no patient recovers more than 20 on UE_FM at 3 months. Conclusion: Compared with clinical assessment, a neuroimaging measure of CST injury excels in post-stroke motor outcome prediction in a severely impaired subgroup.

scholarly journals Eye Gaze Correlates of Motor Impairment in VR Observation of Motor Actions

2016 ◽  
Vol 55 (01) ◽  
pp. 79-83 ◽  
Author(s):  
A. Vourvopoulos ◽  
A. Bernardino ◽  
i Bermúdez Badia ◽  
J. Alves
Keyword(s):  
Virtual Reality ◽  
Smooth Pursuit ◽  
Healthy Subjects ◽  
Eye Gaze ◽  
Action Observation ◽  
Motor Impairment ◽  
Motor Deficits ◽  
Stroke Patients ◽  
Motor Actions ◽  
Healthy Participants

Summary Introduction: This article is part of the Focus Theme of Methods of Information in Medicine on “Methodologies, Models and Algorithms for Patients Rehabilitation”. Objective: Identify eye gaze correlates of motor impairment in a virtual reality motor observation task in a study with healthy participants and stroke patients. Methods: Participants consisted of a group of healthy subjects (N = 20) and a group of stroke survivors (N = 10). Both groups were required to observe a simple reach-and-grab and place-and-release task in a virtual environment. Additionally, healthy subjects were required to observe the task in a normal condition and a constrained movement condition. Eye movements were recorded during the observation task for later analysis. Results: For healthy participants, results showed differences in gaze metrics when comparing the normal and arm-constrained conditions. Differences in gaze metrics were also found when comparing dominant and non-dominant arm for saccades and smooth pursuit events. For stroke patients, results showed longer smooth pursuit segments in action observation when observing the paretic arm, thus providing evidence that the affected circuitry may be activated for eye gaze control during observation of the simulated motor action. Conclusions: This study suggests that neural motor circuits are involved, at multiple levels, in observation of motor actions displayed in a virtual reality environment. Thus, eye tracking combined with action observation tasks in a virtual reality display can be used to monitor motor deficits derived from stroke, and consequently can also be used for re -habilitation of stroke patients.

scholarly journals Is There Full or Proportional Somatosensory Recovery in the Upper Limb After Stroke? Investigating Behavioral Outcome and Neural Correlates

2018 ◽  
Vol 32 (8) ◽  
pp. 691-700 ◽  
Author(s):  
Leonardo Boccuni ◽  
Sarah Meyer ◽  
Simon S. Kessner ◽  
Nele De Bruyn ◽  
Bea Essers ◽  
...  
Keyword(s):  
Upper Limb ◽  
Significant Contribution ◽  
Motor Impairment ◽  
Neural Correlates ◽  
Somatosensory Processing ◽  
Resonance Imaging ◽  
Stroke Patients ◽  
Sensory Assessment ◽  
Lesion Load ◽  
Behavioral Outcome

Background. Proportional motor recovery in the upper limb has been investigated, indicating about 70% of the potential for recovery of motor impairment within the first months poststroke. Objective. To investigate whether the proportional recovery rule is applicable for upper-limb somatosensory impairment and to study underlying neural correlates of impairment and outcome at 6 months. Methods. A total of 32 patients were evaluated at 4 to 7 days and 6 months using the Erasmus MC modification of the revised Nottingham Sensory Assessment (NSA) for impairment of (1) somatosensory perception (exteroception) and (2) passive somatosensory processing (sharp/blunt discrimination and proprioception); (3) active somatosensory processing was evaluated using the stereognosis component of the NSA. Magnetic resonance imaging scans were obtained within 1 week poststroke, from which lesion load (LL) was calculated for key somatosensory tracts. Results. Somatosensory perception fully recovered within 6 months. Passive and active somatosensory processing showed proportional recovery of 86% (95% CI = 79%-93%) and 69% (95% CI = 49%-89%), respectively. Patients with somatosensory impairment at 4 to 7 days showed significantly greater thalamocortical and insulo-opercular tracts (TCT and IOT) LL ( P < .05) in comparison to patients without impairment. Sensorimotor tract disruption at 4 to 7 days did not provide significant contribution above somatosensory processing score at 4 to 7 days when predicting somatosensory processing outcome at 6 months. Conclusions. Our sample of stroke patients assessed early showed full somatosensory perception but proportional passive and active somatosensory processing recovery. Disruption of both the TCT and IOT early after stroke appears to be a factor associated with somatosensory impairment but not outcome.

scholarly journals Acute changes in diffusion tensor-derived metrics and its correlation with the motor outcome in gliomas adjacent to the corticospinal tract

2021 ◽  
Vol 12 ◽  
pp. 51
Author(s):  
Santiago Cepeda ◽  
Sergio García-García ◽  
Ignacio Arrese ◽  
María Velasco-Casares ◽  
Rosario Sarabia
Keyword(s):  
Corticospinal Tract ◽  
Diffusion Tensor ◽  
Premotor Cortex ◽  
Motor Impairment ◽  
Mean Diffusivity ◽  
Motor Deficits ◽  
Low Grade ◽  
Contralateral Hemisphere ◽  
Motor Outcome ◽  
Acute Changes

Background: This study involves analysis of the relationship between variables obtained using diffusion tensor imaging (DTI) and motor outcome in gliomas adjacent to the corticospinal tract (CST). Methods: Histologically confirmed glioma patients who were to undergo surgery between January 2018 and December 2019 were prospectively enrolled. All patients had a preoperative magnetic resonance imaging (MRI) study that included DTI, a tumor 2 cm or less from the CST, and postsurgical control within 48 h. Patients with MRI that was performed at other center, tumors with primary and premotor cortex invasion, postsurgical complications directly affecting motor outcome and tumor progression <6 months were excluded in the study. In pre- and post-surgical MRI, we measured the following DTI-derived metrics: fractional anisotropy (FA), mean diffusivity, axial diffusivity, and radial diffusivity of the entire CST and peritumoral CST regions and in the contralateral hemisphere. The motor outcome was assessed at 1, 3, and 6 months using the Medical Research Council scale. Results: Eleven patients were analyzed, and six corresponded to high-grade gliomas and five to low-grade gliomas. Four patients had previous motor impairment and seven patients had postsurgical motor deficits (four transient and three permanent). An FA ratio of 0.8 between peritumoral CST regions and the contralateral hemisphere was found to be the cutoff, and lower values were obtained in patients with permanent motor deficits. Conclusion: Quantitative analysis of DTI that was performed in the immediate postsurgery period can provide valuable information about the motor prognosis after surgery for gliomas near the CST.

scholarly journals Acupuncture for stroke: perceptions and possibilities

2020 ◽  
Vol 38 (3) ◽  
pp. 158-168
Author(s):  
Nicola Robinson ◽  
Tian Ye ◽  
Patricia Ronan ◽  
Pietro Emanuele Garbelli ◽  
David Smithard
Keyword(s):  
Acute Stroke ◽  
Motor Impairment ◽  
Stroke Care ◽  
Stroke Patients ◽  
Acute Stroke Care ◽  
Rehabilitation Care ◽  
Stakeholder Groups ◽  
The Uk ◽  
Insufficient Knowledge ◽  
Knowledge And Acceptance

Objective: To investigate perceptions and acceptability of, and attitudes towards, acupuncture for post-acute stroke and rehabilitation care by exploring the views of different stakeholders. Methods: Three electronic surveys were conducted to gauge the breadth of knowledge and acceptance of acupuncture in post-acute stroke and rehabilitation care among three stakeholder groups: (1) traditional acupuncturists registered with the British Acupuncture Council (BAcC); (2) National Health Service (NHS) professionals attending the 2017 UK Stroke Forum conference; and (3) the UK network of Stroke Club co-ordinators. Results: Of 278 NHS respondents, 31% were doctors. Over half (52%) of all NHS respondents reported they had insufficient knowledge about acupuncture, its effectiveness (23%) or how to refer (21%). Only 12% had previously referred stroke patients for acupuncture but 46% thought that there was role for acupuncture in post-acute stroke care (50% were unsure). Two thirds of BAcC acupuncturist respondents had treated at least one stroke patient, with 70.1% having treated 1–5 stroke patients and 71% having provided treatment in the last year, most commonly for motor impairment (88.2%). Of 99 Stroke Club coordinators who responded, only seven had ever been asked about acupuncture by patients, but most felt there would be interest. Conclusion: Interest in the provision of acupuncture for post-acute stroke care was expressed by both NHS practitioners and acupuncturists. Further research is required on the acceptability of acupuncture to patients as well as evidence of its clinical and cost effectiveness.

scholarly journals Motor improvement estimation and task adaptation for personalized robot-aided therapy: a feasibility study

2019 ◽  
Author(s):  
Christian Giang ◽  
Elvira Pirondini ◽  
Nawal Kinany ◽  
Camilla Pierella ◽  
Alessandro Panarese ◽  
...  
Keyword(s):  
Motor Impairment ◽  
Motor Deficits ◽  
Pilot Test ◽  
Stroke Patients ◽  
Rehabilitation Therapy ◽  
Model Based ◽  
Link Type ◽  
Upper Limb Exoskeleton ◽  
Subacute Stroke ◽  
Motor Improvement

AbstractBackgroundIn the past years, robotic systems have become increasingly popular in both upper and lower limb rehabilitation. Nevertheless, clinical studies have so far not been able to confirm superior efficacy of robotic therapy over conventional methods. The personalization of robot-aided therapy according to the patients’ individual motor deficits has been suggested as a pivotal step to improve the clinical outcome of such approaches.MethodsHere, we present a model-based approach to personalize robot-aided rehabilitation therapy within training sessions. The proposed method combines the information from different motor performance measures recorded from the robot to continuously estimate patients’ motor improvement for a series of point-to-point reaching movements in different directions and comprises a personalization routine to automatically adapt the rehabilitation training. We engineered our approach using an upper limb exoskeleton and tested it with seventeen healthy subjects, who underwent a motor-adaptation paradigm, and two subacute stroke patients, exhibiting different degrees of motor impairment, who participated in a pilot test.ResultsThe experiments illustrated the model’s capability to differentiate distinct motor improvement progressions among subjects and subtasks. The model suggested personalized training schedules based on motor improvement estimations for each movement in different directions. Patients’ motor performances were retained when training movements were reintroduced at a later stage.ConclusionsOur results demonstrated the feasibility of the proposed model-based approach for the personalization of robot-aided rehabilitation therapy. The pilot test with two subacute stroke patients further supported our approach, while providing auspicious results for the applicability in clinical settings.Trial registrationThis study is registered in ClinicalTrials.gov (NCT02770300, registered 30 March 2016, https://clinicaltrials.gov/ct2/show/NCT02770300).

scholarly journals Neuromotor Prosthetic to Treat Stroke-Related Paresis

2021 ◽  
Author(s):  
Mijail D. Serruya ◽  
Alessandro Napoli ◽  
Nicholas Satterthwaite ◽  
Joseph Kardine ◽  
Joseph McCoy ◽  
...  
Keyword(s):  
Therapeutic Potential ◽  
Motor Impairment ◽  
Arm Movement ◽  
Myoelectric Control ◽  
Voluntary Control ◽  
Motor Deficits ◽  
Precentral Gyrus ◽  
Home Setting ◽  
Hemiparetic Stroke ◽  
Hand Opening

AbstractBackgroundFunctional recovery of independent arm movement typically plateaus within six months following a stroke, leaving chronic motor deficits. This feasibility study tested whether a wearable, powered exoskeletal orthosis, driven by a percutaneous, implanted brain–computer interface (BCI), using the activity of neurons in the precentral gyrus in the affected cortical hemisphere, could restore voluntary upper extremity function in a person with chronic hemiparetic subsequent to a cerebral hemispheric stroke of subcortical gray and white matter and cortical gray matter.MethodsOne person with chronic hemiparetic stroke with upper-limb motor impairment used a powered elbow-wrist-hand orthosis that opened and closed the affected hand using cortical activity, recorded from four 64-channel microelectrode arrays implanted in the ipsilesional precentral gyrus, based on decoding of spiking patterns and high frequency field potentials generated by imagined hand movements using technology and decoding methods used for people with other causes of paralysis. The system was evaluated in a home setting daily for 12 weeks.ResultsRobust single unit activity, modulating with attempted or imagined movement, was present throughout the precentral gyrus areas. The participant was able to acquire voluntary control over a hand-orthosis BCI, with a score of 10 points on the Action Research Arm Test (out of 53) using the BCI, compared to 0 without any device, and 5 using myoelectric control. Orthosis-powered hand-opening was faster with BCI control compared to myoelectric control, on a standardized object-movement task.ConclusionsThe findings demonstrate the therapeutic potential of an implantable BCI system coupled to a brace to “electrically bypass” the stroke and promote neurally driven limb function. The participant’s ability to rapidly acquire voluntary control over otherwise paralyzed hand opening, more than 18 months after a subcortical stroke, lays the foundation for a fully implanted movement restoration system.

EFFECT OF ACTION OBSERVATION THERAPY ON IMPROVING UPPER LIMB FUNCTIONS IN ACUTE STROKE PATIENTS: AN EXPERIMENTAL STUDY

2021 ◽  
pp. 33-36
Author(s):  
Sudha Desale
Keyword(s):  
Acute Stroke ◽  
Upper Limb ◽  
Action Observation ◽  
Motor Impairment ◽  
Motor Recovery ◽  
P Value ◽  
Daily Routine ◽  
Motor Sequence ◽  
Stroke Patients ◽  
Observation Training

BACKGROUND & PURPOSE: The most common disabling motor decit following stroke is the loss of upper limb function. 5-20% of patients presenting an upper limb paralysis at onset may improve the motor impairment overtime. Action observation training is a novel rehabilitation approach exploiting this mirror mechanism and its potential role in motor learning for motor recovery. Aim of this study was to examine the effects of action observation therapy on upper limb functions in acute stroke patients. METHODOLOGY: Stroke survivors (N= 50) were consecutively recruited 22 days (±5) after a rst-ever stroke and participants watched video footage of daily routine tasks (actions). Each action based on some relevant ADLs motor sequence display in order of ascending difculty and lasting for 3 minutes and therapist prompted the patient to perform the same movement for 2 minutes. At the end of each sequence, patients were given conventional physiotherapy and AOT 1 hour daily for 5 days/week for 4 weeks. RESULTS: Upper Limb part of FMA, Modied Ashworth Scale scores & nine-hole peg test were taken at baseline and after 4 weeks as outcome measure. Paired 't' test and Wilcoxon's signed-rank has been used for analysis of Fugl Meyer scale, Modied Ashwarth Scale and Nine-hole peg pre and post treatment scores respectively (p value<0.05) So, a statistically signicant difference was found after treatment for all variables. CONCLUSION: The nding of this study is suggesting that Action observation training programs contribute to improve motor recovery in acute stroke patients.

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