Abstract 13: Corticospinal Tract Injury Estimated From Acute Stroke Imaging Predicts Upper Extremity Motor Recovery After Stroke

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
David J Lin ◽  
Alison M Cloutier ◽  
Kimberly S Erler ◽  
Jessica M Cassidy ◽  
Samuel B Snider ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Upper Extremity ◽  
Corticospinal Tract ◽  
Standard Of Care ◽  
Major Effect ◽  
Motor Recovery ◽  
Post Stroke ◽  
Stroke Imaging ◽  
Recovery Potential ◽  
Structural Injury

Introduction: Injury to the corticospinal tract (CST) has been shown to have a major effect on upper extremity motor recovery after stroke. This study aimed to examine how well CST injury, measured from neuroimaging acquired during the acute stroke workup, predicts upper extremity motor recovery. Methods: Patients (N = 48) with upper extremity weakness after ischemic stroke were assessed using the upper extremity Fugl-Meyer (FM) during the acute stroke hospitalization and again at 3-month follow-up. CST injury was quantified and compared, using four different methods, from images obtained as part of the stroke standard-of-care workup. Logistic and linear regression were performed using CST injury to predict delta FM. Injury to primary motor and premotor cortices were included as potential modifiers of the effect of CST injury on recovery. Results: 48 patients were enrolled 4.2 ± 2.7 days post-stroke and completed this study. CST injury distinguished patients who reached their recovery potential (as predicted from initial impairment) from those who did not, with AUC values ranging from 0.75 to 0.8. In addition, CST injury explained ~20% of the variance in the magnitude of upper extremity recovery, even after controlling for the severity of initial impairment. Results were consistent when comparing four different methods of measuring CST injury. Extent of injury to primary motor and premotor cortices did not significantly influence the predictive value that CST injury had for recovery. Conclusions: Structural injury to the CST, as estimated from standard-of-care imaging available during the acute stroke hospitalization, is a robust way to distinguish patients who achieve their predicted recovery potential and explains a significant amount of the variance in post-stroke upper extremity motor recovery.

scholarly journals Corticospinal Tract Injury Estimated From Acute Stroke Imaging Predicts Upper Extremity Motor Recovery After Stroke

Stroke ◽  
2019 ◽  
Vol 50 (12) ◽  
pp. 3569-3577 ◽  
Author(s):  
David J. Lin ◽  
Alison M. Cloutier ◽  
Kimberly S. Erler ◽  
Jessica M. Cassidy ◽  
Samuel B. Snider ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Upper Extremity ◽  
Corticospinal Tract ◽  
Area Under The Curve ◽  
Standard Of Care ◽  
Major Effect ◽  
Motor Recovery ◽  
Stroke Imaging ◽  
Recovery Potential

Background and Purpose— Injury to the corticospinal tract (CST) has been shown to have a major effect on upper extremity motor recovery after stroke. This study aimed to examine how well CST injury, measured from neuroimaging acquired during the acute stroke workup, predicts upper extremity motor recovery. Methods— Patients with upper extremity weakness after ischemic stroke were assessed using the upper extremity Fugl-Meyer during the acute stroke hospitalization and again at 3-month follow-up. CST injury was quantified and compared, using 4 different methods, from images obtained as part of the stroke standard-of-care workup. Logistic and linear regression were performed using CST injury to predict ΔFugl-Meyer. Injury to primary motor and premotor cortices were included as potential modifiers of the effect of CST injury on recovery. Results— N=48 patients were enrolled 4.2±2.7 days poststroke and completed 3-month follow-up (median 90-day modified Rankin Scale score, 3; interquartile range, 1.5). CST injury distinguished patients who reached their recovery potential (as predicted from initial impairment) from those who did not, with area under the curve values ranging from 0.70 to 0.8. In addition, CST injury explained ≈20% of the variance in the magnitude of upper extremity recovery, even after controlling for the severity of initial impairment. Results were consistent when comparing 4 different methods of measuring CST injury. Extent of injury to primary motor and premotor cortices did not significantly influence the predictive value that CST injury had for recovery. Conclusions— Structural injury to the CST, as estimated from standard-of-care imaging available during the acute stroke hospitalization, is a robust way to distinguish patients who achieve their predicted recovery potential and explains a significant amount of the variance in poststroke upper extremity motor recovery.

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 TMP31: Peripheral Nerve Stimulation Paired with Constraint-Induced Therapy to Enhance Post-Stroke Upper Extremity Motor Performance

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Cheryl Carrico ◽  
KC Chelette ◽  
Laurie Nichols ◽  
Lumy Sawaki
Keyword(s):  
Peripheral Nerve ◽  
Upper Extremity ◽  
Motor Function ◽  
Nerve Stimulation ◽  
Motor Performance ◽  
Motor Recovery ◽  
Peripheral Nerve Stimulation ◽  
Motor Deficit ◽  
Motor Training ◽  
Post Stroke

Research has shown that peripheral nerve stimulation (PNS) can enhance motor learning following cortical lesions. Studies have also shown that intensive upper extremity motor training can significantly enhance post-stroke motor performance. Constraint-induced therapy (CIT) is a form of intensive training that restricts use of the non-paretic upper extremity during repetitive, task-oriented motor training of the paretic extremity. Extensive evidence has validated the effectiveness of CIT for enhancing post-stroke upper extremity motor recovery. No studies have evaluated how PNS may modulate the effects of CIT. Therefore, we conducted a pilot study of PNS paired with CIT and hypothesized that in subjects with stroke, pairing CIT with active PNS would lead to significantly more improved motor function in the paretic upper extremity than CIT paired with sham PNS. Outcome measures included the Fugl-Meyer Assessment Scale (FMA; primary outcome measure), the Wolf Motor Function Test (WMFT), and the Action Research Arm Test (ARAT). Nineteen chronic stroke subjects with mild to moderate upper extremity motor deficit received 2 hours of either active (n=10) or sham (n=9) PNS preceding 4 hours of CIT for 10 consecutive weekdays. Changes in FMA, WMFT, and ARAT were analyzed using factorial ANOVA. Results showed significant (p<0.05) change in all measures at completion evaluation compared with baseline (FMA (p=0.005); WMFT (p=0.030); ARAT (p=0.020)) as well as 1-month follow-up compared with baseline (FMA (p=0.048); WMFT (p=0.045); ARAT (p=0.047)). These results highlight the enormous potential for PNS paired with CIT to enhance post-stroke upper extremity motor recovery more effectively than CIT alone.

Establishing Criterion Validity for the Functional Upper-Extremity Levels (FUEL) in Comparison to the Fugl-Meyer To Classify Functional Motor Recovery in the Acute Stroke Population

2019 ◽  
Vol 73 (4_Supplement_1) ◽  
pp. 7311500012p1
Author(s):  
Rachel Feld-Glazman ◽  
Lisa Spinelli ◽  
Ashley Foley ◽  
Daniel Geller ◽  
Steve Van Lew ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Upper Extremity ◽  
Criterion Validity ◽  
Motor Recovery ◽  
Stroke Population

Abstract P219: Somatosensory Impairments at Baseline Limit Motor Recovery in Stroke Survivors Using a BCI

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Alexander B Remsik ◽  
Shawna Gloe ◽  
Leroy Williams ◽  
PETER L VAN KAN ◽  
Veena A Nair ◽  
...  
Keyword(s):  
Upper Extremity ◽  
Brain Injuries ◽  
Somatosensory System ◽  
Motor Recovery ◽  
Stroke Survivors ◽  
Motor Rehabilitation ◽  
Recovery Potential ◽  
System Integrity ◽  
Upper Extremity Rehabilitation

Objective: This study is part of a clinical trial designed to test the efficacy of an EEG-based BCI intervention for upper extremity motor rehabilitation in stroke survivors. The analyses presented here focus on the effectiveness of BCI intervention as a function of somatosensory integrity. Introduction: Human motor control requires integration of sensory and motor signals in the generation of motor commands. Stroke lesions often result in sensorimotor impairments and survivors may require rehabilitation to regain motor function and capacity. Stroke affects individuals differentially, based on a range of factors, including, but not limited to, lesion location and volume. Such factors may restrain recovery potential. Hypothesis: We tested the hypothesis that stroke survivors with measurable somatosensory impairments realize the same amount of motor recovery as those participants without somatosensory impairments. Methods: N= 23 stroke survivors participated in up to 30 hours of BCI intervention (13.8 ±1.3, mean + SD) for upper extremity rehabilitation, as measured by the ARAT. Participants were grouped post-hoc on presence or absence of somatosensory impairments, as measured by the NIHSS subdomains of Sensory (i.e. cutaneous), and Motor Arm (i.e. proprioceptive) and their group means compared. Results: The hypothesis was not confirmed. Mean ARAT scores at completion and follow up differed between groups (Cutaneous loss: ARAT mean change at completion: 0.9 ± 2.23, p= 0.234; ARAT mean change at follow-up: 1.20 ± 2.860, p = 0.217), (No Cutaneous loss: ARAT mean change at completion: 2.15 ± 6.34, p= 0.244; ARAT mean change at follow-up: 4.39 ± 6.41, p= 0.0297) (Proprioceptive loss: ARAT mean change at completion: 0.867 ± 3.66, p= 0.375, ARAT mean change at follow-up: 2.47 ± 5.38, p= 0.097), (No Proprioceptive loss: ARAT mean change at completion: 3 ± 6.80, p= 0.252, ARAT mean change at follow-up: 4 ± 5.42, p= 0.075). Conclusions: These results suggest that BCI intervention is more effective at delivering motor improvements in participants with less somatosensory impairments. These results are consistent with the view that somatosensory system integrity may be key to BCI motor rehabilitation of brain injuries following stroke.

The Effectiveness of Mirror Therapy to Upper Extremity Rehabilitation in Acute Stroke Patients

2021 ◽  
Author(s):  
Phassakorn Klinkwan ◽  
Chalunda Kongmaroeng ◽  
Sombat Muengtaweepongsa ◽  
Wiroj Limtrakarn
Keyword(s):  
Acute Stroke ◽  
Upper Extremity ◽  
Upper Limb ◽  
Conventional Therapy ◽  
Motor Recovery ◽  
Stroke Recovery ◽  
Home Exercise ◽  
Control Group ◽  
Mirror Therapy ◽  
Stroke Patients

Rehabilitation is a crucial part of stroke recovery to help them regain use of their limb. The aim of this article was to compare the effectiveness of long-term training of mirror therapy with conventional rehabilitation therapy on neurological and recovery of upper limb in acute stroke patients. In this randomized and assessor-blinded control study, 20 acute stroke patients were analyzed in this study and allocated to a case (n = 10, 50.6 ± 17.90 years) and control group (n = 10, 55.9 ± 11.25 years). All the participants performed daily home exercise during 12 weeks. The patients in the control group were treated with conventional therapy (CT) and a group of cases were treated with mirror therapy (MT) alone program. The outcome measurements were assessed by a therapist blinded assessor using Fugl-Meyer Assessment (FMA) upper extremity score, Brunnstrom recovery stages (BRS), Modified Ashworth Scale (MAS) and Muscle Strength to evaluate upper limb motor function and motor recovery. Data were analyzed using Wilcoxon and Mann-Whitney U tests to compare within-groups and between-group differences. The results revealed that, after 12 weeks of treatment, patients of both groups presented statistically significant improvements in all the variables measured (p < 0.05). Compared with the control group, the patients of the MT group had greater improvement in the proximal movement portion of the FMA upper extremity mean score change (15.8 ± 3.2 versus 10.0 ± 2.7, p = 0.002) while there were no differences in other variables (p > 0.05). There were also no adverse events. It suggests that 12 weeks training of mirror therapy alone was likely to improve the motor recovery of the upper limb and activity of daily living in acute stroke patients than conventional therapy, if treated early.

scholarly journals Does Measurement of Corticospinal Tract Involvement Add Value to Clinical Behavioral Biomarkers in Predicting Motor Recovery after Stroke?

2020 ◽  
Vol 2020 ◽  
pp. 1-10
Author(s):  
Jong Youb Lim ◽  
Mi-Kyoung Oh ◽  
Jihong Park ◽  
Nam-Jong Paik
Keyword(s):  
Upper Extremity ◽  
Corticospinal Tract ◽  
Prediction Models ◽  
Explanatory Power ◽  
Brain Magnetic Resonance Imaging ◽  
Motor Recovery ◽  
Motor Deficit ◽  
Motor Deficits ◽  
Unique Contribution

Background. The prediction of motor recovery after stroke is an important issue, and various prediction models have been proposed using either clinical behavioral or neurological biomarkers. This study sought to identify the effects of clinical behavioral biomarkers combined with corticospinal tract (CST) injury measurement on the prediction of motor recovery after stroke. Methods. The region of interest was drawn on the normalized brain magnetic resonance imaging scans of patients with first-ever unilateral hemispheric stroke, and the degree of CST injury was calculated in a total of 67 such subjects. Patients who had initial minor deficits and showed a ceiling effect on motor recovery were excluded. To predict the follow-up Fugl-Meyer assessment (FMA) scores, correlation and regression analyses were performed using various clinical behavioral biomarkers, including age, sex, lesion location, and initial FMA scores and CST injury measurements. Results. Only the initial FMA-upper extremity (UE) score was statistically correlated with the follow-up FMA-UE score at ≥2 months after the onset (adjusted R 2 = 0.626 ), and the relationship between CST injury and follow-up FMA-UE score was unclear ( n = 53 ). Hierarchical clustering between the initial and follow-up FMA-UE scores showed three clusters. After exclusion of a cluster with an initial FMA-UE ≥ 35, the prediction of the follow-up FMA-UE score was possible by incorporating the initial FMA-UE score and CST injury measurements ( n = 39 ). However, the explanatory power decreased (adjusted R 2 = 0.445 ), and the unique contribution of the CST injury (10.1%) was lower than that of the initial FMA-UE score (26.7%). With respect to the FMA-lower extremity score, CST injury was not related to recovery. Conclusions. Motor recovery of the upper and lower extremities after stroke could be predicted using the initial FMA score. CST injury was significant for the prediction of motor recovery of the upper extremity in patients with severe initial motor deficits (FMA-UE < 35); however, its portion of prediction of motor recovery was low. The prediction of poststroke motor recovery using the initial motor deficit was not improved by the addition of CST injury measurements.

scholarly journals Application Of Mirror Therapy On Upper Extremity Motor Recovery In Post-Stroke Patients

2021 ◽  
pp. 136-144
Author(s):  
Roh Hastuti Prasetyaningsih ◽  
Hendri Kurniawan
Keyword(s):  
Upper Extremity ◽  
Motor Recovery ◽  
The Body ◽  
P Value ◽  
Mirror Therapy ◽  
Research Subjects ◽  
Hand Rehabilitation ◽  
Stroke Patients ◽  
Post Stroke ◽  
Significant Difference

Background: Stroke is a health problem for both developed and developing countries, including Indonesia. Paralysis in stroke is mainly due to damage to the internal capsule. This damage requires neuroplasticity involving a number of parts of the brain to restore. One therapy that is beneficial for neuroplasticity is Mirror Therapy (MT). MT is a rehabilitation tool that aims to restore some of the pathological conditions in which the body representation is affected, including post-stroke motor impairment. Methods: This research is a quantitative pre-experimental design with the type one group pretest-postest. The research subjects were 15 post-stroke patients in residency of Semarang. Research data were collected in August-September 2020. Sample selection with  purposive sampling technique who conform inclusion criteria. The Fulg-Meyer Upper Extremity Assessment (FMA-UE) as an aoutcame measure that be avowed valid and reliabel. Data analysis using Paired Sample T-Test because of normally distributed. Results: Statistically the results represent a significant difference in the UE  motor ability of post-stroke patients between baseline and after mirror therapy intervention, with a mean difference (5,14) and p value =  0.000  (ρ < 0,05). Application  of MT effect on upper extremity motor recovery in post-stroke patients. Conclusions: MT program is an effective intervention for UE motor recovery and motor function improvement in post- stroke patients. MT program can be used as a standardized of hand rehabilitation intervention in hospital, clinics and homes.

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