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 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.

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.

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 A novel predictor of clinical progression in patients on active surveillance for prostate cancer

2019 ◽  
Vol 13 (8) ◽  
Author(s):  
Guan Hee Tan ◽  
Antonio Finelli ◽  
Ardalan Ahmad ◽  
Marian Wettstein ◽  
Alexandre Zlotta ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Active Surveillance ◽  
Cox Regression ◽  
Area Under The Curve ◽  
Progression Free Survival ◽  
Roc Curves ◽  
Standard Of Care ◽  
Low Risk ◽  
Clinical Progression

Introduction: Active surveillance (AS) is standard of care in low-risk prostate cancer (PC). This study describes a novel total cancer location (TCLo) density metric and aims to determine its performance in predicting clinical progression (CP) and grade progression (GP).     Methods: This was a retrospective study of patients on AS after confirmatory biopsy (CBx). We excluded patients with Gleason ≥7 at CBx and <2 years follow-up. TCLo was the number of locations with positive cores at diagnosis (DBx) and CBx. TCLo density was TCLo / prostate volume (PV). CP was progression to any active treatment while GP occurred if Gleason ≥7 was identified on repeat biopsy or surgical pathology. Independent predictors of time to CP or GP were estimated with Cox regression. Kaplan-Meier analysis compared progression-free survival curves between TCLo density groups. Test characteristics of TCLo were explored with receiver operating characteristic (ROC) curves.     Results: We included 181 patients who had CBx between 2012-2015, and met inclusion criteria. The mean age of patients was 62.58 years (SD=7.13) and median follow-up was 60.9 months (IQR=23.4). A high TCLo density score (>0.05) was independently associated with time to CP (HR 4.70, 95% CI: 2.62-8.42, p<0.001), and GP (HR 3.85, 95% CI: 1.91-7.73, p<0.001). ROC curves showed TCLo density has greater area under the curve than number of positive cores at CBx in predicting progression.     Conclusion: TCLo density is able to stratify patients on AS for risk of CP and GP. With further validation, it could be added to the decision-making algorithm in AS for low-risk localized PC.

Abstract TP44: Quantifying Edema in Acute Stroke

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
George Harston ◽  
James Kennedy
Keyword(s):  
Acute Stroke ◽  
Vasogenic Edema ◽  
Relative Difference ◽  
Hemorrhagic Transformation ◽  
Stroke Imaging ◽  
Research Priority ◽  
The Difference ◽  
Mri Study ◽  
Selection Of

Introduction: The Acute Stroke Imaging Roadmap III identifies structural distortion due to vasogenic edema and hemorrhage as a research priority for defining final infarction. Non-linear registration (NLR) of a follow up scan to an undistorted presenting scan could correct for distortions due to edema, hemorrhage or atrophy, achieving this goal. In addition, the difference between the volume of infarction following NLR and the volume following a rigid body registration (RBR) reflects the degree of anatomical distortion. In this study we evaluate this technique to correct for subacute edema at different timepoints, and generate a metric to quantify brain swelling at these times. We determine whether early edema at 24 hours predicts edema at 1 week. Methods: Patients with non-lacunar ischemic stroke were recruited into a MRI study. Patients had structural T1-weighted, T2-weighted FLAIR and diffusion-weighted imaging (DWI, b=1000/0) at presentation, 24hrs, 1wk and 1mo. Infarction was defined manually at 24hrs using DWI, and at 1wk and 1mo using FLAIR image by 2 raters. To quantify edema, both NLR warps and RBR matrices were generated between the T1 images at each timepoint to the presenting T1 scan. Infarct masks were transformed to presenting image space using RBR and NLR, and the relative difference in volumes used to quantify the Edema Metric (EM). Results: 34 patients were recruited into the study. NLR corrected for distortions due to edema and hemorrhagic transformation at the 24hr and 1wk timepoints. The EM at 24 hours, 1 week and 1 month were 17.7% (p=0.009), 26.5% (p=0.02), and 7.1% (p=0.05) respectively for the manually defined infarct masks. EM at 24 hours predicted edema at 1 week (r 2 =37%, p=0.009), but not at 1 month (r 2 =3%, p=0.6). Conclusions: NLR provides an opportunity to correct for edema at subacute timepoints and by comparing infarct volumes to those following RBR provides a measure of edema. The EM quantifies the contribution of edema at 24hrs and 1wk, and potentially allows the selection of patients at 24hrs who are likely to develop significant swelling at 1 week. The EM may also be useful in stroke trials to quantify the effect sizes of treatments aimed at minimizing edema in stroke.

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

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.

Bilateral Transcutaneous Electrical Nerve Stimulation Improves Upper Limb Motor Recovery in Stroke: A Randomized Controlled Trial

Stroke ◽  
2021 ◽  
Author(s):  
Peiming Chen ◽  
Tai-Wa Liu ◽  
Patrick W.H. Kwong ◽  
Claudia K.Y. Lai ◽  
Raymond C.K. Chung ◽  
...  
Keyword(s):  
Upper Extremity ◽  
Upper Limb ◽  
Nerve Stimulation ◽  
Transcutaneous Electrical Nerve Stimulation ◽  
Controlled Trial ◽  
Motor Recovery ◽  
Mean Difference ◽  
Post Intervention ◽  
Electrical Nerve Stimulation

Background and Purpose: Recent evidence has shown bilateral transcutaneous electrical nerve stimulation (Bi-TENS) combined with task-oriented training (TOT) to be superior to unilateral transcutaneous electrical nerve stimulation (Uni-TENS)+TOT in improving lower limb motor functioning following stroke. However, no research explored the effect of Bi-TENS+TOT in improving upper limb motor recovery. This study aimed to compare Bi-TENS+TOT with Uni-TENS+TOT, Placebo transcutaneous electrical nerve stimulation (Placebo-TENS)+TOT, and no treatment (Control) groups in upper limb motor recovery. Methods: This is a 4-group parallel design. One hundred and twenty subjects were given either Bi-TENS+TOT, Uni-TENS+TOT, Placebo-TENS+TOT, or Control without treatment in this randomized controlled trial. Twenty 60-minute sessions were administered 3× per week for 7 weeks. The outcome measure was the Fugl-Meyer Assessment of Upper Extremity, which was assessed at baseline, after 10 sessions (mid-intervention) and 20 sessions (post-intervention) of intervention, and at 1- and 3-month follow-up. Results: Patients in the Bi-TENS+TOT group showed greater improvement in the Fugl-Meyer Assessment of Upper Extremity scores than Uni-TENS+TOT (mean difference, 2.13; P =0.004), Placebo-TENS+TOT (mean difference, 2.63; P <0.001), and Control groups (mean difference, 3.11; P <0.001) at post-intervention. Both Bi-TENS+TOT (mean difference, 3.39; P <0.001) and Uni-TENS+TOT (mean difference, 1.26; P =0.018) showed significant within-group improvement in the Fugl-Meyer Assessment of Upper Extremity scores. Patients in the Bi-TENS+TOT group showed earlier within-group improvement in the Fugl-Meyer Assessment of Upper Extremity scores at mid-intervention than Uni-TENS+TOT. These improvements were maintained at the 3-month follow-up assessment. Conclusions: Bi-TENS combined with TOT is an effective therapy for improving upper limb motor recovery following stroke. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT03112473.

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