Multimodal Imaging Biomarker-Based Model Using Stratification Strategies for Predicting Upper Extremity Motor Recovery in Severe Stroke Patients

2021 ◽  
pp. 154596832110702
Author(s):  
Jungsoo Lee ◽  
Heegoo Kim ◽  
Jinuk Kim ◽  
Won Hyuk Chang ◽  
Yun-Hee Kim
Keyword(s):  
Functional Connectivity ◽  
Upper Extremity ◽  
Motor Function ◽  
Multimodal Imaging ◽  
Motor Recovery ◽  
Imaging Biomarker ◽  
Imaging Biomarkers ◽  
Stroke Patients ◽  
Severe Stroke ◽  
Recovery Group

Background. Various prognostic biomarkers for upper extremity (UE) motor recovery after stroke have been reported. However, most have relatively low predictive accuracy in severe stroke patients. Objective. This study suggests an imaging biomarker-based model for effectively predicting UE recovery in severe stroke patients. Methods. Of 104 ischemic stroke patients screened, 42 with severe motor impairment were included. All patients underwent structural, diffusion, and functional magnetic resonance imaging at 2 weeks and underwent motor function assessments at 2 weeks and 3 months after stroke onset. According to motor function recovery at 3 months, patients were divided into good and poor subgroups. The value of multimodal imaging biomarkers of lesion load, lesion volume, white matter integrity, and cortical functional connectivity for motor recovery prediction was investigated in each subgroup. Results. Imaging biomarkers varied depending on recovery pattern. The integrity of the cerebellar tract ( P = .005, R 2 = .432) was the primary biomarker in the good recovery group. In contrast, the sensory-related corpus callosum tract ( P = .026, R 2 = .332) and sensory-related functional connectivity ( P = .001, R 2 = .531) were primary biomarkers in the poor recovery group. A prediction model was proposed by applying each biomarker in the subgroup to patients with different motor evoked potential responses ( P < .001, R 2 = .853, root mean square error = 5.28). Conclusions. Our results suggest an optimized imaging biomarker model for predicting UE motor recovery after stroke. This model can contribute to individualized management of severe stroke in a clinical setting.

Abstract TP312: Longitudinal Functional Connectivity Change Associated With Rehabilitation Training In Sub-acute Stroke Patients

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
yumei zhang ◽  
jun wang
Keyword(s):  
Functional Connectivity ◽  
Acute Stroke ◽  
Motor Function ◽  
Resting State ◽  
Resting State Fmri ◽  
Motor Recovery ◽  
Stroke Patients ◽  
Rehabilitation Training ◽  
Inferior Temporal Gyrus ◽  
Crus I

Background and aims: The neural correlate of the motor recovery associated with different rehabilitation therapy is still unknown in stroke patients. In this study, the resting-state fMRI was employed to identify longitudinal functional connectivity changes associated with different rehabilitation training in sub-acute stroke patients. Methods: Twenty-four sub-acute ischemic stroke patients with right-handed were recruited from Beijing Tiantan Hospital, all of the patients had unilateral upper limb paresis. The subjects were randomly divided into conventional rehabilitation training (CRT) group and functional electrical stimulation (FES) training group. The motor function assessments included FMA, ARAT and MAS. Resting-state fMRI scan were acquired on a Siemens 3.0 T scanner at pre-training and post-training. Ipsilesional primary motor cortex (M1) was selected as the region of interest (ROI), then the functional connectivity (FC) with ipsilesional M1 were analyzed respectively for the two groups. Results: Compared with CRT group, the motor function assessments showed that each motor index increased significantly in FES group. For CRT group, compared with pre-training, we found that the FC of ipsilesional M1 increased with the contralesional cerebellum crus I&II, medial and inferior temporal gyrus at post-training . On the contrary, for FES group, compared with pre-training, FC of ipsilesional M1 decreased with the contralesional cerebellum crus I&II, medial and inferior temporal gyrus at post-training . Conclusion: The different pattern of the longitudinal changes of functional connectivity might contribute to the motor recovery with different rehabilitation training.

Predicting Hand Motor Recovery in Severe Stroke: The Role of Motor Evoked Potentials in Relation to Early Clinical Assessment

2008 ◽  
Vol 23 (1) ◽  
pp. 45-51 ◽  
Author(s):  
Annette A. van Kuijk ◽  
Jaco W. Pasman ◽  
Henk T. Hendricks ◽  
Machiel J. Zwarts ◽  
Alexander C. H. Geurts
Keyword(s):  
Lower Extremity ◽  
Evoked Potentials ◽  
Upper Extremity ◽  
Clinical Assessment ◽  
Predictive Value ◽  
Motor Evoked Potentials ◽  
Motor Recovery ◽  
Stroke Patients ◽  
Abductor Digiti Minimi

Objective. The primary aim of this study was to compare the predictive value of motor evoked potentials (MEPs) and early clinical assessment with regard to long-term hand motor recovery in patients with profound hemiplegia after stroke. Methods. The sample was an inception cohort of 39 stroke patients with an acute, ischemic, supratentorial stroke and an initial upper-extremity paralysis admitted to an academic hospital. Hand motor function recovery was defined at 26 weeks poststroke as a Fugl–Meyer Motor Assessment (FMA) hand score >3 points. The following prognostic factors were compared at week 1 and week 3 poststroke: motor functions as assessed by the FMA upper-extremity and lower-extremity subscores, and the presence of an MEP in the abductor digiti minimi and biceps brachii muscle. Results. Both the presence of an abductor digiti minimi–MEP and any motor recovery in the FMA upper-extremity subscore showed a positive predictive value of 1.00 at weeks 1 and 3. The FMA lower-extremity subscore showed the best negative predictive value (0.90; 95% CI 0.78-1.00 at week 1 and 0.95; 95% CI 0.87-1.00 at week 3). Conclusions. In stroke patients with an initial paralysis of the upper extremity the presence or absence of an MEP has similar predictive value compared with early clinical assessment with regard to long-term hand motor recovery.

The effect and optimal parameters of repetitive transcranial magnetic stimulation on motor recovery in stroke patients: a systematic review and meta-analysis of randomized controlled trials

2019 ◽  
Vol 33 (5) ◽  
pp. 847-864 ◽  
Author(s):  
Huifang Xiang ◽  
Jing Sun ◽  
Xiang Tang ◽  
Kebin Zeng ◽  
Xiushu Wu
Keyword(s):  
Motor Function ◽  
Repetitive Transcranial Magnetic Stimulation ◽  
Meta Analysis ◽  
Motor Recovery ◽  
Controlled Trials ◽  
Optimal Parameters ◽  
Stroke Patients ◽  
Randomized Controlled ◽  
Stimulation Parameters ◽  
Stroke Population

Objective: The primary aim of this meta-analysis was to evaluate the effects of repetitive transcranial magnetic stimulation (rTMS) on limb movement recovery post-stroke and cortex excitability, to explore the optimal parameters of rTMS and suitable stroke population. Second, adverse events were also included. Data sources: The databases of PubMed, EBSCO, MEDLINE, the Cochrane Central Register of Controlled Trials, EBM Reviews-Cochrane Database, the Chinese National Knowledge Infrastructure, and the Chinese Science and Technology Journals Database were searched for randomized controlled trials exploring the effects of rTMS on limb motor function recovery post-stroke before December 2018. Review methods: The effect sizes of rTMS on limb motor recovery, the effect size of rTMS stimulation parameters, and different stroke population were summarized by calculating the standardized mean difference (SMD) and the 95% confidence interval using fixed/random effect models as appropriate. Results: For the motor function assessment, 42 eligible studies involving 1168 stroke patients were identified. The summary effect size indicated that rTMS had positive effects on limb motor recovery (SMD = 0.50, P < 0.00001) and activities of daily living (SMD = 0.82, P < 0.00001), and motor-evoked potentials of the stimulated hemisphere differed according to the stimulation frequency, that is, the high-frequency group (SMD = 0.57, P = 0.0006), except the low-frequency group (SMD = –0.27, P = 0.05). No significant differences were observed among the stimulation parameter subgroups except for the sessions subgroup ( P = 0.02). Only 10 included articles reported transient mild discomfort after rTMS. Conclusions: rTMS promoted the recovery of limb motor function and changed the cortex excitability. rTMS may be better for early and pure subcortical stroke patients. Regarding different stimulation parameters, the number of stimulation sessions has an impact on the effect of rTMS.

Effects of bilateral arm training on upper extremity function in right and left hemispheric stroke

2020 ◽  
pp. 1-9
Author(s):  
Humera Ambreen ◽  
Hina Tariq ◽  
Imran Amjad
Keyword(s):  
Upper Extremity ◽  
Motor Function ◽  
Recovery Of Function ◽  
Hand Function ◽  
Group Analysis ◽  
Stroke Patients ◽  
Hemispheric Stroke ◽  
Beneficial Effects ◽  
Significant Difference ◽  
Bilateral Arm Training

Abstract Objective: This experimental study on 24 stroke patients aimed at evaluating and comparing the effects of bilateral arm training on upper extremity (UE) motor function between right and left hemispheric chronic stroke patients. Methods: Both groups received the same intervention involving 5 functional tasks for 1 hour, 3 days per week, for a total of 6 weeks. Fugl-Meyer Assessment-Upper Extremity and Wolf-Motor Function Test were applied as outcome measures at baseline and after 6 weeks of training to assess the recovery of function in the affected area. Results: Intra-group analysis showed no significant improvement in the wrist and hand function in the left hemispheric stroke (LHS) (p>0.05), while right hemispheric stroke (RHS) patients did not improve significantly in the coordination/speed domain (p>0.05). Inter-group analysis showed no significant difference between right and left hemispheric stroke patients (p>0.05). Conclusion: Bilateral arm training showed beneficial effects in improving UE function in both RHS and LHS patients. Distal UE function in LHS and coordination and speed of movement in RHS patients did not show any significant improvement. Key Words: Stroke, Upper extremity, Recovery of function, Bilateral arm training. Continuous...

Effects of home-based telerehabilitation in patients with stroke

Neurology ◽  
2020 ◽  
Vol 95 (17) ◽  
pp. e2318-e2330 ◽  
Author(s):  
Jing Chen ◽  
Dalong Sun ◽  
Shufan Zhang ◽  
Yonghui Shi ◽  
Fenglei Qiao ◽  
...  
Keyword(s):  
Functional Connectivity ◽  
Motor Function ◽  
Primary Motor Cortex ◽  
Brain Plasticity ◽  
Analysis Of Covariance ◽  
Imaging Biomarkers ◽  
Motor Training ◽  
Neural Function ◽  
Resting State Functional Connectivity ◽  
Home Based

ObjectiveTo determine the effects of a 12-week home-based motor training telerehabilitation program in patients with subcortical stroke by combining motor function assessments and multimodality MRI analysis methods.MethodsFifty-two patients with stroke and hemiplegia were randomly assigned to either a home-based motor training telerehabilitation (TR) group or a conventional rehabilitation (CR) group for 12 weeks. The Fugl-Meyer assessment (FMA) for upper and lower extremities and the modified Barthel Index were used as primary outcomes. The secondary outcomes included resting-state functional connectivity (rsFC) between the bilateral M1 areas, gray matter volumes of the primary motor cortex (M1) areas, and white matter integrity of the corticospinal tract. Analysis of covariance was applied to examine the effects of the home-based motor training TR program on neural function recovery and brain plasticity.ResultsCompared with the CR group, the TR group showed significant improvement in the FMA (p = 0.011) and significantly increased M1-M1 rsFC (p = 0.031) at the end of the rehabilitation. The M1-M1 rsFC change was significantly positively correlated with the FMA change in the TR group (p = 0.018).ConclusionThis study showed a beneficial effect of the home-based motor training telerehabilitation program on motor function in patients with stroke, which was accompanied by enhanced interhemispheric functional connectivity of the M1 areas. We inferred that it is feasible, safe, and efficacious for patients with stroke to receive professional rehabilitation training at home. The combined use of imaging biomarkers should be encouraged in motor training clinical studies in patients with stroke.Classification of evidenceThis study provides Class II evidence that for patients with stroke with hemiplegia, home-based telerehabilitation compared to conventional rehabilitation significantly improves some motor function tests.

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