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Kaufmann BC, Pastore-Wapp M, Bartolomeo P, Geiser N, Nyffeler T, Cazzoli D. Severity-Dependent Interhemispheric White Matter Connectivity Predicts Poststroke Neglect Recovery. J Neurosci 2024; 44:e1311232024. [PMID: 38565290 PMCID: PMC11112644 DOI: 10.1523/jneurosci.1311-23.2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 12/15/2023] [Accepted: 03/15/2024] [Indexed: 04/04/2024] Open
Abstract
Left-sided spatial neglect is a very common and challenging issue after right-hemispheric stroke, which strongly and negatively affects daily living behavior and recovery of stroke survivors. The mechanisms underlying recovery of spatial neglect remain controversial, particularly regarding the involvement of the intact, contralesional hemisphere, with potential contributions ranging from maladaptive to compensatory. In the present prospective, observational study, we assessed neglect severity in 54 right-hemispheric stroke patients (32 male; 22 female) at admission to and discharge from inpatient neurorehabilitation. We demonstrate that the interaction of initial neglect severity and spared white matter (dis)connectivity resulting from individual lesions (as assessed by diffusion tensor imaging, DTI) explains a significant portion of the variability of poststroke neglect recovery. In mildly impaired patients, spared structural connectivity within the lesioned hemisphere is sufficient to attain good recovery. Conversely, in patients with severe impairment, successful recovery critically depends on structural connectivity within the intact hemisphere and between hemispheres. These distinct patterns, mediated by their respective white matter connections, may help to reconcile the dichotomous perspectives regarding the role of the contralesional hemisphere as exclusively compensatory or not. Instead, they suggest a unified viewpoint wherein the contralesional hemisphere can - but must not necessarily - assume a compensatory role. This would depend on initial impairment severity and on the available, spared structural connectivity. In the future, our findings could serve as a prognostic biomarker for neglect recovery and guide patient-tailored therapeutic approaches.
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Affiliation(s)
- Brigitte C Kaufmann
- Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, Inserm, CNRS, Paris 75013, France
- Neurocenter, Luzerner Kantonsspital, Lucerne 6016, Switzerland
| | - Manuela Pastore-Wapp
- Neurocenter, Luzerner Kantonsspital, Lucerne 6016, Switzerland
- ARTORG Center for Biomedical Engineering Research, Gerontechnology and Rehabilitation Group, University of Bern, Bern 3010, Switzerland
| | - Paolo Bartolomeo
- Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, Inserm, CNRS, Paris 75013, France
| | - Nora Geiser
- Neurocenter, Luzerner Kantonsspital, Lucerne 6016, Switzerland
- ARTORG Center for Biomedical Engineering Research, Gerontechnology and Rehabilitation Group, University of Bern, Bern 3010, Switzerland
- Graduate School for Health Sciences, University of Bern, Bern 3012, Switzerland
| | - Thomas Nyffeler
- Neurocenter, Luzerner Kantonsspital, Lucerne 6016, Switzerland
- Graduate School for Health Sciences, University of Bern, Bern 3012, Switzerland
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern 3010, Switzerland
| | - Dario Cazzoli
- Neurocenter, Luzerner Kantonsspital, Lucerne 6016, Switzerland
- ARTORG Center for Biomedical Engineering Research, Gerontechnology and Rehabilitation Group, University of Bern, Bern 3010, Switzerland
- Department of Psychology, University of Bern, Bern 3012, Switzerland
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Paul T, Wiemer VM, Hensel L, Cieslak M, Tscherpel C, Grefkes C, Grafton ST, Fink GR, Volz LJ. Interhemispheric Structural Connectivity Underlies Motor Recovery after Stroke. Ann Neurol 2023; 94:785-797. [PMID: 37402647 DOI: 10.1002/ana.26737] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 06/29/2023] [Accepted: 06/29/2023] [Indexed: 07/06/2023]
Abstract
OBJECTIVE Although ample evidence highlights that the ipsilesional corticospinal tract (CST) plays a crucial role in motor recovery after stroke, studies on cortico-cortical motor connections remain scarce and provide inconclusive results. Given their unique potential to serve as structural reserve enabling motor network reorganization, the question arises whether cortico-cortical connections may facilitate motor control depending on CST damage. METHODS Diffusion spectrum imaging (DSI) and a novel compartment-wise analysis approach were used to quantify structural connectivity between bilateral cortical core motor regions in chronic stroke patients. Basal and complex motor control were differentially assessed. RESULTS Both basal and complex motor performance were correlated with structural connectivity between bilateral premotor areas and ipsilesional primary motor cortex (M1) as well as interhemispheric M1 to M1 connectivity. Whereas complex motor skills depended on CST integrity, a strong association between M1 to M1 connectivity and basal motor control was observed independent of CST integrity especially in patients who underwent substantial motor recovery. Harnessing the informational wealth of cortico-cortical connectivity facilitated the explanation of both basal and complex motor control. INTERPRETATION We demonstrate for the first time that distinct aspects of cortical structural reserve enable basal and complex motor control after stroke. In particular, recovery of basal motor control may be supported via an alternative route through contralesional M1 and non-crossing fibers of the contralesional CST. Our findings help to explain previous conflicting interpretations regarding the functional role of the contralesional M1 and highlight the potential of cortico-cortical structural connectivity as a future biomarker for motor recovery post-stroke. ANN NEUROL 2023;94:785-797.
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Affiliation(s)
- Theresa Paul
- Medical Faculty, University of Cologne, and Department of Neurology, University Hospital Cologne, Cologne, Germany
- Institute of Neuroscience and Medicine, Cognitive Neuroscience (INM-3), Research Centre Juelich, Juelich, Germany
| | - Valerie M Wiemer
- Medical Faculty, University of Cologne, and Department of Neurology, University Hospital Cologne, Cologne, Germany
- Institute of Neuroscience and Medicine, Cognitive Neuroscience (INM-3), Research Centre Juelich, Juelich, Germany
| | - Lukas Hensel
- Medical Faculty, University of Cologne, and Department of Neurology, University Hospital Cologne, Cologne, Germany
| | - Matthew Cieslak
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Caroline Tscherpel
- Medical Faculty, University of Cologne, and Department of Neurology, University Hospital Cologne, Cologne, Germany
| | - Christian Grefkes
- Department of Neurology, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Scott T Grafton
- Department of Psychological & Brain Sciences, University of California, Santa Barbara, CA
| | - Gereon R Fink
- Medical Faculty, University of Cologne, and Department of Neurology, University Hospital Cologne, Cologne, Germany
- Institute of Neuroscience and Medicine, Cognitive Neuroscience (INM-3), Research Centre Juelich, Juelich, Germany
| | - Lukas J Volz
- Medical Faculty, University of Cologne, and Department of Neurology, University Hospital Cologne, Cologne, Germany
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Domin M, Hordacre B, Hok P, Boyd LA, Conforto AB, Andrushko JW, Borich MR, Craddock RC, Donnelly MR, Dula AN, Warach SJ, Kautz SA, Lo BP, Schranz C, Seo NJ, Srivastava S, Wong KA, Zavaliangos-Petropulu A, Thompson PM, Liew SL, Lotze M. White Matter Integrity and Chronic Poststroke Upper Limb Function: An ENIGMA Stroke Recovery Analysis. Stroke 2023; 54:2438-2441. [PMID: 37465999 PMCID: PMC10529837 DOI: 10.1161/strokeaha.123.043713] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 06/26/2023] [Indexed: 07/20/2023]
Abstract
BACKGROUND Integrity of the corticospinal tract (CST) is an important biomarker for upper limb motor function following stroke. However, when structurally compromised, other tracts may become relevant for compensation or recovery of function. METHODS We used the ENIGMA Stroke Recovery data set, a multicenter, retrospective, and cross-sectional collection of patients with upper limb impairment during the chronic phase of stroke to test the relevance of tracts in individuals with less and more severe (laterality index of CST fractional anisotropy ≥0.25) CST damage in an observational study design. White matter integrity was quantified using fractional anisotropy for the CST, the superior longitudinal fascicle, and the callosal fibers interconnecting the primary motor cortices between hemispheres. Optic radiations served as a control tract as they have no a priori relevance for the motor system. Pearson correlation was used for testing correlation with upper limb motor function (Fugl-Meyer upper extremity). RESULTS From 1235 available data sets, 166 were selected (by imaging, Fugl-Meyer upper extremity, covariates, stroke location, and stage) for analyses. Only individuals with severe CST damage showed a positive association of fractional anisotropy in both callosal fibers interconnecting the primary motor cortices (r[21]=0.49; P=0.025) and superior longitudinal fascicle (r[21]=0.51; P=0.018) with Fugl-Meyer upper extremity. CONCLUSIONS Our data support the notion that individuals with more severe damage of the CST depend on residual pathways for achieving better upper limb outcome than those with less affected CST.
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Affiliation(s)
- Martin Domin
- Functional Imaging Unit, Diagnostic and Neuroradiology, University Hospital Greifswald, Greifswald, Germany
| | - Brenton Hordacre
- IIMPACT in Health, University of South Australia, Adelaide, South Australia, Australia
| | - Pavel Hok
- Functional Imaging Unit, Diagnostic and Neuroradiology, University Hospital Greifswald, Greifswald, Germany
| | - Lara A Boyd
- Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
| | - Adriana B Conforto
- Hospital das Clínicas, São Paulo University, São Paulo, Brazil
- Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Justin W Andrushko
- Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
| | - Michael R Borich
- Department of Rehabilitation Medicine, Emory School of Medicine, Atlanta, GA, USA
| | - Richard C Craddock
- Department of Diagnostic Medicine, The University of Texas at Austin, Austin, TX, USA
| | - Miranda R Donnelly
- Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA, USA
| | - Adrienne N Dula
- Department of Neurology, Dell Medical School at The University of Texas Austin, Austin, TX, USA
| | - Steven J Warach
- Department of Neurology, Dell Medical School at The University of Texas Austin, Austin, TX, USA
| | - Steven A Kautz
- Department of Health Sciences & Research, Medical University of South Carolina, Charleston, SC, USA
- Ralph H. Johnson VA Health Care System, Charleston, SC, USA
| | - Bethany P Lo
- Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA, USA
| | - Christian Schranz
- Department of Rehabilitation Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Na Jin Seo
- Department of Health Sciences & Research, Medical University of South Carolina, Charleston, SC, USA
- Ralph H. Johnson VA Health Care System, Charleston, SC, USA
- Department of Rehabilitation Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Shraddha Srivastava
- Department of Health Sciences & Research, Medical University of South Carolina, Charleston, SC, USA
| | - Kristin A Wong
- Department of Physical Medicine & Rehabilitation, The University of Texas at Austin, Austin, TX, USA
| | - Artemis Zavaliangos-Petropulu
- Brain Mapping Center, Department of Neurology, Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Paul M Thompson
- Imaging Genetics Center, Mark & Mary Stevens Neuroimaging & Informatics Institute, Keck School of Medicine, University of Southern California, Marina del Rey, CA, USA
| | - Sook-Lei Liew
- Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA, USA
- Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Martin Lotze
- Functional Imaging Unit, Diagnostic and Neuroradiology, University Hospital Greifswald, Greifswald, Germany
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Repetitive Transcranial Magnetic Stimulation of the Brain Region Activated by Motor Imagery Involving a Paretic Wrist and Hand for Upper-Extremity Motor Improvement in Severe Stroke: A Preliminary Study. Brain Sci 2022; 13:brainsci13010069. [PMID: 36672050 PMCID: PMC9856429 DOI: 10.3390/brainsci13010069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Revised: 12/14/2022] [Accepted: 12/25/2022] [Indexed: 12/31/2022] Open
Abstract
Approximately two-thirds of stroke survivors experience chronic upper-limb paresis; however, treatment options are limited. Repetitive transcranial magnetic stimulation (rTMS) can enhance motor function recovery in stroke survivors, but its efficacy is controversial. We compared the efficacy of stimulating different targets in 10 chronic stroke patients with severe upper-limb motor impairment. Motor imagery-based brain-computer interface training augmented with virtual reality was used to induce neural activity in the brain region during an imagery task. Participants were then randomly assigned to two groups: an experimental group (received high-frequency rTMS delivered to the brain region activated earlier) and a comparison group (received low-frequency rTMS delivered to the contralesional primary motor cortex). Behavioural metrics and diffusion tensor imaging were compared pre- and post rTMS. After the intervention, participants in both groups improved somewhat. This preliminary study indicates that in chronic stroke patients with severe upper-limb motor impairment, inducing activation in specific brain regions during motor imagery tasks and selecting these regions as a target is feasible. Further studies are needed to explore the efficacy of this intervention.
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Elango S, Francis AJA, Chakravarthy VS. Interaction of network and rehabilitation therapy parameters in defining recovery after stroke in a Bilateral Neural Network. J Neuroeng Rehabil 2022; 19:142. [PMID: 36536385 PMCID: PMC9762011 DOI: 10.1186/s12984-022-01106-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 10/27/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Restoring movement after hemiparesis caused by stroke is an ongoing challenge in the field of rehabilitation. With several therapies in use, there is no definitive prescription that optimally maps parameters of rehabilitation with patient condition. Recovery gets further complicated once patients enter chronic phase. In this paper, we propose a rehabilitation framework based on computational modeling, capable of mapping patient characteristics to parameters of rehabilitation therapy. METHOD To build such a system, we used a simple convolutional neural network capable of performing bilateral reaching movements in 3D space using stereovision. The network was designed to have bilateral symmetry to reflect the bilaterality of the cerebral hemispheres with the two halves joined by cross-connections. This network was then modified according to 3 chosen patient characteristics-lesion size, stage of recovery (acute or chronic) and structural integrity of cross-connections (analogous to Corpus Callosum). Similarly, 3 parameters were used to define rehabilitation paradigms-movement complexity (Exploratory vs Stereotypic), hand selection mode (move only affected arm, CIMT vs move both arms, BMT), and extent of plasticity (local vs global). For each stroke condition, performance under each setting of the rehabilitation parameters was measured and results were analyzed to find the corresponding optimal rehabilitation protocol. RESULTS Upon analysis, we found that regardless of patient characteristics network showed better recovery when high complexity movements were used and no significant difference was found between the two hand selection modes. Contrary to these two parameters, optimal extent of plasticity was influenced by patient characteristics. For acute stroke, global plasticity is preferred only for larger lesions. However, for chronic, plasticity varies with structural integrity of cross-connections. Under high integrity, chronic prefers global plasticity regardless of lesion size, but with low integrity local plasticity is preferred. CONCLUSION Clinically translating the results obtained, optimal recovery may be observed when paretic arm explores the available workspace irrespective of the hand selection mode adopted. However, the extent of plasticity to be used depends on characteristics of the patient mainly stage of stroke and structural integrity. By using systems as developed in this study and modifying rehabilitation paradigms accordingly it is expected post-stroke recovery can be maximized.
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Affiliation(s)
- Sundari Elango
- grid.417969.40000 0001 2315 1926Computational Neuroscience Laboratory, Department of Biotechnology, Indian Institute of Technology, Madras, India
| | - Amal Jude Ashwin Francis
- grid.417969.40000 0001 2315 1926Computational Neuroscience Laboratory, Department of Biotechnology, Indian Institute of Technology, Madras, India
| | - V. Srinivasa Chakravarthy
- grid.417969.40000 0001 2315 1926Computational Neuroscience Laboratory, Department of Biotechnology, Indian Institute of Technology, Madras, India
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Hayward KS, Ferris JK, Lohse KR, Borich MR, Borstad A, Cassidy JM, Cramer SC, Dukelow SP, Findlater SE, Hawe RL, Liew SL, Neva JL, Stewart JC, Boyd LA. Observational Study of Neuroimaging Biomarkers of Severe Upper Limb Impairment After Stroke. Neurology 2022; 99:e402-e413. [PMID: 35550551 PMCID: PMC9421772 DOI: 10.1212/wnl.0000000000200517] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 02/28/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES It is difficult to predict poststroke outcome for individuals with severe motor impairment because both clinical tests and corticospinal tract (CST) microstructure may not reliably indicate severe motor impairment. Here, we test whether imaging biomarkers beyond the CST relate to severe upper limb (UL) impairment poststroke by evaluating white matter microstructure in the corpus callosum (CC). In an international, multisite hypothesis-generating observational study, we determined if (1) CST asymmetry index (CST-AI) can differentiate between individuals with mild-moderate and severe UL impairment and (2) CC biomarkers relate to UL impairment within individuals with severe impairment poststroke. We hypothesized that CST-AI would differentiate between mild-moderate and severe impairment, but CC microstructure would relate to motor outcome for individuals with severe UL impairment. METHODS Seven cohorts with individual diffusion imaging and motor impairment (Fugl-Meyer Upper Limb) data were pooled. Hand-drawn regions-of-interest were used to seed probabilistic tractography for CST (ipsilesional/contralesional) and CC (prefrontal/premotor/motor/sensory/posterior) tracts. Our main imaging measure was mean fractional anisotropy. Linear mixed-effects regression explored relationships between candidate biomarkers and motor impairment, controlling for observations nested within cohorts, as well as age, sex, time poststroke, and lesion volume. RESULTS Data from 110 individuals (30 with mild-moderate and 80 with severe motor impairment) were included. In the full sample, greater CST-AI (i.e., lower fractional anisotropy in the ipsilesional hemisphere, p < 0.001) and larger lesion volume (p = 0.139) were negatively related to impairment. In the severe subgroup, CST-AI was not reliably associated with impairment across models. Instead, lesion volume and CC microstructure explained impairment in the severe group beyond CST-AI (p's < 0.010). DISCUSSION Within a large cohort of individuals with severe UL impairment, CC microstructure related to motor outcome poststroke. Our findings demonstrate that CST microstructure does relate to UL outcome across the full range of motor impairment but was not reliably associated within the severe subgroup. Therefore, CC microstructure may provide a promising biomarker for severe UL outcome poststroke, which may advance our ability to predict recovery in individuals with severe motor impairment after stroke.
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Affiliation(s)
- Kathryn S Hayward
- From the Departments of Physiotherapy (K.S.H.), Medicine and Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Heidelberg, Victoria, Australia; Rehabilitation Sciences Graduate Research Program (J.K.F., L.A.B.), University of British Columbia, Vancouver, British Columbia, Canada; Physical Therapy and Neurology (K.R.L.), Washington University School of Medicine in Saint Louis, MO; Division of Physical Therapy (M.R.B.), Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, GA; School of Health Sciences (A.B.), Department of Physical Therapy, College of St. Scholastica, Duluth, MN; Department of Allied Health Sciences (J.M.C.), University of North Carolina at Chapel Hill, NC; Department of Neurology (S.C.C.), University of California Los Angeles; California Rehabilitation Institute (S.C.C.), Los Angeles, California; Department of Clinical Neurosciences (S.P.D., S.E.F.), Cumming School of Medicine, University of Calgary, Alberta, Canada; School of Kinesiology (R.L.H.), University of Minnesota, Minneapolis; Chan Division of Occupational Science and Occupational Therapy (S.-L.L.), Biokinesiology and Physical Therapy, Biomedical Engineering, and Neurology, USC Stevens Neuroimaging and Informatics Institute, University of Southern California, Los Angeles; Université de Montréal (J.L.N.), École de Kinésiologie et des Sciences de l'activité Physique, Faculté de Médecine, and Centre de recherche de l'institut universitaire de gériatrie de Montréal, Quebec, Canada; and Physical Therapy Program (J.C.S.), Department of Exercise Science, University of South Carolina, Columbia.
| | - Jennifer K Ferris
- From the Departments of Physiotherapy (K.S.H.), Medicine and Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Heidelberg, Victoria, Australia; Rehabilitation Sciences Graduate Research Program (J.K.F., L.A.B.), University of British Columbia, Vancouver, British Columbia, Canada; Physical Therapy and Neurology (K.R.L.), Washington University School of Medicine in Saint Louis, MO; Division of Physical Therapy (M.R.B.), Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, GA; School of Health Sciences (A.B.), Department of Physical Therapy, College of St. Scholastica, Duluth, MN; Department of Allied Health Sciences (J.M.C.), University of North Carolina at Chapel Hill, NC; Department of Neurology (S.C.C.), University of California Los Angeles; California Rehabilitation Institute (S.C.C.), Los Angeles, California; Department of Clinical Neurosciences (S.P.D., S.E.F.), Cumming School of Medicine, University of Calgary, Alberta, Canada; School of Kinesiology (R.L.H.), University of Minnesota, Minneapolis; Chan Division of Occupational Science and Occupational Therapy (S.-L.L.), Biokinesiology and Physical Therapy, Biomedical Engineering, and Neurology, USC Stevens Neuroimaging and Informatics Institute, University of Southern California, Los Angeles; Université de Montréal (J.L.N.), École de Kinésiologie et des Sciences de l'activité Physique, Faculté de Médecine, and Centre de recherche de l'institut universitaire de gériatrie de Montréal, Quebec, Canada; and Physical Therapy Program (J.C.S.), Department of Exercise Science, University of South Carolina, Columbia
| | - Keith R Lohse
- From the Departments of Physiotherapy (K.S.H.), Medicine and Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Heidelberg, Victoria, Australia; Rehabilitation Sciences Graduate Research Program (J.K.F., L.A.B.), University of British Columbia, Vancouver, British Columbia, Canada; Physical Therapy and Neurology (K.R.L.), Washington University School of Medicine in Saint Louis, MO; Division of Physical Therapy (M.R.B.), Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, GA; School of Health Sciences (A.B.), Department of Physical Therapy, College of St. Scholastica, Duluth, MN; Department of Allied Health Sciences (J.M.C.), University of North Carolina at Chapel Hill, NC; Department of Neurology (S.C.C.), University of California Los Angeles; California Rehabilitation Institute (S.C.C.), Los Angeles, California; Department of Clinical Neurosciences (S.P.D., S.E.F.), Cumming School of Medicine, University of Calgary, Alberta, Canada; School of Kinesiology (R.L.H.), University of Minnesota, Minneapolis; Chan Division of Occupational Science and Occupational Therapy (S.-L.L.), Biokinesiology and Physical Therapy, Biomedical Engineering, and Neurology, USC Stevens Neuroimaging and Informatics Institute, University of Southern California, Los Angeles; Université de Montréal (J.L.N.), École de Kinésiologie et des Sciences de l'activité Physique, Faculté de Médecine, and Centre de recherche de l'institut universitaire de gériatrie de Montréal, Quebec, Canada; and Physical Therapy Program (J.C.S.), Department of Exercise Science, University of South Carolina, Columbia
| | - Michael R Borich
- From the Departments of Physiotherapy (K.S.H.), Medicine and Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Heidelberg, Victoria, Australia; Rehabilitation Sciences Graduate Research Program (J.K.F., L.A.B.), University of British Columbia, Vancouver, British Columbia, Canada; Physical Therapy and Neurology (K.R.L.), Washington University School of Medicine in Saint Louis, MO; Division of Physical Therapy (M.R.B.), Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, GA; School of Health Sciences (A.B.), Department of Physical Therapy, College of St. Scholastica, Duluth, MN; Department of Allied Health Sciences (J.M.C.), University of North Carolina at Chapel Hill, NC; Department of Neurology (S.C.C.), University of California Los Angeles; California Rehabilitation Institute (S.C.C.), Los Angeles, California; Department of Clinical Neurosciences (S.P.D., S.E.F.), Cumming School of Medicine, University of Calgary, Alberta, Canada; School of Kinesiology (R.L.H.), University of Minnesota, Minneapolis; Chan Division of Occupational Science and Occupational Therapy (S.-L.L.), Biokinesiology and Physical Therapy, Biomedical Engineering, and Neurology, USC Stevens Neuroimaging and Informatics Institute, University of Southern California, Los Angeles; Université de Montréal (J.L.N.), École de Kinésiologie et des Sciences de l'activité Physique, Faculté de Médecine, and Centre de recherche de l'institut universitaire de gériatrie de Montréal, Quebec, Canada; and Physical Therapy Program (J.C.S.), Department of Exercise Science, University of South Carolina, Columbia
| | - Alexandra Borstad
- From the Departments of Physiotherapy (K.S.H.), Medicine and Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Heidelberg, Victoria, Australia; Rehabilitation Sciences Graduate Research Program (J.K.F., L.A.B.), University of British Columbia, Vancouver, British Columbia, Canada; Physical Therapy and Neurology (K.R.L.), Washington University School of Medicine in Saint Louis, MO; Division of Physical Therapy (M.R.B.), Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, GA; School of Health Sciences (A.B.), Department of Physical Therapy, College of St. Scholastica, Duluth, MN; Department of Allied Health Sciences (J.M.C.), University of North Carolina at Chapel Hill, NC; Department of Neurology (S.C.C.), University of California Los Angeles; California Rehabilitation Institute (S.C.C.), Los Angeles, California; Department of Clinical Neurosciences (S.P.D., S.E.F.), Cumming School of Medicine, University of Calgary, Alberta, Canada; School of Kinesiology (R.L.H.), University of Minnesota, Minneapolis; Chan Division of Occupational Science and Occupational Therapy (S.-L.L.), Biokinesiology and Physical Therapy, Biomedical Engineering, and Neurology, USC Stevens Neuroimaging and Informatics Institute, University of Southern California, Los Angeles; Université de Montréal (J.L.N.), École de Kinésiologie et des Sciences de l'activité Physique, Faculté de Médecine, and Centre de recherche de l'institut universitaire de gériatrie de Montréal, Quebec, Canada; and Physical Therapy Program (J.C.S.), Department of Exercise Science, University of South Carolina, Columbia
| | - Jessica M Cassidy
- From the Departments of Physiotherapy (K.S.H.), Medicine and Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Heidelberg, Victoria, Australia; Rehabilitation Sciences Graduate Research Program (J.K.F., L.A.B.), University of British Columbia, Vancouver, British Columbia, Canada; Physical Therapy and Neurology (K.R.L.), Washington University School of Medicine in Saint Louis, MO; Division of Physical Therapy (M.R.B.), Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, GA; School of Health Sciences (A.B.), Department of Physical Therapy, College of St. Scholastica, Duluth, MN; Department of Allied Health Sciences (J.M.C.), University of North Carolina at Chapel Hill, NC; Department of Neurology (S.C.C.), University of California Los Angeles; California Rehabilitation Institute (S.C.C.), Los Angeles, California; Department of Clinical Neurosciences (S.P.D., S.E.F.), Cumming School of Medicine, University of Calgary, Alberta, Canada; School of Kinesiology (R.L.H.), University of Minnesota, Minneapolis; Chan Division of Occupational Science and Occupational Therapy (S.-L.L.), Biokinesiology and Physical Therapy, Biomedical Engineering, and Neurology, USC Stevens Neuroimaging and Informatics Institute, University of Southern California, Los Angeles; Université de Montréal (J.L.N.), École de Kinésiologie et des Sciences de l'activité Physique, Faculté de Médecine, and Centre de recherche de l'institut universitaire de gériatrie de Montréal, Quebec, Canada; and Physical Therapy Program (J.C.S.), Department of Exercise Science, University of South Carolina, Columbia
| | - Steven C Cramer
- From the Departments of Physiotherapy (K.S.H.), Medicine and Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Heidelberg, Victoria, Australia; Rehabilitation Sciences Graduate Research Program (J.K.F., L.A.B.), University of British Columbia, Vancouver, British Columbia, Canada; Physical Therapy and Neurology (K.R.L.), Washington University School of Medicine in Saint Louis, MO; Division of Physical Therapy (M.R.B.), Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, GA; School of Health Sciences (A.B.), Department of Physical Therapy, College of St. Scholastica, Duluth, MN; Department of Allied Health Sciences (J.M.C.), University of North Carolina at Chapel Hill, NC; Department of Neurology (S.C.C.), University of California Los Angeles; California Rehabilitation Institute (S.C.C.), Los Angeles, California; Department of Clinical Neurosciences (S.P.D., S.E.F.), Cumming School of Medicine, University of Calgary, Alberta, Canada; School of Kinesiology (R.L.H.), University of Minnesota, Minneapolis; Chan Division of Occupational Science and Occupational Therapy (S.-L.L.), Biokinesiology and Physical Therapy, Biomedical Engineering, and Neurology, USC Stevens Neuroimaging and Informatics Institute, University of Southern California, Los Angeles; Université de Montréal (J.L.N.), École de Kinésiologie et des Sciences de l'activité Physique, Faculté de Médecine, and Centre de recherche de l'institut universitaire de gériatrie de Montréal, Quebec, Canada; and Physical Therapy Program (J.C.S.), Department of Exercise Science, University of South Carolina, Columbia
| | - Sean P Dukelow
- From the Departments of Physiotherapy (K.S.H.), Medicine and Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Heidelberg, Victoria, Australia; Rehabilitation Sciences Graduate Research Program (J.K.F., L.A.B.), University of British Columbia, Vancouver, British Columbia, Canada; Physical Therapy and Neurology (K.R.L.), Washington University School of Medicine in Saint Louis, MO; Division of Physical Therapy (M.R.B.), Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, GA; School of Health Sciences (A.B.), Department of Physical Therapy, College of St. Scholastica, Duluth, MN; Department of Allied Health Sciences (J.M.C.), University of North Carolina at Chapel Hill, NC; Department of Neurology (S.C.C.), University of California Los Angeles; California Rehabilitation Institute (S.C.C.), Los Angeles, California; Department of Clinical Neurosciences (S.P.D., S.E.F.), Cumming School of Medicine, University of Calgary, Alberta, Canada; School of Kinesiology (R.L.H.), University of Minnesota, Minneapolis; Chan Division of Occupational Science and Occupational Therapy (S.-L.L.), Biokinesiology and Physical Therapy, Biomedical Engineering, and Neurology, USC Stevens Neuroimaging and Informatics Institute, University of Southern California, Los Angeles; Université de Montréal (J.L.N.), École de Kinésiologie et des Sciences de l'activité Physique, Faculté de Médecine, and Centre de recherche de l'institut universitaire de gériatrie de Montréal, Quebec, Canada; and Physical Therapy Program (J.C.S.), Department of Exercise Science, University of South Carolina, Columbia
| | - Sonja E Findlater
- From the Departments of Physiotherapy (K.S.H.), Medicine and Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Heidelberg, Victoria, Australia; Rehabilitation Sciences Graduate Research Program (J.K.F., L.A.B.), University of British Columbia, Vancouver, British Columbia, Canada; Physical Therapy and Neurology (K.R.L.), Washington University School of Medicine in Saint Louis, MO; Division of Physical Therapy (M.R.B.), Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, GA; School of Health Sciences (A.B.), Department of Physical Therapy, College of St. Scholastica, Duluth, MN; Department of Allied Health Sciences (J.M.C.), University of North Carolina at Chapel Hill, NC; Department of Neurology (S.C.C.), University of California Los Angeles; California Rehabilitation Institute (S.C.C.), Los Angeles, California; Department of Clinical Neurosciences (S.P.D., S.E.F.), Cumming School of Medicine, University of Calgary, Alberta, Canada; School of Kinesiology (R.L.H.), University of Minnesota, Minneapolis; Chan Division of Occupational Science and Occupational Therapy (S.-L.L.), Biokinesiology and Physical Therapy, Biomedical Engineering, and Neurology, USC Stevens Neuroimaging and Informatics Institute, University of Southern California, Los Angeles; Université de Montréal (J.L.N.), École de Kinésiologie et des Sciences de l'activité Physique, Faculté de Médecine, and Centre de recherche de l'institut universitaire de gériatrie de Montréal, Quebec, Canada; and Physical Therapy Program (J.C.S.), Department of Exercise Science, University of South Carolina, Columbia
| | - Rachel L Hawe
- From the Departments of Physiotherapy (K.S.H.), Medicine and Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Heidelberg, Victoria, Australia; Rehabilitation Sciences Graduate Research Program (J.K.F., L.A.B.), University of British Columbia, Vancouver, British Columbia, Canada; Physical Therapy and Neurology (K.R.L.), Washington University School of Medicine in Saint Louis, MO; Division of Physical Therapy (M.R.B.), Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, GA; School of Health Sciences (A.B.), Department of Physical Therapy, College of St. Scholastica, Duluth, MN; Department of Allied Health Sciences (J.M.C.), University of North Carolina at Chapel Hill, NC; Department of Neurology (S.C.C.), University of California Los Angeles; California Rehabilitation Institute (S.C.C.), Los Angeles, California; Department of Clinical Neurosciences (S.P.D., S.E.F.), Cumming School of Medicine, University of Calgary, Alberta, Canada; School of Kinesiology (R.L.H.), University of Minnesota, Minneapolis; Chan Division of Occupational Science and Occupational Therapy (S.-L.L.), Biokinesiology and Physical Therapy, Biomedical Engineering, and Neurology, USC Stevens Neuroimaging and Informatics Institute, University of Southern California, Los Angeles; Université de Montréal (J.L.N.), École de Kinésiologie et des Sciences de l'activité Physique, Faculté de Médecine, and Centre de recherche de l'institut universitaire de gériatrie de Montréal, Quebec, Canada; and Physical Therapy Program (J.C.S.), Department of Exercise Science, University of South Carolina, Columbia
| | - Sook-Lei Liew
- From the Departments of Physiotherapy (K.S.H.), Medicine and Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Heidelberg, Victoria, Australia; Rehabilitation Sciences Graduate Research Program (J.K.F., L.A.B.), University of British Columbia, Vancouver, British Columbia, Canada; Physical Therapy and Neurology (K.R.L.), Washington University School of Medicine in Saint Louis, MO; Division of Physical Therapy (M.R.B.), Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, GA; School of Health Sciences (A.B.), Department of Physical Therapy, College of St. Scholastica, Duluth, MN; Department of Allied Health Sciences (J.M.C.), University of North Carolina at Chapel Hill, NC; Department of Neurology (S.C.C.), University of California Los Angeles; California Rehabilitation Institute (S.C.C.), Los Angeles, California; Department of Clinical Neurosciences (S.P.D., S.E.F.), Cumming School of Medicine, University of Calgary, Alberta, Canada; School of Kinesiology (R.L.H.), University of Minnesota, Minneapolis; Chan Division of Occupational Science and Occupational Therapy (S.-L.L.), Biokinesiology and Physical Therapy, Biomedical Engineering, and Neurology, USC Stevens Neuroimaging and Informatics Institute, University of Southern California, Los Angeles; Université de Montréal (J.L.N.), École de Kinésiologie et des Sciences de l'activité Physique, Faculté de Médecine, and Centre de recherche de l'institut universitaire de gériatrie de Montréal, Quebec, Canada; and Physical Therapy Program (J.C.S.), Department of Exercise Science, University of South Carolina, Columbia
| | - Jason L Neva
- From the Departments of Physiotherapy (K.S.H.), Medicine and Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Heidelberg, Victoria, Australia; Rehabilitation Sciences Graduate Research Program (J.K.F., L.A.B.), University of British Columbia, Vancouver, British Columbia, Canada; Physical Therapy and Neurology (K.R.L.), Washington University School of Medicine in Saint Louis, MO; Division of Physical Therapy (M.R.B.), Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, GA; School of Health Sciences (A.B.), Department of Physical Therapy, College of St. Scholastica, Duluth, MN; Department of Allied Health Sciences (J.M.C.), University of North Carolina at Chapel Hill, NC; Department of Neurology (S.C.C.), University of California Los Angeles; California Rehabilitation Institute (S.C.C.), Los Angeles, California; Department of Clinical Neurosciences (S.P.D., S.E.F.), Cumming School of Medicine, University of Calgary, Alberta, Canada; School of Kinesiology (R.L.H.), University of Minnesota, Minneapolis; Chan Division of Occupational Science and Occupational Therapy (S.-L.L.), Biokinesiology and Physical Therapy, Biomedical Engineering, and Neurology, USC Stevens Neuroimaging and Informatics Institute, University of Southern California, Los Angeles; Université de Montréal (J.L.N.), École de Kinésiologie et des Sciences de l'activité Physique, Faculté de Médecine, and Centre de recherche de l'institut universitaire de gériatrie de Montréal, Quebec, Canada; and Physical Therapy Program (J.C.S.), Department of Exercise Science, University of South Carolina, Columbia
| | - Jill C Stewart
- From the Departments of Physiotherapy (K.S.H.), Medicine and Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Heidelberg, Victoria, Australia; Rehabilitation Sciences Graduate Research Program (J.K.F., L.A.B.), University of British Columbia, Vancouver, British Columbia, Canada; Physical Therapy and Neurology (K.R.L.), Washington University School of Medicine in Saint Louis, MO; Division of Physical Therapy (M.R.B.), Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, GA; School of Health Sciences (A.B.), Department of Physical Therapy, College of St. Scholastica, Duluth, MN; Department of Allied Health Sciences (J.M.C.), University of North Carolina at Chapel Hill, NC; Department of Neurology (S.C.C.), University of California Los Angeles; California Rehabilitation Institute (S.C.C.), Los Angeles, California; Department of Clinical Neurosciences (S.P.D., S.E.F.), Cumming School of Medicine, University of Calgary, Alberta, Canada; School of Kinesiology (R.L.H.), University of Minnesota, Minneapolis; Chan Division of Occupational Science and Occupational Therapy (S.-L.L.), Biokinesiology and Physical Therapy, Biomedical Engineering, and Neurology, USC Stevens Neuroimaging and Informatics Institute, University of Southern California, Los Angeles; Université de Montréal (J.L.N.), École de Kinésiologie et des Sciences de l'activité Physique, Faculté de Médecine, and Centre de recherche de l'institut universitaire de gériatrie de Montréal, Quebec, Canada; and Physical Therapy Program (J.C.S.), Department of Exercise Science, University of South Carolina, Columbia
| | - Lara A Boyd
- From the Departments of Physiotherapy (K.S.H.), Medicine and Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Heidelberg, Victoria, Australia; Rehabilitation Sciences Graduate Research Program (J.K.F., L.A.B.), University of British Columbia, Vancouver, British Columbia, Canada; Physical Therapy and Neurology (K.R.L.), Washington University School of Medicine in Saint Louis, MO; Division of Physical Therapy (M.R.B.), Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, GA; School of Health Sciences (A.B.), Department of Physical Therapy, College of St. Scholastica, Duluth, MN; Department of Allied Health Sciences (J.M.C.), University of North Carolina at Chapel Hill, NC; Department of Neurology (S.C.C.), University of California Los Angeles; California Rehabilitation Institute (S.C.C.), Los Angeles, California; Department of Clinical Neurosciences (S.P.D., S.E.F.), Cumming School of Medicine, University of Calgary, Alberta, Canada; School of Kinesiology (R.L.H.), University of Minnesota, Minneapolis; Chan Division of Occupational Science and Occupational Therapy (S.-L.L.), Biokinesiology and Physical Therapy, Biomedical Engineering, and Neurology, USC Stevens Neuroimaging and Informatics Institute, University of Southern California, Los Angeles; Université de Montréal (J.L.N.), École de Kinésiologie et des Sciences de l'activité Physique, Faculté de Médecine, and Centre de recherche de l'institut universitaire de gériatrie de Montréal, Quebec, Canada; and Physical Therapy Program (J.C.S.), Department of Exercise Science, University of South Carolina, Columbia
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7
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Varghese R, Chang B, Kim B, Liew SL, Schweighofer N, Winstein CJ. Corpus Callosal Microstructure Predicts Bimanual Motor Performance in Chronic Stroke Survivors: a Preliminary Cross-Sectional Study. Top Stroke Rehabil 2022:1-9. [PMID: 35856402 PMCID: PMC9852360 DOI: 10.1080/10749357.2022.2095085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND Microstructural changes in the corpus callosum (CC) are associated with more severe motor impairment in the paretic hand, poor recovery, and general disability. The purpose of this study was to determine if CC microstructure predicts bimanual motor performance in chronic stroke survivors. METHODS We examined the relationship between the fractional anisotropy (FA) across the CC, in both the sensorimotor and non-sensorimotor regions, and movement times for two self-initiated and self-paced bimanual tasks in 41 chronic stroke survivors. Using publicly available control datasets (n = 52), matched closely for imaging acquisition parameters, we also explored the effect of stroke and age on callosal microstructure. RESULTS In mild-to-moderate chronic stroke survivors with relatively localized lesions to the motor areas, lower callosal FA values, suggestive of a more disorganized microstructure, were associated with slower bimanual performance. Associations were strongest for the primary motor fibers (b = -2.19 ± 1.03, p = .035), followed closely by premotor/supplementary motor (b = -2.07 ± 1.07, p = .041) and prefrontal (b = -1.92 ± 0.97, p = .05) fibers of the callosum. Secondary analysis revealed that compared to neurologically age-similar adults, chronic stroke survivors exhibited significantly lower mean FA in all regions of the CC, except the splenium. CONCLUSION Remote widespread changes in the callosal genu and body are associated with slower performance on cooperative bimanual tasks that require precise and interdependent coordination of the hands. Measures of callosal microstructure may prove to be a useful predictor of real-world bimanual performance in chronic stroke survivors.
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Affiliation(s)
- Rini Varghese
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA 90089
| | - Brianna Chang
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA 90089
| | - Bokkyu Kim
- SUNY Upstate Medical University, Department of Physical Therapy, Syracuse, NY 13210
| | - Sook-Lei Liew
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA 90089.,Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA 90089
| | - Nicolas Schweighofer
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA 90089
| | - Carolee J. Winstein
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA 90089.,Department of Neurology, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033
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8
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Hildesheim FE, Silver AN, Dominguez-Vargas AU, Andrushko JW, Edwards JD, Dancause N, Thiel A. Predicting Individual Treatment Response to rTMS for Motor Recovery After Stroke: A Review and the CanStim Perspective. FRONTIERS IN REHABILITATION SCIENCES 2022; 3:795335. [PMID: 36188894 PMCID: PMC9397689 DOI: 10.3389/fresc.2022.795335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 01/17/2022] [Indexed: 11/13/2022]
Abstract
Background Rehabilitation is critical for reducing stroke-related disability and improving quality-of-life post-stroke. Repetitive transcranial magnetic stimulation (rTMS), a non-invasive neuromodulation technique used as stand-alone or adjunct treatment to physiotherapy, may be of benefit for motor recovery in subgroups of stroke patients. The Canadian Platform for Trials in Non-Invasive Brain Stimulation (CanStim) seeks to advance the use of these techniques to improve post-stroke recovery through clinical trials and pre-clinical studies using standardized research protocols. Here, we review existing clinical trials for demographic, clinical, and neurobiological factors which may predict treatment response to identify knowledge gaps which need to be addressed before implementing these parameters for patient stratification in clinical trial protocols. Objective To provide a review of clinical rTMS trials of stroke recovery identifying factors associated with rTMS response in stroke patients with motor deficits and develop research perspectives for pre-clinical and clinical studies. Methods A literature search was performed in PubMed, using the Boolean search terms stroke AND repetitive transcranial magnetic stimulation OR rTMS AND motor for studies investigating the use of rTMS for motor recovery in stroke patients at any recovery phase. A total of 1,676 articles were screened by two blinded raters, with 26 papers identified for inclusion in this review. Results Multiple possible factors associated with rTMS response were identified, including stroke location, cortical thickness, brain-derived neurotrophic factor (BDNF) genotype, initial stroke severity, and several imaging and clinical factors associated with a relatively preserved functional motor network of the ipsilesional hemisphere. Age, sex, and time post-stroke were generally not related to rTMS response. Factors associated with greater response were identified in studies of both excitatory ipsilesional and inhibitory contralesional rTMS. Heterogeneous study designs and contradictory data exemplify the need for greater protocol standardization and high-quality controlled trials. Conclusion Clinical, brain structural and neurobiological factors have been identified as potential predictors for rTMS response in stroke patients with motor impairment. These factors can inform the design of future clinical trials, before being considered for optimization of individual rehabilitation therapy for stroke patients. Pre-clinical models for stroke recovery, specifically developed in a clinical context, may accelerate this process.
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Affiliation(s)
- Franziska E. Hildesheim
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, QC, Canada
- Canadian Platform for Trials in Non-Invasive Brain Stimulation (CanStim), Montréal, QC, Canada
- Department of Neurology and Neurosurgery, McGill University, Montréal, QC, Canada
| | - Alexander N. Silver
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, QC, Canada
- Canadian Platform for Trials in Non-Invasive Brain Stimulation (CanStim), Montréal, QC, Canada
- Department of Neurology and Neurosurgery, McGill University, Montréal, QC, Canada
| | - Adan-Ulises Dominguez-Vargas
- Canadian Platform for Trials in Non-Invasive Brain Stimulation (CanStim), Montréal, QC, Canada
- Centre interdisciplinaire de recherche sur le cerveau et l'apprentissage (CIRCA), Université de Montréal, Montréal, QC, Canada
- Département de Neurosciences, Faculté de Médecine, Université de Montréal, Montréal, QC, Canada
| | - Justin W. Andrushko
- Canadian Platform for Trials in Non-Invasive Brain Stimulation (CanStim), Montréal, QC, Canada
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Jodi D. Edwards
- Canadian Platform for Trials in Non-Invasive Brain Stimulation (CanStim), Montréal, QC, Canada
- University of Ottawa Heart Institute, Ottawa, ON, Canada
- School of Epidemiology and Public Health, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Numa Dancause
- Canadian Platform for Trials in Non-Invasive Brain Stimulation (CanStim), Montréal, QC, Canada
- Centre interdisciplinaire de recherche sur le cerveau et l'apprentissage (CIRCA), Université de Montréal, Montréal, QC, Canada
- Département de Neurosciences, Faculté de Médecine, Université de Montréal, Montréal, QC, Canada
| | - Alexander Thiel
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, QC, Canada
- Canadian Platform for Trials in Non-Invasive Brain Stimulation (CanStim), Montréal, QC, Canada
- Department of Neurology and Neurosurgery, McGill University, Montréal, QC, Canada
- *Correspondence: Alexander Thiel
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9
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Brancaccio A, Tabarelli D, Belardinelli P. A New Framework to Interpret Individual Inter-Hemispheric Compensatory Communication after Stroke. J Pers Med 2022; 12:jpm12010059. [PMID: 35055374 PMCID: PMC8778334 DOI: 10.3390/jpm12010059] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 12/14/2021] [Accepted: 12/30/2021] [Indexed: 12/15/2022] Open
Abstract
Stroke constitutes the main cause of adult disability worldwide. Even after application of standard rehabilitation protocols, the majority of patients still show relevant motor impairment. Outcomes of standard rehabilitation protocols have led to mixed results, suggesting that relevant factors for brain re-organization after stroke have not been considered in explanatory models. Therefore, finding a comprehensive model to optimally define patient-dependent rehabilitation protocols represents a crucial topic in clinical neuroscience. In this context, we first report on the rehabilitation models conceived thus far in the attempt of predicting stroke rehabilitation outcomes. Then, we propose a new framework to interpret results in stroke literature in the light of the latest evidence regarding: (1) the role of the callosum in inter-hemispheric communication, (2) the role of prefrontal cortices in exerting a control function, and (3) diaschisis mechanisms. These new pieces of evidence on the role of callosum can help to understand which compensatory mechanism may take place following a stroke. Moreover, depending on the individual impairment, the prefrontal control network will play different roles according to the need of high-level motor control. We believe that our new model, which includes crucial overlooked factors, will enable clinicians to better define individualized motor rehabilitation protocols.
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10
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Chiou-Tan F, Ughwanogho U, Taber K. Special anatomy series: Updates in structural, functional, and clinical relevance of the corpus callosum: What new imaging techniques have revealed. THE JOURNAL OF THE INTERNATIONAL SOCIETY OF PHYSICAL AND REHABILITATION MEDICINE 2022. [DOI: 10.4103/jisprm.jisprm-000159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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11
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Cassidy JM, Wodeyar A, Srinivasan R, Cramer SC. Coherent neural oscillations inform early stroke motor recovery. Hum Brain Mapp 2021; 42:5636-5647. [PMID: 34435705 PMCID: PMC8559506 DOI: 10.1002/hbm.25643] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 08/11/2021] [Accepted: 08/16/2021] [Indexed: 12/24/2022] Open
Abstract
Neural oscillations may contain important information pertaining to stroke rehabilitation. This study examined the predictive performance of electroencephalography‐derived neural oscillations following stroke using a data‐driven approach. Individuals with stroke admitted to an inpatient rehabilitation facility completed a resting‐state electroencephalography recording and structural neuroimaging around the time of admission and motor testing at admission and discharge. Using a lasso regression model with cross‐validation, we determined the extent of motor recovery (admission to discharge change in Functional Independence Measurement motor subscale score) prediction from electroencephalography, baseline motor status, and corticospinal tract injury. In 27 participants, coherence in a 1–30 Hz band between leads overlying ipsilesional primary motor cortex and 16 leads over bilateral hemispheres predicted 61.8% of the variance in motor recovery. High beta (20–30 Hz) and alpha (8–12 Hz) frequencies contributed most to the model demonstrating both positive and negative associations with motor recovery, including high beta leads in supplementary motor areas and ipsilesional ventral premotor and parietal regions and alpha leads overlying contralesional temporal–parietal and ipsilesional parietal regions. Electroencephalography power, baseline motor status, and corticospinal tract injury did not significantly predict motor recovery during hospitalization (R2 = 0–6.2%). Findings underscore the relevance of oscillatory synchronization in early stroke rehabilitation while highlighting contributions from beta and alpha frequency bands and frontal, parietal, and temporal–parietal regions overlooked by traditional hypothesis‐driven prediction models.
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Affiliation(s)
- Jessica M Cassidy
- Department of Allied Health Sciences, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Anirudh Wodeyar
- Department of Cognitive Sciences, University of California Irvine, Irvine, California, USA
| | - Ramesh Srinivasan
- Department of Cognitive Sciences, University of California Irvine, Irvine, California, USA.,Department of Biomedical Engineering, University of California Irvine, Irvine, California, USA
| | - Steven C Cramer
- Department of Neurology, University of California, Los Angeles, Los Angeles, California, USA.,California Rehabilitation Institute, Los Angeles, California, USA
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12
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Upper and Lower Limb Motor Function Correlates with Ipsilesional Corticospinal Tract and Red Nucleus Structural Integrity in Chronic Stroke: A Cross-Sectional, ROI-Based MRI Study. Behav Neurol 2021; 2021:3010555. [PMID: 34804258 PMCID: PMC8601844 DOI: 10.1155/2021/3010555] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 10/27/2021] [Indexed: 12/31/2022] Open
Abstract
Background Structural integrity of the ipsilesional corticospinal tract (CST) is important for upper limb motor recovery after stroke. However, additional neuromechanisms associated with motor function poststroke are less well understood, especially regarding the lower limb. Objective To investigate the neural basis of upper/lower limb motor deficits poststroke by correlating measures of motor function with diffusion tensor imaging-derived indices of white matter integrity (fractional anisotropy (FA), mean diffusivity (MD)) in primary and secondary motor tracts/structures. Methods Forty-three individuals with chronic stroke (time poststroke, 64.4 ± 58.8 months) underwent a comprehensive motor assessment and MRI scanning. Correlation and multiple regression analyses were performed to examine relationships between FA/MD in a priori motor tracts/structures and motor function. Results FA in the ipsilesional CST and red nucleus (RN) was positively correlated with motor function of both the affected upper and lower limb (r = 0.36‐0.55, p ≤ 0.01), while only ipsilesional RN FA was associated with gait speed (r = 0.50). Ipsilesional CST FA explained 37.3% of the variance in grip strength (p < 0.001) and 31.5% of the variance in Arm Motricity Index (p = 0.004). Measures of MD were not predictors of motor performance. Conclusions Microstructural integrity of the ipsilesional CST is associated with both upper and lower limb motor function poststroke, but appears less important for gait speed. Integrity of the ipsilesional RN was also associated with motor performance, suggesting increased contributions from secondary motor areas may play a role in supporting chronic motor function and could become a target for interventions.
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13
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Lewis AF, Stewart JC. Comparison of corticospinal tract integrity measures extracted from standard versus native space in chronic stroke. J Neurosci Methods 2021; 359:109216. [PMID: 33971202 PMCID: PMC8205992 DOI: 10.1016/j.jneumeth.2021.109216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 04/16/2021] [Accepted: 04/30/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Fractional anisotropy (FA) and mean diffusivity (MD) are measures derived from diffusion-weighted imaging that represent the integrity of the corticospinal tract (CST) after stroke. Some studies of the motor system after stroke extract FA and MD from native space while others extract from standard space making comparison across studies challenging. NEW METHOD The purpose was to compare CST integrity measures extracted from standard versus native space in individuals with chronic stroke. Twenty-four individuals with stroke underwent diffusion-weighted imaging and motor impairment assessment. The spatial location of the CST was identified using four commonly utilized approaches; therefore, our results are applicable to a variety of approaches. RESULTS FA extracted from standard space (FAstd) was significantly different from FA extracted from native space (FAnat) for all four approaches; FAstd was greater than FAnat for three approaches. The relationship between ipsilesional CST FA and UE FM was significant for all approaches and similar regardless of extraction space. MDstd was significantly different from MDnat for most approaches, however, the directionality of the differences was not consistent. COMPARISON WITH EXISTING METHOD(S) Our study shows that extraction space influences diffusion-based microstructural integrity values (FA and MD) of the CST in individuals with stroke, which is important when considering methods for aggregating CST integrity data across studies. The relationship between CST integrity and motor impairment appears to be robust to extraction space. CONCLUSIONS The differences we identified are important for comparing FA and MD values across studies that use different extraction space. Our results provide context for future meta-analyses of diffusion-based metrics of CST integrity in individuals with stroke.
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Affiliation(s)
- Allison F Lewis
- Department of Exercise Science, University of South Carolina, Columbia, SC, 29201, USA.
| | - Jill C Stewart
- Department of Exercise Science, University of South Carolina, Columbia, SC, 29201, USA.
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14
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Mattos DJS, Rutlin J, Hong X, Zinn K, Shimony JS, Carter AR. White matter integrity of contralesional and transcallosal tracts may predict response to upper limb task-specific training in chronic stroke. NEUROIMAGE-CLINICAL 2021; 31:102710. [PMID: 34126348 PMCID: PMC8209270 DOI: 10.1016/j.nicl.2021.102710] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 05/25/2021] [Accepted: 05/26/2021] [Indexed: 11/19/2022]
Abstract
Increase in upper limb function post task specific training in chronic stroke. Motor improvements were not accompanied by changes in white matter integrity. Integrity in contralesional fibers predicted larger motor recovery in Responders. Non-responders had more severe damage of transcallosal fibers than Responders.
Objective To investigate white matter (WM) plasticity induced by intensive upper limb (UL) task specific training (TST) in chronic stroke. Methods Diffusion tensor imaging data and UL function measured by the Action Research Arm Test (ARAT) were collected in 30 individuals with chronic stroke prior to and after intensive TST. ANOVAs tested the effects of training on the entire sample and on the Responders [ΔARAT ≥ 5.8, N = 13] and Non-Responders [ΔARAT < 5.8, N = 17] groups. Baseline fractional anisotropy (FA) values were correlated with ARATpost TST controlling for baseline ARAT and age to identify voxels predictive of response to TST. Results. While ARAT scores increased following training (p < 0.0001), FA changes within major WM tracts were not significant at p < 0.05. In the Responder group, larger baseline FA of both contralesional (CL) and transcallosal tracts predicted larger ARAT scores post-TST. Subcortical lesions and more severe damage to transcallosal tracts were more pronounced in the Non-Responder than in the Responder group. Conclusions The motor improvements post-TST in the Responder group may reflect the engagement of interhemispheric processes not available to the Non-Responder group. Future studies should clarify differences in the role of CL and transcallosal pathways as biomarkers of recovery in response to training for individuals with cortical and subcortical stroke. This knowledge may help to identify sources of heterogeneity in stroke recovery, which is necessary for the development of customized rehabilitation interventions.
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Affiliation(s)
- Daniela J S Mattos
- Department of Neurology, Washington University School of Medicine, Saint Louis, MO 63110, USA.
| | - Jerrel Rutlin
- Department of Psychiatry, Washington University School of Medicine, Saint Louis, MO 63110, USA.
| | - Xin Hong
- Department of Genetics, Washington University School of Medicine, Saint Louis, MO 63110, USA.
| | - Kristina Zinn
- Department of Radiology, Washington University School of Medicine, Saint Louis, MO 63110, USA
| | - Joshua S Shimony
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, Saint Louis, MO 63110, USA.
| | - Alexandre R Carter
- Department of Neurology, Washington University School of Medicine, Saint Louis, MO 63110 USA.
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15
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Scheulin KM, Jurgielewicz BJ, Spellicy SE, Waters ES, Baker EW, Kinder HA, Simchick GA, Sneed SE, Grimes JA, Zhao Q, Stice SL, West FD. Exploring the predictive value of lesion topology on motor function outcomes in a porcine ischemic stroke model. Sci Rep 2021; 11:3814. [PMID: 33589720 PMCID: PMC7884696 DOI: 10.1038/s41598-021-83432-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 02/02/2021] [Indexed: 12/11/2022] Open
Abstract
Harnessing the maximum diagnostic potential of magnetic resonance imaging (MRI) by including stroke lesion location in relation to specific structures that are associated with particular functions will likely increase the potential to predict functional deficit type, severity, and recovery in stroke patients. This exploratory study aims to identify key structures lesioned by a middle cerebral artery occlusion (MCAO) that impact stroke recovery and to strengthen the predictive capacity of neuroimaging techniques that characterize stroke outcomes in a translational porcine model. Clinically relevant MRI measures showed significant lesion volumes, midline shifts, and decreased white matter integrity post-MCAO. Using a pig brain atlas, damaged brain structures included the insular cortex, somatosensory cortices, temporal gyri, claustrum, and visual cortices, among others. MCAO resulted in severely impaired spatiotemporal gait parameters, decreased voluntary movement in open field testing, and higher modified Rankin Scale scores at acute timepoints. Pearson correlation analyses at acute timepoints between standard MRI metrics (e.g., lesion volume) and functional outcomes displayed moderate R values to functional gait outcomes. Moreover, Pearson correlation analyses showed higher R values between functional gait deficits and increased lesioning of structures associated with motor function, such as the putamen, globus pallidus, and primary somatosensory cortex. This correlation analysis approach helped identify neuroanatomical structures predictive of stroke outcomes and may lead to the translation of this topological analysis approach from preclinical stroke assessment to a clinical biomarker.
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Affiliation(s)
- Kelly M Scheulin
- Regenerative Bioscience Center, University of Georgia, Athens, GA, USA
- Department of Animal and Dairy Sciences, University of Georgia, Athens, GA, USA
- Biomedical and Health Sciences Institute, Neuroscience Program, University of Georgia, Athens, GA, USA
| | - Brian J Jurgielewicz
- Regenerative Bioscience Center, University of Georgia, Athens, GA, USA
- Department of Animal and Dairy Sciences, University of Georgia, Athens, GA, USA
- Biomedical and Health Sciences Institute, Neuroscience Program, University of Georgia, Athens, GA, USA
| | - Samantha E Spellicy
- Regenerative Bioscience Center, University of Georgia, Athens, GA, USA
- Department of Animal and Dairy Sciences, University of Georgia, Athens, GA, USA
- Biomedical and Health Sciences Institute, Neuroscience Program, University of Georgia, Athens, GA, USA
| | - Elizabeth S Waters
- Regenerative Bioscience Center, University of Georgia, Athens, GA, USA
- Department of Animal and Dairy Sciences, University of Georgia, Athens, GA, USA
- Biomedical and Health Sciences Institute, Neuroscience Program, University of Georgia, Athens, GA, USA
| | | | - Holly A Kinder
- Regenerative Bioscience Center, University of Georgia, Athens, GA, USA
- Department of Animal and Dairy Sciences, University of Georgia, Athens, GA, USA
| | - Gregory A Simchick
- Regenerative Bioscience Center, University of Georgia, Athens, GA, USA
- Department of Physics, University of Georgia, Athens, GA, USA
| | - Sydney E Sneed
- Regenerative Bioscience Center, University of Georgia, Athens, GA, USA
- Department of Animal and Dairy Sciences, University of Georgia, Athens, GA, USA
| | - Janet A Grimes
- Department of Small Animal Medicine and Surgery, College of Veterinary Medicine, University of Georgia, Athens, GA, USA
| | - Qun Zhao
- Regenerative Bioscience Center, University of Georgia, Athens, GA, USA
- Department of Physics, University of Georgia, Athens, GA, USA
| | - Steven L Stice
- Regenerative Bioscience Center, University of Georgia, Athens, GA, USA
- Department of Animal and Dairy Sciences, University of Georgia, Athens, GA, USA
- Biomedical and Health Sciences Institute, Neuroscience Program, University of Georgia, Athens, GA, USA
- Aruna Bio Inc, Athens, GA, USA
| | - Franklin D West
- Regenerative Bioscience Center, University of Georgia, Athens, GA, USA.
- Department of Animal and Dairy Sciences, University of Georgia, Athens, GA, USA.
- Biomedical and Health Sciences Institute, Neuroscience Program, University of Georgia, Athens, GA, USA.
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16
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Cramer SC, Wolf SL, Saver JL, Johnston KC, Mocco J, Lansberg MG, Savitz SI, Liebeskind DS, Smith W, Wintermark M, Elm JJ, Khatri P, Broderick JP, Janis S. The Utility of Domain-Specific End Points in Acute Stroke Trials. Stroke 2021; 52:1154-1161. [PMID: 33563009 DOI: 10.1161/strokeaha.120.031939] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Steven C Cramer
- Department of Neurology, David Geffen School of Medicine at the University of California, Los Angeles (S.C.C., J.L.S., D.S.L.).,California Rehabilitation Institute, Los Angeles (S.C.C.)
| | - Steven L Wolf
- Division of Physical Therapy, Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, GA (S.L.W.)
| | - Jeffrey L Saver
- Department of Neurology, David Geffen School of Medicine at the University of California, Los Angeles (S.C.C., J.L.S., D.S.L.)
| | - Karen C Johnston
- Department of Neurology, University of Virginia, Charlottesville (K.C.J.)
| | - J Mocco
- Department of Neurosurgery, Mt. Sinai, New York (J.M.)
| | | | - Sean I Savitz
- Institute for Stroke and Cerebrovascular Disease, University of Texas Health Science Center, Houston (S.I.S.)
| | - David S Liebeskind
- Department of Neurology, David Geffen School of Medicine at the University of California, Los Angeles (S.C.C., J.L.S., D.S.L.)
| | - Wade Smith
- Department Neurology, University of California, San Francisco (W.S.)
| | | | - Jordan J Elm
- Department of Public Health Sciences, Medical University of South Carolina, Charleston (J.J.E.)
| | - Pooja Khatri
- Department of Neurology, University of Cincinnati (P.K.)
| | - Joseph P Broderick
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati Gardner Neuroscience Institute, University of Cincinnati Academic Health Center, OH (J.P.B.)
| | - Scott Janis
- Division of Clinical Research, The National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD (S.J.)
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17
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Lench DH, Hutchinson S, Woodbury ML, Hanlon CA. Kinematic Measures of Bimanual Performance are Associated With Callosum White Matter Change in People With Chronic Stroke. Arch Rehabil Res Clin Transl 2021; 2:100075. [PMID: 33543100 PMCID: PMC7853365 DOI: 10.1016/j.arrct.2020.100075] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Objectives To investigate the relationship between bimanual performance deficits measured using kinematics and callosum (CC) white matter changes that occur in people with chronic stroke. Design Cross-sectional, observational study of participants with chronic stroke and age-matched controls. Setting Recruitment and assessments occurred at a stroke recovery research center. Behavioral assessments were performed in a controlled laboratory setting. Magnetic resonance imaging scans were performed at the Center for Biomedical Imaging. Participants Individuals were enrolled and completed the study (N=39; 21 participants with chronic stroke; 18 age-matched controls with at least 2 stroke risk factors). Main Outcome Measures Diffusion imaging metrics were obtained for each individual’s CC and corticospinal tract (CST), including mean kurtosis (MK) and fractional anisotropy (FA). A battery of motor assessments, including bimanual kinematics, were collected from individuals while performing bimanual reaching. Results Participants with stroke had lower FA and MK in the CST of the lesioned hemisphere when compared with the non-lesioned hemisphere. The FA and MK values in the CST were correlated with measures of unimanual hand performance. In addition, participants with stroke had significantly lower FA and MK in the CC than matched controls. CC diffusion metrics positively correlated with hand asymmetry and trunk displacement during bimanual performance, even when correcting for age and lesion volume. Conclusions These data confirm previous studies that linked CST integrity to unimanual performance and provide new data demonstrating a link between CC integrity and both bimanual motor deficits and compensatory movements. Fractional anisotropy and mean kurtosis in the corpus callosum are lower in participants with stroke. Hand position symmetry and trunk displacement are disrupted during bimanual tasks. Corpus callosum white matter correlated with bimanual kinematics in participants with stroke.
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Key Words
- ANOVA, analysis of variance
- ARAT, Action Research Arm Test
- CC, corpus callosum
- CST, corticospinal tract
- DKI, diffusion kurtosis imaging
- DTI, diffusion tensor imaging
- Diffusion
- FA, fractional anisotropy
- FMA, Fugl-Meyer Assessment
- M1, primary motor cortex
- MK, mean kurtosis
- MRI, magnetic resonance imaging
- Motor Activity
- Pyramidal Tracts
- ROI, region of interest
- Rehabilitation
- SMA, supplementary motor area
- Stroke
- UE, upper extremity
- WMFT, Wolf Motor Function Test
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Affiliation(s)
- Daniel H. Lench
- Departments of Psychiatry and Neurosciences, College of Medicine, Medical University of South Carolina, Charleston, SC
| | - Scott Hutchinson
- Department of Health Research, College of Health Professions, Medical University of South Carolina, Charleston, SC
| | - Michelle L. Woodbury
- Department of Health Research, College of Health Professions, Medical University of South Carolina, Charleston, SC
| | - Colleen A. Hanlon
- Departments of Psychiatry and Neurosciences, College of Medicine, Medical University of South Carolina, Charleston, SC
- Department of Health Research, College of Health Professions, Medical University of South Carolina, Charleston, SC
- Department of Cancer Biology, College of Medicine, Wake Forest Health Sciences, Winston-Salem, NC
- Corresponding author Colleen A. Hanlon, PhD, 1 Medical Center Blvd, Wake Forest School of Medicine, Winston-Salem, NC 27157.
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18
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Nazarova M, Kulikova S, Piradov MA, Limonova AS, Dobrynina LA, Konovalov RN, Novikov PA, Sehm B, Villringer A, Saltykova A, Nikulin VV. Multimodal Assessment of the Motor System in Patients With Chronic Ischemic Stroke. Stroke 2020; 52:241-249. [PMID: 33317414 DOI: 10.1161/strokeaha.119.028832] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND PURPOSE Despite continuing efforts in the multimodal assessment of the motor system after stroke, conclusive findings on the complementarity of functional and structural metrics of the ipsilesional corticospinal tract integrity and the role of the contralesional hemisphere are still lacking. This research aimed to find the best combination of motor system metrics, allowing the classification of patients into 3 predefined groups of upper limb motor recovery. METHODS We enrolled 35 chronic ischemic stroke patients (mean 47 [26-66] years old, 29 [6-58] months poststroke) with a single supratentorial lesion and unilateral upper extremity weakness. Patients were divided into 3 groups, depending on upper limb motor recovery: good, moderate, and bad. Nonparametric statistical tests and regression analysis were used to investigate the relationships among microstructural (fractional anisotropy (FA) ratio of the corticospinal tracts at the internal capsule (IC) level (classic method) and along the length of the tracts (Fréchet distance), and of the corpus callosum) and functional (motor evoked potentials [MEPs] for 2 hand muscles) motor system metrics. Stratification rules were also tested using a decision tree classifier. RESULTS IC FA ratio in the IC and MEP absence were both equally discriminative of the bad motor outcome (96% accuracy). For the 3 recovery groups' classification, the best parameter combination was IC FA ratio and the Fréchet distance between the contralesional and ipsilesional corticospinal tract FA profiles (91% accuracy). No other metrics had any additional value for patients' classification. MEP presence differed for 2 investigated muscles. CONCLUSIONS This study demonstrates that better separation between 3 motor recovery groups may be achieved when considering the similarity between corticospinal tract FA profiles along its length in addition to region of interest-based assessment and lesion load calculation. Additionally, IC FA ratio and MEP absence are equally important markers for poor recovery, while for MEP probing it may be important to investigate more than one hand muscle.
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Affiliation(s)
- Maria Nazarova
- Centre for Cognition and Decision making, ICN, HSE University, Moscow, Russia (M.N., A.L., P.N., V.N.).,FSBI «Federal center of brain and neurotechnologies» of the Federal Medical Biological Agency, Moscow, Russia (M.N.)
| | | | | | - Alena S Limonova
- Laboratory of Clinomics, National Medical Research Center for Therapy & Preventive Medicine, Moscow, Russia (A.L.)
| | | | | | - Pavel A Novikov
- Centre for Cognition and Decision making, ICN, HSE University, Moscow, Russia (M.N., A.L., P.N., V.N.)
| | - Bernhard Sehm
- Department of Neurology, Martin Luther University of Halle-Wittenberg, Germany (B.S.).,Department of Neurology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany (B.S., A.V., V.N.)
| | - Arno Villringer
- Department of Neurology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany (B.S., A.V., V.N.).,Clinic for Cognitive Neurology, University Hospital Leipzig, Germany (A.V.)
| | | | - Vadim V Nikulin
- Centre for Cognition and Decision making, ICN, HSE University, Moscow, Russia (M.N., A.L., P.N., V.N.).,Department of Neurology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany (B.S., A.V., V.N.)
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19
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Neural correlates of within-session practice effects in mild motor impairment after stroke: a preliminary investigation. Exp Brain Res 2020; 239:151-160. [PMID: 33130906 DOI: 10.1007/s00221-020-05964-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 10/16/2020] [Indexed: 12/20/2022]
Abstract
While the structural integrity of the corticospinal tract (CST) has been shown to support motor performance after stroke, the neural correlates of within-session practice effects are not known. The purpose of this preliminary investigation was to examine the structural brain correlates of within-session practice effects on a functional motor task completed with the more impaired arm after stroke. Eleven individuals with mild motor impairment (mean age 57.0 ± 9.4 years, mean months post-stroke 37.0 ± 66.1, able to move ≥ 26 blocks on the Box and Blocks Test) due to left hemisphere stroke completed structural MRI and practiced a functional motor task that involved spooning beans from a start cup to three distal targets. Performance on the motor task improved with practice (p = 0.004), although response was variable. Baseline motor performance (Block 1) correlated with integrity of the CST (r = - 0.696) while within-session practice effects (change from Block 1 to Block 3) did not. Instead, practice effects correlated with degree of lesion to the superior longitudinal fasciculus (r = 0.606), a pathway that connects frontal and parietal brain regions previously shown to support motor learning. This difference between white matter tracts associated with baseline motor performance and within-session practice effects may have implications for understanding response to motor practice and the application of brain-focused intervention approaches aimed at improving hand function after stroke.
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20
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Loprinzi PD, Harper J, Ikuta T. The effects of aerobic exercise on corpus callosum integrity: systematic review. PHYSICIAN SPORTSMED 2020; 48:400-406. [PMID: 32315243 DOI: 10.1080/00913847.2020.1758545] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Objective: To evaluate the influence of exercise on the body and genu of the corpus callosum (CC), which is a critical brain structure involved in facilitating interhemispheric communication. Methods: Studies were identified using electronic databases, including PubMed, PsychInfo, Sports Discus and Google Scholar. The search terms, including their combinations, included exercise, physical activity, cardiorespiratory fitness, interhemispheric, and corpus callosum. To be eligible for inclusion in this review, studies had to be published in English; employ a cross-sectional, prospective or experimental design; include a measure of exercise as the independent variable; and the outcome variable had to include an integrity, volumetric or functional measure of the CC. Extraction parameters include study design, study population, exercise protocol, CC assessment, main findings regarding the relationship between exercise and the CC, and the evaluated or speculated mechanisms of this relationship. Results: 20 articles met the study inclusion criteria. Among these, 5 were conducted in animals and 15 were conducted in humans. Among the 5 animal studies, all provided suggestive evidence associating aerobic exercise with increased white matter integrity. Among the 15 human studies, 6 studies employed tract-based special statistics (TBSS), 4 utilized regions of interest (ROI) approach and 5 executed whole brain voxel wise analysis. Changes in the body was detected by 5 out of 6 TBSS studies and the genu by 3. Out of 4 ROI studies, three detected changes in the genu, but only one did in the body (out of 3 studies). One whole brain voxelwise study detected changes in the CC body of old adults and two found changes in the genu. Conclusion: This review provides evidence to suggest that aerobic exercise, and in turn, enhanced cardiorespiratory fitness, are associated with structural and functional outcomes increasing CC integrity.
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Affiliation(s)
- Paul D Loprinzi
- Exercise & Memory Laboratory Department of Health, Exercise Science and Recreation Management, The University of Mississippi , University, MS, USA
| | - Jacob Harper
- Exercise & Memory Laboratory Department of Health, Exercise Science and Recreation Management, The University of Mississippi , University, MS, USA
| | - Toshikazu Ikuta
- Digital Neuroscience Laboratory Department of Communication Sciences and Disorders, The University of Mississippi , University, MS, USA
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21
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A Review of Exercise-Induced Neuroplasticity in Ischemic Stroke: Pathology and Mechanisms. Mol Neurobiol 2020; 57:4218-4231. [PMID: 32691303 DOI: 10.1007/s12035-020-02021-1] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Accepted: 07/08/2020] [Indexed: 12/13/2022]
Abstract
After ischemic stroke, survivors experience motor dysfunction and deterioration of memory and cognition. These symptoms are associated with the disruption of normal neuronal function, i.e., the secretion of neurotrophic factors, interhemispheric connections, and synaptic activity, and hence the disruption of the normal neural circuit. Exercise is considered an effective and feasible rehabilitation strategy for improving cognitive and motor recovery following ischemic stroke through the facilitation of neuroplasticity. In this review, our aim was to discuss the mechanisms by which exercise-induced neuroplasticity improves motor function and cognitive ability after ischemic stroke. The associated mechanisms include increases in neurotrophins, improvements in synaptic structure and function, the enhancement of interhemispheric connections, the promotion of neural regeneration, the acceleration of neural function reorganization, and the facilitation of compensation beyond the infarcted tissue. We also discuss some common exercise strategies and a novel exercise therapy, robot-assisted movement, which might be widely applied in the clinic to help stroke patients in the future.
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22
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Lewis AF, Myers M, Heiser J, Kolar M, Baird JF, Stewart JC. Test-retest reliability and minimal detectable change of corticospinal tract integrity in chronic stroke. Hum Brain Mapp 2020; 41:2514-2526. [PMID: 32090440 PMCID: PMC7268047 DOI: 10.1002/hbm.24961] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 02/07/2020] [Accepted: 02/11/2020] [Indexed: 02/04/2023] Open
Abstract
Diffusion tensor imaging (DTI) can be used to index white matter integrity of the corticospinal tract (CST) after stroke; however, the psychometric properties of DTI-based measures of white matter integrity are unknown. The purpose of this study was to examine test-retest reliability as determined by intraclass correlation coefficients (ICC) and calculate minimal detectable change (MDC) of DTI-based measures of CST integrity using three different approaches: a Cerebral Peduncle approach, a Probabilistic Tract approach, and a Tract Template approach. Eighteen participants with chronic stroke underwent DTI on the same magnetic resonance imaging scanner 4 days apart. For the Cerebral Peduncle approach, a researcher hand drew masks at the cerebral peduncle. For the Probabilistic Tract approach, tractography was seeded in motor areas of the cortex to the cerebral peduncle. For the Tract Template approach, a standard CST template was transformed into native space. For all approaches, the researcher performing analyses was blind to participant number and day of data collection. All three approaches had good to excellent test-retest reliability for fractional anisotropy (FA; ICCs >0.786). Mean diffusivity, axial diffusivity, and radial diffusivity were less reliable than FA. The ICC values were highest and MDC values were the smallest for the most automated approach (Tract Template), followed by the combined manual/automated approach (Probabilistic Tract) then the manual approach (Cerebral Peduncle). The results of this study may have implications for how DTI-based measures of CST integrity are used to define impairment, predict outcomes, and interpret change after stroke.
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Affiliation(s)
- Allison F. Lewis
- Department of Exercise ScienceUniversity of South CarolinaColumbiaSouth Carolina
| | - Makenzie Myers
- Department of Exercise ScienceUniversity of South CarolinaColumbiaSouth Carolina
| | - Jenny Heiser
- Department of Exercise ScienceUniversity of South CarolinaColumbiaSouth Carolina
| | - Melissa Kolar
- Department of Exercise ScienceUniversity of South CarolinaColumbiaSouth Carolina
| | - Jessica F. Baird
- Department of Exercise ScienceUniversity of South CarolinaColumbiaSouth Carolina
| | - Jill C. Stewart
- Department of Exercise ScienceUniversity of South CarolinaColumbiaSouth Carolina
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23
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Hordacre B, Goldsworthy MR, Welsby E, Graetz L, Ballinger S, Hillier S. Resting State Functional Connectivity Is Associated With Motor Pathway Integrity and Upper-Limb Behavior in Chronic Stroke. Neurorehabil Neural Repair 2020; 34:547-557. [PMID: 32436426 DOI: 10.1177/1545968320921824] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Background. Resting state functional connectivity (RSFC) is a developmental priority for stroke recovery. Objective. To determine whether (1) RSFC differs between stroke survivors based on integrity of descending motor pathways; (2) RSFC is associated with upper-limb behavior in chronic stroke; and (3) the relationship between interhemispheric RSFC and upper-limb behavior differs based on descending motor pathway integrity. Methods. A total of 36 people with stroke (aged 64.4 ± 11.1 years, time since stroke 4.0 ± 2.8 years) and 25 healthy adults (aged 67.3 ± 6.7 years) participated in this study. RSFC was estimated from electroencephalography (EEG) recordings. Integrity of descending motor pathways was ascertained using transcranial magnetic stimulation to determine motor-evoked potential (MEP) status and magnetic resonance imaging to determine lesion overlap and fractional anisotropy of the corticospinal tract (CST). For stroke participants, upper-limb motor behavior was assessed using the Fugl-Meyer test, Action Research Arm Test and grip strength. Results. β-Frequency interhemispheric sensorimotor RSFC was greater for MEP+ stroke participants compared with MEP- (P = .020). There was a significant positive correlation between β RSFC and upper-limb behavior (P = .004) that appeared to be primarily driven by the MEP+ group. A hierarchical regression identified that the addition of β RSFC to measures of CST integrity explained greater variance in upper-limb behavior (R2 change = 0.13; P = .01). Conclusions. This study provides insight to understand the role of EEG-based measures of interhemispheric network activity in chronic stroke. Resting state interhemispheric connectivity was positively associated with upper-limb behavior for stroke survivors where residual integrity of descending motor pathways was maintained.
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Affiliation(s)
- Brenton Hordacre
- University of South Australia, IIMPACT in Health, Adelaide, Australia
| | - Mitchell R Goldsworthy
- Lifespan Human Neurophysiology group, Adelaide Medical School, The University of Adelaide, Australia
| | - Ellana Welsby
- University of South Australia, IIMPACT in Health, Adelaide, Australia
| | - Lynton Graetz
- Lifespan Human Neurophysiology group, Adelaide Medical School, The University of Adelaide, Australia
| | - Sophie Ballinger
- Lifespan Human Neurophysiology group, Adelaide Medical School, The University of Adelaide, Australia
| | - Susan Hillier
- University of South Australia, IIMPACT in Health, Adelaide, Australia
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24
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Berenguer-Rocha M, Baltar A, Rocha S, Shirahige L, Brito R, Monte-Silva K. Interhemispheric asymmetry of the motor cortex excitability in stroke: relationship with sensory-motor impairment and injury chronicity. Neurol Sci 2020; 41:2591-2598. [PMID: 32253636 DOI: 10.1007/s10072-020-04350-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Accepted: 03/16/2020] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To compare the interhemispheric asymmetry of the motor cortex excitability of chronic stroke patients with healthy and to observe if the magnitude of this asymmetry is associated to sensory-motor impairment and stroke chronicity. METHODS This cross-sectional study was performed with chronic stroke and aged and sex-matched healthy individuals. The interhemispheric asymmetry index was calculated by the difference of rest motor threshold (rMT) of the brain hemispheres. The rMT was assessed by transcranial magnetic stimulation over the cortical representation of the first dorsal interosseous muscle. To investigate the relationship of the asymmetry with sensory-motor impairment and injury chronicity, the stroke patients were grouped according to the level of sensory-motor impairment (mild/moderate, moderate/severe, and severe) and different chronicity stages (> 3-12, 13-24, 25-60, and > 60 months since stroke). RESULTS Fifty-six chronic stroke and twenty-six healthy were included. We found higher interhemispheric asymmetry in stroke patients (mean, 27.1 ± 20.9) compared to healthy (mean, 4.9 ± 4.7). The asymmetry was higher in patients with moderate/severe (mean, 35.4 ± 20.4) and severe (mean, 32.9 ± 22.7) impairment. No difference was found between patients with mild/moderate impairment (mean, 15.5 ± 12.5) and healthy. There were no differences of the interhemispheric asymmetry between patients with different times since stroke (> 3-12, mean, 32 ± 18.1; > 13-24, mean, 20.7 ± 16.2; > 25-60, mean, 29.6 ± 18.1; > 60 months, mean, 25.9 ± 17.5). CONCLUSION Stroke patients showed higher interhemispheric asymmetry of the motor cortex excitability when compared to healthy, and the magnitude of this asymmetry seems to be correlated with the severity of sensory-motor impairment, but not with stroke chronicity. SIGNIFICANCE Higher interhemispheric asymmetry was found in stroke patients with greatest sensory-motor impairment.
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Affiliation(s)
- Marina Berenguer-Rocha
- Applied Neuroscience Laboratory, Department of Physical Therapy, Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil
| | - Adriana Baltar
- Applied Neuroscience Laboratory, Department of Physical Therapy, Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil
| | - Sérgio Rocha
- Applied Neuroscience Laboratory, Department of Physical Therapy, Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil
| | - Lívia Shirahige
- Applied Neuroscience Laboratory, Department of Physical Therapy, Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil
| | - Rodrigo Brito
- Applied Neuroscience Laboratory, Department of Physical Therapy, Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil
| | - Kátia Monte-Silva
- Applied Neuroscience Laboratory, Department of Physical Therapy, Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil.
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Pinter D, Gattringer T, Fandler-Höfler S, Kneihsl M, Eppinger S, Deutschmann H, Pichler A, Poltrum B, Reishofer G, Ropele S, Schmidt R, Enzinger C. Early Progressive Changes in White Matter Integrity Are Associated with Stroke Recovery. Transl Stroke Res 2020; 11:1264-1272. [PMID: 32130685 PMCID: PMC7575507 DOI: 10.1007/s12975-020-00797-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 02/12/2020] [Accepted: 02/24/2020] [Indexed: 11/26/2022]
Abstract
Information on microstructural white matter integrity has been shown to explain post-stroke recovery beyond clinical measures and focal brain damage. Especially, knowledge about early white matter changes might improve prediction of outcome. We investigated 42 acute reperfused ischemic stroke patients (mean age 66.5 years, 40% female, median admission NIHSS 9.5) with a symptomatic MRI-confirmed unilateral middle cerebral artery territory infarction 24-72 h post-stroke and after 3 months. All patients underwent neurological examination and brain MRI. Fifteen older healthy controls (mean age 57.3 years) were also scanned twice. We assessed fractional anisotropy (FA), mean diffusivity (MD), axial (AD), and radial diffusivity (RD). Patients showed significantly decreased white matter integrity in the hemisphere affected by the acute infarction 24-72 h post-stroke, which further decreased over 3 months compared with controls. Less decrease in FA of remote white matter tracts was associated with better stroke recovery even after correcting for infarct location and extent. A regression model including baseline information showed that the modified Rankin Scale and mean FA of the genu of the corpus callosum explained 53.5% of the variance of stroke recovery, without contribution of infarct volume. Furthermore, early dynamic FA changes of the corpus callosum within the first 3 months post-stroke independently predicted stroke recovery. Information from advanced MRI measures on white matter integrity at the acute stage, as well as early dynamic white matter degeneration beyond infarct location and extent, improve our understanding of post-stroke reorganization in the affected hemisphere and contribute to an improved prediction of recovery.
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Affiliation(s)
- Daniela Pinter
- Department of Neurology, Research Unit for Neuronal Plasticity and Repair, Medical University of Graz, Graz, Austria.
- Department of Neurology, Medical University of Graz, Graz, Austria.
| | - Thomas Gattringer
- Department of Neurology, Medical University of Graz, Graz, Austria
- Department of Radiology, Division of Neuroradiology, Vascular and Interventional Radiology, Medical University of Graz, Graz, Austria
| | | | - Markus Kneihsl
- Department of Neurology, Medical University of Graz, Graz, Austria
| | | | - Hannes Deutschmann
- Department of Radiology, Division of Neuroradiology, Vascular and Interventional Radiology, Medical University of Graz, Graz, Austria
| | | | - Birgit Poltrum
- Department of Neurology, Medical University of Graz, Graz, Austria
| | - Gernot Reishofer
- Department of Radiology, Division of Neuroradiology, Vascular and Interventional Radiology, Medical University of Graz, Graz, Austria
| | - Stefan Ropele
- Department of Neurology, Medical University of Graz, Graz, Austria
| | - Reinhold Schmidt
- Department of Neurology, Medical University of Graz, Graz, Austria
| | - Christian Enzinger
- Department of Neurology, Research Unit for Neuronal Plasticity and Repair, Medical University of Graz, Graz, Austria
- Department of Neurology, Medical University of Graz, Graz, Austria
- Department of Radiology, Division of Neuroradiology, Vascular and Interventional Radiology, Medical University of Graz, Graz, Austria
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26
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Bundy DT, Leuthardt EC. The Cortical Physiology of Ipsilateral Limb Movements. Trends Neurosci 2019; 42:825-839. [PMID: 31514976 PMCID: PMC6825896 DOI: 10.1016/j.tins.2019.08.008] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 07/25/2019] [Accepted: 08/16/2019] [Indexed: 12/19/2022]
Abstract
Whereas voluntary movements have long been understood to derive primarily from the cortical hemisphere contralateral to a moving limb, substantial cortical activations also occur in the same-sided, or ipsilateral, cortical hemisphere. These ipsilateral motor activations have recently been shown to be useful to decode specific movement features. Furthermore, in contrast to the classical understanding that unilateral limb movements are solely driven by the contralateral hemisphere, it appears that the ipsilateral hemisphere plays an active and specific role in the planning and execution of voluntary movements. Here we review the movement-related activations observed in the ipsilateral cortical hemisphere, interpret this evidence in light of the potential roles of the ipsilateral hemisphere in the planning and execution of movements, and describe the implications for clinical populations.
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Affiliation(s)
- David T Bundy
- Department of Rehabilitation Medicine, University of Kansas Medical Center, Kansas City, KS, USA; Department of Biomedical Engineering, Washington University, St. Louis, MO, USA
| | - Eric C Leuthardt
- Department of Biomedical Engineering, Washington University, St. Louis, MO, USA; Department of Neurological Surgery, Washington University, St. Louis, MO, USA; Center of Innovation in Neuroscience and Technology, Washington University, St. Louis, MO, USA.
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27
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Rüber T, Schlaug G. Repair after brainstem ischemia involves neurogenesis and the rubrospinal system. Ann Neurol 2019; 83:1069-1071. [PMID: 29908075 DOI: 10.1002/ana.25265] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 05/19/2018] [Accepted: 05/21/2018] [Indexed: 12/19/2022]
Affiliation(s)
- Theodor Rüber
- Department of Epileptology, University of Bonn Medical Center, Bonn, Germany
| | - Gottfried Schlaug
- Department of Neurology Division of Stroke Recovery and Neurorestoration and Division of Cerebrovascular Diseases, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA
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28
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Koh CL, Tang PF, Chen HI, Hsu YC, Hsieh CL, Tseng WYI. Impaired Callosal Motor Fiber Integrity and Upper Extremity Motor Impairment Are Associated With Stroke Lesion Location. Neurorehabil Neural Repair 2019; 32:602-612. [PMID: 30016930 DOI: 10.1177/1545968318779730] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Damage to the callosal motor fibers (CMFs) may affect motor recovery in patients with stroke. However, whether the severity of CMF impairment varies with lesion locations remains unclear. OBJECTIVE To investigate (1) whether CMF impairment occurs after stroke and whether the impairment varies with lesion locations and (2) the associations of CMF impairment and upper extremity (UE) motor impairment. METHODS Twenty-nine patients with lesions involving the corticospinal tract (CST) were categorized into 2 groups: lesions involving the CMFs (CMF group, n = 15), and lesions not involving the CMFs (non-CMF group, n = 14). Thirteen healthy adults served as the control group. Tract integrity, assessed by the mean generalized fractional anisotropy (mGFA) using diffusion spectrum imaging, of the CMFs and the CST above the internal capsule (CSTABOVE) of the ipsilesional hemisphere were compared. RESULTS After accounting for the effect of lesion load on the CST, the CMF group exhibited a significantly lower mGFA of the CMFs than did the control and non-CMF groups (post hoc P = .005 and .001, respectively). No significant difference was observed between the non-CMF and control groups (post hoc P = .999). The CST and CMF impairment accounted for 56% of the variance of UE motor impairment in the CMF group ( P = .007), whereas no significant association was observed in the non-CMF group ( P = .570). CONCLUSIONS CMF impairment after stroke depends on lesion locations and CMF integrity has an incremental contribution to the severity of UE motor impairment in the CMF group.
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Affiliation(s)
- Chia-Lin Koh
- 1 National Taiwan University, Taipei, Taiwan.,2 Florey Institute of Neuroscience and Mental Health, Melbourne, Victoria, Australia
| | - Pei-Fang Tang
- 1 National Taiwan University, Taipei, Taiwan.,3 National Taiwan University Hospital, Taipei, Taiwan
| | | | | | - Ching-Lin Hsieh
- 1 National Taiwan University, Taipei, Taiwan.,3 National Taiwan University Hospital, Taipei, Taiwan
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29
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Yu X, Jiaerken Y, Xu X, Jackson A, Huang P, Yang L, Yuan L, Lou M, Jiang Q, Zhang M. Abnormal corpus callosum induced by diabetes impairs sensorimotor connectivity in patients after acute stroke. Eur Radiol 2018; 29:115-123. [PMID: 29926208 DOI: 10.1007/s00330-018-5576-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Revised: 05/16/2018] [Accepted: 05/29/2018] [Indexed: 12/24/2022]
Abstract
OBJECTIVES To test the hypothesis that abnormal corpus callosum (CC) induced by diabetes may impair inter-hemispheric sensorimotor functional connectivity (FC) that is associated with poor clinical outcome after stroke. METHODS Forty-five patients with acute ischaemic stroke in the middle cerebral artery territory and 14 normal controls participated in the study. CC was divided into five subregions on three-dimensional T1-weighted image. The microstructural integrity of each subregion of CC was analysed by DTI and the inter-hemispheric FCs in primary motor cortex (M1-M1 FC) and primary sensory cortex (S1-S1 FC) were examined by resting-state functional magnetic resonance imaging. RESULTS Diabetic patients (n = 26) had significantly lower fractional anisotropy (FA) in the isthmus of CC (CCisthmus) when compared with non-diabetic patients (n = 19) and normal controls (p < 0.0001). In addition, diabetic patients had the lowest M1-M1 FC (p = 0.015) and S1-S1 FC (p = 0.001). In diabetic patients, reduced FA of CCisthmus correlated with decreased M1-M1 FC (r = 0.549, p = 0.004) and S1-S1 FC (r = 0.507, p = 0.008). Decreased M1-M1 FC was independently associated with poor outcome after stroke in patients with diabetes (odds ratio = 0.448, p = 0.017). CONCLUSIONS CC degeneration induced by diabetes impairs sensorimotor connectivity and dysfunction of motor connectivity can contribute to poor recovery after stroke in patients with diabetes. KEY POINTS • Abnormal isthmus of corpus callosum in stroke patients with diabetes. • Abnormal isthmus of corpus callosum correlated with decreased inter-hemispheric sensorimotor connectivity. • Decreased motor connectivity correlated with poor stroke outcome in diabetic patients.
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Affiliation(s)
- Xinfeng Yu
- Department of Radiology, The 2nd Affiliated Hospital of Zhejiang University, School of Medicine, No.88 Jiefang Road, Shangcheng District, Hangzhou, 310009, China
| | - Yeerfan Jiaerken
- Department of Radiology, The 2nd Affiliated Hospital of Zhejiang University, School of Medicine, No.88 Jiefang Road, Shangcheng District, Hangzhou, 310009, China
| | - Xiaojun Xu
- Department of Radiology, The 2nd Affiliated Hospital of Zhejiang University, School of Medicine, No.88 Jiefang Road, Shangcheng District, Hangzhou, 310009, China
| | - Alan Jackson
- Wolfson Molecular Imaging Centre, University of Manchester, Manchester, UK
| | - Peiyu Huang
- Department of Radiology, The 2nd Affiliated Hospital of Zhejiang University, School of Medicine, No.88 Jiefang Road, Shangcheng District, Hangzhou, 310009, China
| | - Linglin Yang
- Department of Psychiatry, The 2nd Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Lixia Yuan
- Department of Biomedical Engineering and Instrument Science, Key Laboratory for Biomedical Engineering of Education Ministry of China, Zhejiang University, Hangzhou, China
| | - Min Lou
- Department of Neurology, The 2nd Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Quan Jiang
- Department of Neurology, Henry Ford Health System, Detroit, Michigan, USA
| | - Minming Zhang
- Department of Radiology, The 2nd Affiliated Hospital of Zhejiang University, School of Medicine, No.88 Jiefang Road, Shangcheng District, Hangzhou, 310009, China.
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30
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Feldman SJ, Boyd LA, Neva JL, Peters S, Hayward KS. Extraction of corticospinal tract microstructural properties in chronic stroke. J Neurosci Methods 2018. [PMID: 29522781 DOI: 10.1016/j.jneumeth.2018.03.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Information about the structural integrity of the corticospinal tract (CST) from diffusion-weighted imaging can improve our ability to understand motor outcomes in people with upper limb impairment after stroke, especially those with severe impairment. Yet, there is no consensus on which method of CST generation most accurately represents function and impairment in individuals with chronic stroke. NEW METHOD The aim of the study was to compare different methods of CST reconstruction and resulting microstructural properties, as well as the relationship between these properties and motor function and impairment. Fifteen individuals with mild-moderate impairment and 15 with severe impairment who were in the chronic phase post-stroke underwent a diffusion-weighted imaging scan and motor function and impairment assessments. RESULTS Different relationships existed between reconstruction methods, microstructural properties, and impairment and function. In severe stroke, fractional anisotropy (FA) emerged over and above apparent diffusion coefficient (ADC) and tract number to index CST integrity; FA correlated with impairment and function, whereas ADC and tract number did not correlate. No significant differences between methods or microstructural properties were found in mild-moderate stroke. COMPARISON WITH EXISTING METHODS Our study demonstrates that CST reconstruction method influences the extraction of microstructural integrity in individuals with chronic severe stroke, with FA appearing to be the most representative method. A similar line of investigation is warranted earlier post-stroke. CONCLUSION Differences in this data set highlight the need to establish a common methodology for CST reconstruction and analysis which may eliminate discrepancies in interpreting DWI and enhance biomarker use post-stroke for motor function.
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Affiliation(s)
- S J Feldman
- Graduate Program in Neuroscience, Faculty of Medicine, University of British Columbia, Vancouver BC, V6T 1Z3, Canada
| | - L A Boyd
- Department of Physical Therapy, University of British Columbia, Vancouver BC, V6T 1Z3, Canada; Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver BC, V6T 1Z3, Canada
| | - J L Neva
- Department of Physical Therapy, University of British Columbia, Vancouver BC, V6T 1Z3, Canada
| | - S Peters
- Graduate Program in Rehabilitation Sciences, Faculty of Medicine, University of British Columbia, Vancouver BC, V6T 1Z3, Canada
| | - K S Hayward
- Department of Physical Therapy, University of British Columbia, Vancouver BC, V6T 1Z3, Canada; Stroke Division, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne VIC, 3084, Australia; NHMRC Centre of Research Excellence in Stroke Rehabilitation and Brain Recovery, Australia.
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31
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Stinear CM, Byblow WD, Ackerley SJ, Smith MC, Borges VM, Barber PA. PREP2: A biomarker-based algorithm for predicting upper limb function after stroke. Ann Clin Transl Neurol 2017; 4:811-820. [PMID: 29159193 PMCID: PMC5682112 DOI: 10.1002/acn3.488] [Citation(s) in RCA: 179] [Impact Index Per Article: 25.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Accepted: 09/08/2017] [Indexed: 12/11/2022] Open
Abstract
Objective Recovery of motor function is important for regaining independence after stroke, but difficult to predict for individual patients. Our aim was to develop an efficient, accurate, and accessible algorithm for use in clinical settings. Clinical, neurophysiological, and neuroimaging biomarkers of corticospinal integrity obtained within days of stroke were combined to predict likely upper limb motor outcomes 3 months after stroke. Methods Data from 207 patients recruited within 3 days of stroke [103 females (50%), median age 72 (range 18–98) years] were included in a Classification and Regression Tree analysis to predict upper limb function 3 months poststroke. Results The analysis produced an algorithm that sequentially combined a measure of upper limb impairment; age; the presence or absence of upper limb motor evoked potentials elicited with transcranial magnetic stimulation; and stroke lesion load obtained from MRI or stroke severity assessed with the NIHSS score. The algorithm makes correct predictions for 75% of patients. A key biomarker obtained with transcranial magnetic stimulation is required for one third of patients. This biomarker combined with NIHSS score can be used in place of more costly magnetic resonance imaging, with no loss of prediction accuracy. Interpretation The new algorithm is more accurate, efficient, and accessible than its predecessors, which may support its use in clinical practice. While further work is needed to potentially incorporate sensory and cognitive factors, the algorithm can be used within days of stroke to provide accurate predictions of upper limb functional outcomes at 3 months after stroke. www.presto.auckland.ac.nz
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Affiliation(s)
- Cathy M Stinear
- Department of Medicine University of Auckland Private Bag 92019 Auckland 1142 New Zealand.,Centre for Brain Research University of Auckland Private Bag 92019 Auckland 1142 New Zealand
| | - Winston D Byblow
- Centre for Brain Research University of Auckland Private Bag 92019 Auckland 1142 New Zealand.,Department of Exercise Sciences University of Auckland Private Bag 92019 Auckland 1142 New Zealand
| | - Suzanne J Ackerley
- Department of Medicine University of Auckland Private Bag 92019 Auckland 1142 New Zealand.,Centre for Brain Research University of Auckland Private Bag 92019 Auckland 1142 New Zealand
| | - Marie-Claire Smith
- Department of Medicine University of Auckland Private Bag 92019 Auckland 1142 New Zealand.,Centre for Brain Research University of Auckland Private Bag 92019 Auckland 1142 New Zealand
| | - Victor M Borges
- Department of Medicine University of Auckland Private Bag 92019 Auckland 1142 New Zealand.,Centre for Brain Research University of Auckland Private Bag 92019 Auckland 1142 New Zealand
| | - P Alan Barber
- Department of Medicine University of Auckland Private Bag 92019 Auckland 1142 New Zealand.,Centre for Brain Research University of Auckland Private Bag 92019 Auckland 1142 New Zealand.,Neurology Auckland District Health Board 2 Park Rd, Grafton Auckland 1023 New Zealand
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32
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Corticomuscular coherence in the acute and subacute phase after stroke. Clin Neurophysiol 2017; 128:2217-2226. [PMID: 28987993 DOI: 10.1016/j.clinph.2017.08.033] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Revised: 08/09/2017] [Accepted: 08/21/2017] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Stroke is one of the leading causes of physical disability due to damage of the motor cortex or the corticospinal tract. In the present study we set out to investigate the role of adaptations in the corticospinal pathway for motor recovery during the subacute phase after stroke. METHODS We examined 19 patients with clinically diagnosed stroke and 18 controls. The patients had unilateral mild to moderate weakness of the hand. Each patient attended two sessions at approximately 3days (acute) and 38days post stroke (subacute). Task-related changes in the communication between motor cortex and muscles were evaluated from coupling in the frequency domain between EEG and EMG during movement of the paretic hand. RESULTS Corticomuscular coherence (CMC) and intermuscular coherence (IMC) were reduced in patients as compared to controls. Paretic hand motor performance improved within 4-6weeks after stroke, but no change was observed in CMC or IMC. CONCLUSIONS CMC and IMC were reduced in patients in the early phase after stroke. However, changes in coherence do not appear to be an efficient marker for early recovery of hand function following stroke. SIGNIFICANCE This is the first study to demonstrate sustained reduced coherence in acute and subacute stroke.
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33
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Stewart JC, O'Donnell M, Handlery K, Winstein CJ. Skilled Reach Performance Correlates With Corpus Callosum Structural Integrity in Individuals With Mild Motor Impairment After Stroke: A Preliminary Investigation. Neurorehabil Neural Repair 2017; 31:657-665. [PMID: 28587545 DOI: 10.1177/1545968317712467] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Recovery of arm function after stroke is often incomplete. An improved understanding of brain structure-motor behavior relationships is needed for the development of novel and targeted rehabilitation interventions. OBJECTIVE To examine the relationship between skilled reach performance and the integrity of two putative white matter motor pathways, corticospinal tract and corpus callosum, after stroke. METHODS Eleven individuals with chronic stroke (poststroke duration, mean 62.5 ± 42.4 months) and mild motor impairment (upper extremity Fugl-Meyer score, mean 54.2 ± 7.6) reached to six targets presented at three distances and two directions. Fractional anisotropy (FA) obtained from diffusion tensor imaging was used to determine the structural integrity of the corticospinal tract and the corpus callosum. RESULTS Overall reach performance was decreased in the paretic arm compared with the nonparetic arm. While FA was decreased in the ipsilesional corticospinal tract, FA in the corticospinal tract did not correlate with variability in reach performance between individuals. Instead, FA in the premotor section of the corpus callosum correlated with reach performance; individuals with higher FA in premotor corpus callosum tended to reach faster with both the paretic and nonparetic arms. CONCLUSIONS The structural connections between the two premotor and supplemental cortices that traverse the premotor corpus callosum may play an important role in supporting motor control and could become a target for interventions aimed at improved arm function in this population.
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