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Matsuura C, Sakaeyama Y, Abe M, Mikai M, Kubota S, Fuchinoue Y, Terazono S, Kondo K, Harada N, Sugo N. Prediction of Motor Recovery Using Diffusion Tensor Imaging and Regional Cerebral Blood Flow in Postoperative Brain Tumors. Cureus 2024; 16:e65099. [PMID: 39045019 PMCID: PMC11263762 DOI: 10.7759/cureus.65099] [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] [Accepted: 07/22/2024] [Indexed: 07/25/2024] Open
Abstract
OBJECTIVE To determine whether diffusion tensor image (DTI) parameters and regional cerebral blood flow (rCBF) serve to preoperatively predict postoperative motor outcomes in patients with brain tumors. METHODS We included 81 patients with brain tumors who underwent surgical treatment. Motor function was assessed using the manual muscle test in the upper and lower limbs at admission and discharge. Fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (AD), radial diffusivity (RD), and their ratios (rFA, rMD, rAD, and rRD) were measured at the corona radiata, internal capsule, and cerebral peduncle of the corticospinal tract (CST). In addition, DTI and single photon emission computed tomography (SPECT) were synthesized to measure rCBF at the CST. RESULT Both DTI parameters and rCBF at the CST in the preoperative motor weakness group significantly differed from those of the preoperative normal function group. rFA at the cerebral peduncle and the internal capsule was considerably higher in those showing postoperative motor recovery than in those postoperative unchanged or with deteriorated motor function (P < 0.05). Moreover, there was significantly lower rMD and rRD at the internal capsule in the motor recovery group (P < 0.05, P < 0.01). Furthermore, rCBF was higher at all the cerebral peduncle, internal capsule, and corona radiate in the motor recovery group than in the unchanged and deteriorated motor function group (P < 0.05, P < 0.01, P < 0.01). CONCLUSION The analysis of DTI parameters and rCBF is useful in predicting postoperative motor outcomes in patients with brain tumors.
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Affiliation(s)
- Chie Matsuura
- Department of Neurosurgery (Omori), Toho University Graduate School of Medicine, Tokyo, JPN
| | - Yuki Sakaeyama
- Department of Neurosurgery (Omori), Faculty of Medicine, Toho University, Tokyo, JPN
| | - Mitsuyoshi Abe
- Department of Neurosurgery (Omori), Faculty of Medicine, Toho University, Tokyo, JPN
| | - Masataka Mikai
- Department of Neurosurgery (Omori), Faculty of Medicine, Toho University, Tokyo, JPN
| | - Shuhei Kubota
- Department of Neurosurgery (Omori), Faculty of Medicine, Toho University, Tokyo, JPN
| | - Yutaka Fuchinoue
- Department of Neurosurgery (Omori), Faculty of Medicine, Toho University, Tokyo, JPN
| | - Sayaka Terazono
- Department of Neurosurgery (Omori), Faculty of Medicine, Toho University, Tokyo, JPN
| | - Kosuke Kondo
- Department of Neurosurgery (Omori), Faculty of Medicine, Toho University, Tokyo, JPN
| | - Naoyuki Harada
- Department of Neurosurgery (Omori), Faculty of Medicine, Toho University, Tokyo, JPN
| | - Nobuo Sugo
- Department of Neurosurgery (Omori), Toho University Graduate School of Medicine, Tokyo, JPN
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Ikeda N, Sakurai M, Yamada E, Gotoh S, Tanabe N, Hayashi Y, Matsushita I. Factors associated with independent ambulation at 3 months after putaminal hemorrhage: an observational study. J Phys Ther Sci 2024; 36:167-174. [PMID: 38562533 PMCID: PMC10981957 DOI: 10.1589/jpts.36.167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 12/30/2023] [Indexed: 04/04/2024] Open
Abstract
[Purpose] This study was aimed at evaluating the clinical indicators for predicting ambulation at 3 months after putaminal hemorrhage. [Participants and Methods] The participants were 84 inpatients with putaminal hemorrhage. The patients' background characteristics and computed tomography findings at the time of the onset of putaminal hemorrhage were obtained from their medical records. Impaired consciousness, severity of hemiplegia, higher brain dysfunction, sensory impairment, activities of daily living, and ambulatory ability were evaluated. Logistic regression analysis was performed to identify factors associated with ambulation at 3 months, and receiver operating characteristic curve analysis was conducted to determine the predictive value of the identified factors and the optimal cut-off values. [Results] Ventricular rupture, severity of hemiplegia (determined using the 12-grade hemiplegia function test), and Functional Independence Measure cognitive score were found to be independent predictors of prognosis. Severity of hemiplegia was the strongest predictor of ambulation, with a sensitivity of 80.4% and specificity of 100% when the cut-off was set at grade 6 (the ability for coordinated movement of the extensor and flexor muscles of the hip joint). [Conclusion] The severity of hemiplegia, Functional Independence Measure cognitive score, and ventricular rupture were independently associated with ambulation in patients with putaminal hemorrhage. The ability of the hip joint movement is one of the most important factors in ambulation prognosis.
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Affiliation(s)
- Noriko Ikeda
- Department of Rehabilitation, Kanazawa Medical University
Hospital: 1-1 Daigaku, Uchinada, Ishikawa 920-0293, Japan
| | - Masaru Sakurai
- Department of Social and Environmental Medicine, Kanazawa
Medical University, Japan
| | - Emika Yamada
- Department of Social and Environmental Medicine, Kanazawa
Medical University, Japan
| | - Soichiro Gotoh
- Department of Social and Environmental Medicine, Kanazawa
Medical University, Japan
| | - Nozomu Tanabe
- Department of Physical and Rehabilitation Medicine,
Kanazawa Medical University, Japan
| | | | - Isao Matsushita
- Department of Physical and Rehabilitation Medicine,
Kanazawa Medical University, Japan
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3
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Taki S, Imura T, Mitsutake T, Iwamoto Y, Tanaka R, Imada N, Araki H, Araki O. Identifying the characteristics of patients with stroke who have difficulty benefiting from gait training with the hybrid assistive limb: a retrospective cohort study. Front Neurorobot 2024; 18:1336812. [PMID: 38390525 PMCID: PMC10881777 DOI: 10.3389/fnbot.2024.1336812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Accepted: 01/23/2024] [Indexed: 02/24/2024] Open
Abstract
Robot-assisted gait training is effective for walking independence in stroke rehabilitation, the hybrid assistive limb (HAL) is an example. However, gait training with HAL may not be effective for everyone, and it is not clear who is not expected to benefit. Therefore, we aimed to identify the characteristics of stroke patients who have difficulty gaining benefits from gait training with HAL. We conducted a single-institutional retrospective cohort study. The participants were 82 stroke patients who had received gait training with HAL during hospitalization. The dependent variable was the functional ambulation category (FAC) that a measure of gait independence in stroke patients, and five independent [age, National Institutes of Health Stroke Scale, Brunnstrom recovery stage (BRS), days from stroke onset, and functional independence measure total score (cognitive items)] variables were selected from previous studies and analyzed by logistic regression analysis. We evaluated the validity of logistic regression analysis by using several indicators, such as the area under the curve (AUC), and a confusion matrix. Age, days from stroke onset to HAL initiation, and BRS were identified as factors that significantly influenced walking independence through gait training with HAL. The AUC was 0.86. Furthermore, after building a confusion matrix, the calculated binary accuracy, sensitivity (recall), and specificity were 0.80, 0.80, and 0.81, respectively, indicated high accuracy. Our findings confirmed that older age, greater degree of paralysis, and delayed initiation of HAL-assisted training after stroke onset were associated with increased likelihood of walking dependence upon hospital discharge.
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Affiliation(s)
- Shingo Taki
- Department of Rehabilitation, Araki Neurosurgical Hospital, Hiroshima, Japan
- Graduate School of Humanities and Social Sciences, Hiroshima University, Higashihiroshima, Japan
| | - Takeshi Imura
- Graduate School of Humanities and Social Sciences, Hiroshima University, Higashihiroshima, Japan
- Department of Rehabilitation, Faculty of Health Sciences, Hiroshima Cosmopolitan University, Hiroshima, Japan
| | - Tsubasa Mitsutake
- Graduate School of Humanities and Social Sciences, Hiroshima University, Higashihiroshima, Japan
- Department of Physical Therapy, Fukuoka International University of Health and Welfare, Fukuoka, Japan
| | - Yuji Iwamoto
- Graduate School of Humanities and Social Sciences, Hiroshima University, Higashihiroshima, Japan
- Department of Rehabilitation, Faculty of Health Sciences, Hiroshima Cosmopolitan University, Hiroshima, Japan
| | - Ryo Tanaka
- Graduate School of Humanities and Social Sciences, Hiroshima University, Higashihiroshima, Japan
| | - Naoki Imada
- Department of Rehabilitation, Araki Neurosurgical Hospital, Hiroshima, Japan
| | - Hayato Araki
- Department of Neurosurgery, Araki Neurosurgical Hospital, Hiroshima, Japan
| | - Osamu Araki
- Department of Neurosurgery, Araki Neurosurgical Hospital, Hiroshima, Japan
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4
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Christidi F, Tsiptsios D, Fotiadou A, Kitmeridou S, Karatzetzou S, Tsamakis K, Sousanidou A, Psatha EA, Karavasilis E, Seimenis I, Kokkotis C, Aggelousis N, Vadikolias K. Diffusion Tensor Imaging as a Prognostic Tool for Recovery in Acute and Hyperacute Stroke. Neurol Int 2022; 14:841-874. [PMID: 36278693 PMCID: PMC9589952 DOI: 10.3390/neurolint14040069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Revised: 10/17/2022] [Accepted: 10/17/2022] [Indexed: 11/16/2022] Open
Abstract
Stroke represents a major cause of mortality and long-term disability among adult populations, leaving a devastating socioeconomic impact globally. Clinical manifestation of stroke is characterized by great diversity, ranging from minor disability to considerable neurological impairment interfering with activities of daily living and even death. Prognostic ambiguity has stimulated the interest for implementing stroke recovery biomarkers, including those provided by structural neuroimaging techniques, i.e., diffusion tensor imaging (DTI) and tractography for the study of white matter (WM) integrity. Considering the necessity of prompt and accurate prognosis in stroke survivors along with the potential capacity of DTI as a relevant imaging biomarker, the purpose of our study was to review the pertinent literature published within the last decade regarding DTI as a prognostic tool for recovery in acute and hyperacute stroke. We conducted a thorough literature search in two databases (MEDLINE and Science Direct) in order to trace all relevant studies published between 1 January 2012 and 16 March 2022 using predefined terms as key words. Only full-text human studies published in the English language were included. Forty-four studies were identified and are included in this review. We present main findings and by describing several methodological issues, we highlight shortcomings and gaps in the current literature so that research priorities for future research can be outlined. Our review suggests that DTI can track longitudinal changes and identify prognostic correlates in acute and hyperacute stroke patients.
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Affiliation(s)
- Foteini Christidi
- Neurology Department, School of Medicine, Democritus University of Thrace, 68100 Alexandroupolis, Greece
| | - Dimitrios Tsiptsios
- Neurology Department, School of Medicine, Democritus University of Thrace, 68100 Alexandroupolis, Greece
| | - Aggeliki Fotiadou
- Neurology Department, School of Medicine, Democritus University of Thrace, 68100 Alexandroupolis, Greece
| | - Sofia Kitmeridou
- Neurology Department, School of Medicine, Democritus University of Thrace, 68100 Alexandroupolis, Greece
| | - Stella Karatzetzou
- Neurology Department, School of Medicine, Democritus University of Thrace, 68100 Alexandroupolis, Greece
| | - Konstantinos Tsamakis
- Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King’s College London, London SE5 8AB, UK
| | - Anastasia Sousanidou
- Neurology Department, School of Medicine, Democritus University of Thrace, 68100 Alexandroupolis, Greece
| | - Evlampia A. Psatha
- Department of Radiology, School of Medicine, Democritus University of Thrace, 68100 Alexandroupolis, Greece
| | | | - Ioannis Seimenis
- Medical Physics Laboratory, School of Medicine, National and Kapodistrian University, 11527 Athens, Greece
| | - Christos Kokkotis
- Department of Physical Education and Sport Science, Democritus University of Thrace, 69100 Komotini, Greece
| | - Nikolaos Aggelousis
- Department of Physical Education and Sport Science, Democritus University of Thrace, 69100 Komotini, Greece
| | - Konstantinos Vadikolias
- Neurology Department, School of Medicine, Democritus University of Thrace, 68100 Alexandroupolis, Greece
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Imura T, Mitsutake T, Hori T, Tanaka R. Predicting the prognosis of unilateral spatial neglect using magnetic resonance imaging in patients with stroke: A systematic review. Brain Res 2022; 1789:147954. [DOI: 10.1016/j.brainres.2022.147954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 05/21/2022] [Accepted: 05/24/2022] [Indexed: 11/24/2022]
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6
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Jang SH, Choi EB. Relation Between the Corticospinal Tract State and Activities of Daily Living in Patients With Intracerebral Hemorrhage. Stroke 2021; 53:544-551. [PMID: 34538084 PMCID: PMC8785518 DOI: 10.1161/strokeaha.121.034939] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Supplemental Digital Content is available in the text. Background and Purpose: We investigated the relation between the ipsilesional corticospinal tract (CST) state and activity of daily living independence in patients with chronic intracerebral hemorrhage. Methods: Fifty-six consecutive patients with unilateral intracerebral hemorrhage and 38 healthy control subjects were recruited for this study. The Motricity index and the modified Barthel index were used to evaluate motor function of the affected extremities and activity of daily living independence, respectively. The diffusion tensor imaging parameter values for fractional anisotropy (FA) and voxel number (VN) of the CST were determined. Ratios of the ipsilesional to the contralesional CST measures were calculated and are presented as the CST-ratio (FA value and VN). Results: The FA value and VN of the ipsilesional CST and the CST-ratio in the patient group were lower than those of the control group (P<0.05). There was a strong positive correlation between the Motricity index score of the affected extremities and the modified Barthel index score (P<0.05), while the FA value and VN of the ipsilesional CST and the CST-ratio showed moderate and strong positive correlations with the Motricity index and modified Barthel index scores, respectively (P<0.05). In addition, the VN of the ipsilesional CST showed excellent utility as a classifier, whereas the FA value of the ipsilesional CST and the FA value and VN of the CST-ratio showed good classifier utility (P<0.05). Conclusions: We demonstrated that impairment of activity of daily living independency was closely related to the injury severity of the ipsilesional CST in patients with chronic intracerebral hemorrhage. In addition, the injury severity of the ipsilesional CST can be used to classify the degree of activity of daily living independency. Registration: URL: http://www.e-irb.com/index.jsp; Unique identifier: 2021-03-014.
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Affiliation(s)
- Sung Ho Jang
- Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Republic of Korea
| | - Eun Bi Choi
- Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Republic of Korea
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A systematic review of the usefulness of magnetic resonance imaging in predicting the gait ability of stroke patients. Sci Rep 2021; 11:14338. [PMID: 34253774 PMCID: PMC8275756 DOI: 10.1038/s41598-021-93717-4] [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: 02/01/2021] [Accepted: 06/07/2021] [Indexed: 11/08/2022] Open
Abstract
The usefulness of magnetic resonance imaging (MRI) in predicting gait ability in stroke patients remains unclear. Therefore, MRI evaluations have not yet been standardized in stroke rehabilitation. We performed a systematic review to consolidate evidence regarding the use of MRIs in predicting gait ability of stroke patients. The Medline, Cumulative Index to Nursing and Allied Health Literature, and SCOPUS databases were comprehensively searched. We included all literature published from each source’s earliest date to August 2020. We included 19 studies: 8 were classified as structure- or function-based MRI studies and 11 as neural tract integrity-based MRI studies. Most structure- or function-based MRI studies indicated that damage to motor-related areas (primary motor cortex, corona radiata, internal capsule, and basal ganglia) or insula was related to poor gait recovery. In neural tract integrity-based MRI studies, integrity of the corticospinal tract was related to gait ability. Some studies reported predictive value of the corticoreticular pathway. All included studies had some concerns, at least one, based on the Cochrane risk of bias instrument. This review suggests that MRIs are useful in predicting gait ability of stroke patients. However, we cannot make definitive conclusion regarding the predictive value, due to the lack of quantitative evaluations.
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8
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Jun S, Hong B, Kim Y, Lim S. Does Motor Tract Integrity at 1 Month Predict Gait and Balance Outcomes at 6 Months in Stroke Patients? Brain Sci 2021; 11:867. [PMID: 34210075 PMCID: PMC8301763 DOI: 10.3390/brainsci11070867] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 06/24/2021] [Accepted: 06/28/2021] [Indexed: 11/17/2022] Open
Abstract
Recovery of balance and gait ability is important in stroke patients. Several studies have examined the role of white matter tracts in the recovery of gait and balance, but the results have been inconclusive. Therefore, we examined whether the integrity of the corticospinal tract (CST), corticoreticular pathway (CRP), and cortico-ponto-cerebellar tract (CPCT) at 1 month predicted balance and gait function 6 months after stroke onset. This retrospective longitudinal observational clinical study assessed 27 patients with first-ever unilateral supratentorial stroke. The subjects underwent diffusion tensor imaging 1 month after the stroke, and the Functional Ambulation Categories (FAC) and Berg Balance Scale (BBS) scores were assessed after 6 months. The normalized fiber number (FN) and fractional anisotropy (FA) results for the CST, CRP and CPCT were also obtained. The FN and FA results for the CST, CRP, or CPCT at 1 month were not related to the gait or balance at 6 months. There was also no difference in FAC values at 1 month after stoke onset among three groups differing in degree of independence of ambulation. The integrity of the CST, CRP, and CPCT on 1 month after stroke onset was not associated with gait or balance after 6 months. The white matter integrity did not predict the clinical outcome.
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Affiliation(s)
- SoYeon Jun
- Department of Rehabilitation Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea;
| | - BoYoung Hong
- Department of Rehabilitation Medicine, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea;
| | - YoungKook Kim
- Department of Rehabilitation Medicine, Yeouido St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea;
| | - SeongHoon Lim
- Department of Rehabilitation Medicine, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea;
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Imura T, Iwamoto Y, Azuma Y, Inagawa T, Imada N, Tanaka R, Araki H, Araki O. Machine Learning Algorithm Identifies the Importance of Environmental Factors for Hospital Discharge to Home of Stroke Patients using Wheelchair after Discharge. J Stroke Cerebrovasc Dis 2021; 30:105868. [PMID: 34029887 DOI: 10.1016/j.jstrokecerebrovasdis.2021.105868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 04/25/2021] [Accepted: 04/29/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND AND PURPOSE Physical environmental factors are generally likely to become barriers for discharge to home of wheelchair users, compared with non-wheelchair users. However, the importance of environmental factors has not been investigated adequately. Application of machine learning technology might efficiently identify the most influential factors, although it is not easy to interpret and integrate various information including individual and environmental factors in clinical stroke rehabilitation. This study aimed to identify the influential factors affecting home discharge in the stroke patients who use a wheelchair after discharge by using machine learning technology. METHODS This study used the rehabilitation database of our facility, which includes all stroke patients admitted into the convalescence rehabilitation ward. The chi-squared automatic interaction detection (CHAID) algorithm was used to develop a model to classify wheelchair-using stroke patients discharged to home or not-to-home. RESULTS Among the variables, including basic information, motor functional factor, activities of daily living ability factor, and environmental factors, the CHAID model identified house renovation and the existence of sloping roads around the house as the first and second discriminators for home discharge. CONCLUSIONS Our present results could scientifically clarify that the clinician need to focus on the physical environmental factors for achieving home discharge in the patients who use a wheelchair after discharge.
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Affiliation(s)
- Takeshi Imura
- Department of Rehabilitation, Faculty of Health Sciences, Hiroshima Cosmopolitan University, Hiroshima, Japan; Department of Rehabilitation, Araki Neurosurgical Hospital, Hiroshima, Japan.
| | - Yuji Iwamoto
- Department of Rehabilitation, Araki Neurosurgical Hospital, Hiroshima, Japan; Graduate School of Humanities and Social Sciences, Hiroshima University, Hiroshima, Japan
| | - Yuki Azuma
- Department of Rehabilitation, Araki Neurosurgical Hospital, Hiroshima, Japan
| | - Tetsuji Inagawa
- Department of Neurosurgery, Araki Neurosurgical Hospital, Hiroshima, Japan
| | - Naoki Imada
- Department of Rehabilitation, Araki Neurosurgical Hospital, Hiroshima, Japan
| | - Ryo Tanaka
- Graduate School of Humanities and Social Sciences, Hiroshima University, Hiroshima, Japan
| | - Hayato Araki
- Department of Neurosurgery, Araki Neurosurgical Hospital, Hiroshima, Japan
| | - Osamu Araki
- Department of Neurosurgery, Araki Neurosurgical Hospital, Hiroshima, Japan
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Cleland BT, Madhavan S. Ipsilateral motor pathways to the lower limb after stroke: Insights and opportunities. J Neurosci Res 2021; 99:1565-1578. [PMID: 33665910 DOI: 10.1002/jnr.24822] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 02/17/2021] [Indexed: 01/04/2023]
Abstract
Stroke-related damage to the crossed lateral corticospinal tract causes motor deficits in the contralateral (paretic) limb. To restore functional movement in the paretic limb, the nervous system may increase its reliance on ipsilaterally descending motor pathways, including the uncrossed lateral corticospinal tract, the reticulospinal tract, the rubrospinal tract, and the vestibulospinal tract. Our knowledge about the role of these pathways for upper limb motor recovery is incomplete, and even less is known about the role of these pathways for lower limb motor recovery. Understanding the role of ipsilateral motor pathways to paretic lower limb movement and recovery after stroke may help improve our rehabilitative efforts and provide alternate solutions to address stroke-related impairments. These advances are important because walking and mobility impairments are major contributors to long-term disability after stroke, and improving walking is a high priority for individuals with stroke. This perspective highlights evidence regarding the contributions of ipsilateral motor pathways from the contralesional hemisphere and spinal interneuronal pathways for paretic lower limb movement and recovery. This perspective also identifies opportunities for future research to expand our knowledge about ipsilateral motor pathways and provides insights into how this information may be used to guide rehabilitation.
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Affiliation(s)
- Brice T Cleland
- Brain Plasticity Lab, Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, USA
| | - Sangeetha Madhavan
- Brain Plasticity Lab, Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, USA
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Cepeda S, García-García S, Arrese I, Velasco-Casares M, Sarabia R. Acute changes in diffusion tensor-derived metrics and its correlation with the motor outcome in gliomas adjacent to the corticospinal tract. Surg Neurol Int 2021; 12:51. [PMID: 33654554 PMCID: PMC7911041 DOI: 10.25259/sni_862_2020] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 01/14/2021] [Indexed: 01/07/2023] Open
Abstract
Background: This study involves analysis of the relationship between variables obtained using diffusion tensor imaging (DTI) and motor outcome in gliomas adjacent to the corticospinal tract (CST). Methods: Histologically confirmed glioma patients who were to undergo surgery between January 2018 and December 2019 were prospectively enrolled. All patients had a preoperative magnetic resonance imaging (MRI) study that included DTI, a tumor 2 cm or less from the CST, and postsurgical control within 48 h. Patients with MRI that was performed at other center, tumors with primary and premotor cortex invasion, postsurgical complications directly affecting motor outcome and tumor progression <6 months were excluded in the study. In pre- and post-surgical MRI, we measured the following DTI-derived metrics: fractional anisotropy (FA), mean diffusivity, axial diffusivity, and radial diffusivity of the entire CST and peritumoral CST regions and in the contralateral hemisphere. The motor outcome was assessed at 1, 3, and 6 months using the Medical Research Council scale. Results: Eleven patients were analyzed, and six corresponded to high-grade gliomas and five to low-grade gliomas. Four patients had previous motor impairment and seven patients had postsurgical motor deficits (four transient and three permanent). An FA ratio of 0.8 between peritumoral CST regions and the contralateral hemisphere was found to be the cutoff, and lower values were obtained in patients with permanent motor deficits. Conclusion: Quantitative analysis of DTI that was performed in the immediate postsurgery period can provide valuable information about the motor prognosis after surgery for gliomas near the CST.
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Affiliation(s)
- Santiago Cepeda
- Department of Neurosurgery, University Hospital Río Hortega, Valladolid, Spain
| | | | - Ignacio Arrese
- Department of Neurosurgery, University Hospital Río Hortega, Valladolid, Spain
| | | | - Rosario Sarabia
- Department of Neurosurgery, University Hospital Río Hortega, Valladolid, Spain
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12
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Imura T, Iwamoto Y, Inagawa T, Imada N, Tanaka R, Toda H, Inoue Y, Araki H, Araki O. Decision Tree Algorithm Identifies Stroke Patients Likely Discharge Home After Rehabilitation Using Functional and Environmental Predictors. J Stroke Cerebrovasc Dis 2021; 30:105636. [PMID: 33545520 DOI: 10.1016/j.jstrokecerebrovasdis.2021.105636] [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: 09/29/2020] [Revised: 12/19/2020] [Accepted: 01/18/2021] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND AND PURPOSE The importance of environmental factors for stroke patients to achieve home discharge was not scientifically proven. There are limited studies on the application of the decision tree algorithm with various functional and environmental variables to identify stroke patients with a high possibility of home discharge. The present study aimed to identify the factors, including functional and environmental factors, affecting home discharge after stroke inpatient rehabilitation using the machine learning method. METHOD This was a cohort study on data from the maintained database of all patients with stroke who were admitted to the convalescence rehabilitation ward of our facility. In total, 1125 stroke patients were investigated. We developed three classification and regression tree (CART) models to identify the possibility of home discharge after inpatient rehabilitation. RESULTS Among three models, CART model incorporating basic information, functional factor, and environmental factor variables achieved the highest accuracy for identification of home discharge. This model identified FIM dressing of the upper body (score of ≤2 or >2) as the first single discriminator for home discharge. Performing house renovation was associated with a high possibility of home discharge even in patients with stroke who had a poor FIM score in the ability to dress the upper body (≤2) at admission into the convalescence rehabilitation ward. Interestingly, many patients who performed house renovation have achieved home discharge regardless of the degree of lower limb paralysis. CONCLUSION We identified the influential factors for realizing home discharge using the decision tree algorithm, including environmental factors, in patients with convalescent stroke.
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Affiliation(s)
- Takeshi Imura
- Department of Rehabilitation, Faculty of Health Sciences, Hiroshima Cosmopolitan University, Hiroshima, Japan; Department of Rehabilitation, Araki Neurosurgical Hospital, Hiroshima, Japan.
| | - Yuji Iwamoto
- Department of Rehabilitation, Araki Neurosurgical Hospital, Hiroshima, Japan; Graduate School of Humanities and Social Sciences, Hiroshima University, Hiroshima, Japan.
| | - Tetsuji Inagawa
- Department of Neurosurgery, Araki Neurosurgical Hospital, Hiroshima, Japan.
| | - Naoki Imada
- Department of Rehabilitation, Araki Neurosurgical Hospital, Hiroshima, Japan.
| | - Ryo Tanaka
- Graduate School of Humanities and Social Sciences, Hiroshima University, Hiroshima, Japan
| | - Haruki Toda
- Artificial Intelligence Research Center (AIRC), National Institute of Advanced Industrial Science and Technology (AIST), Tokyo Japan
| | - Yu Inoue
- Research Institute of Health and Welfare, Kibi International University, Okayama, Japan
| | - Hayato Araki
- Department of Neurosurgery, Araki Neurosurgical Hospital, Hiroshima, Japan
| | - Osamu Araki
- Department of Neurosurgery, Araki Neurosurgical Hospital, Hiroshima, Japan
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Iwamoto Y, Imura T, Tanaka R, Imada N, Inagawa T, Araki H, Araki O. Development and Validation of Machine Learning-Based Prediction for Dependence in the Activities of Daily Living after Stroke Inpatient Rehabilitation: A Decision-Tree Analysis. J Stroke Cerebrovasc Dis 2020; 29:105332. [DOI: 10.1016/j.jstrokecerebrovasdis.2020.105332] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 08/03/2020] [Accepted: 09/12/2020] [Indexed: 01/19/2023] Open
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Taki S, Imura T, Iwamoto Y, Imada N, Tanaka R, Araki H, Araki O. Effects of Exoskeletal Lower Limb Robot Training on the Activities of Daily Living in Stroke Patients: Retrospective Pre-Post Comparison Using Propensity Score Matched Analysis. J Stroke Cerebrovasc Dis 2020; 29:105176. [PMID: 32912532 DOI: 10.1016/j.jstrokecerebrovasdis.2020.105176] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 06/25/2020] [Accepted: 07/16/2020] [Indexed: 01/19/2023] Open
Abstract
PURPOSE There is limited evidence of gait training using newly developed exoskeletal lower limb robot called Hybrid Assistive Limb (HAL) on the function and ability to perform ADL in stroke patients. In clinical settings, we frequently find it challenging to conduct a randomized controlled trial; thus, a large-scale observational study using propensity score analysis methods is a feasible alternative. The present study aimed to determine whether exoskeletal lower limb robot training improved the ability to perform ADL in stroke patients. MATERIALS AND METHODS Acute stroke patients who were admitted to our facility from April 2016 to March 2017 were evaluated in the conventional rehabilitation period (CRP) and those admitted from April 2017 to June 2019 were evaluated in the HAL rehabilitation period (HRP). We started a new gait rehabilitation program using HAL at the midpoint of these two periods. The functional outcomes or ADL ability outcomes of the patients in the CRP and the subsequent HRP were compared using propensity score matched analyses. RESULTS Propensity score matching analysis was performed for 108 stroke patients (63 from the CRP and 45 from the HRP), and 36 pairs were matched. The ADL ability, defined by the FIM scores and FIM score change, was significantly higher in patients admitted during the HRP. In addition, more stroke patients obtained practical walking ability during hospitalization in the HRP. CONCLUSION Gait training using HAL affects the ADL ability and obtaining of practical walking ability of stroke patients.
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Affiliation(s)
- Shingo Taki
- Department of Rehabilitation, Araki Neurosurgical Hospital, 2-8-7, Kogokita, Hiroshima, Japan
| | - Takeshi Imura
- Department of Rehabilitation, Araki Neurosurgical Hospital, 2-8-7, Kogokita, Hiroshima, Japan.
| | - Yuji Iwamoto
- Department of Rehabilitation, Araki Neurosurgical Hospital, 2-8-7, Kogokita, Hiroshima, Japan; Graduate School of Integrated Arts and Sciences, Hiroshima University, Hiroshima, Japan
| | - Naoki Imada
- Department of Rehabilitation, Araki Neurosurgical Hospital, 2-8-7, Kogokita, Hiroshima, Japan.
| | - Ryo Tanaka
- Graduate School of Integrated Arts and Sciences, Hiroshima University, Hiroshima, Japan.
| | - Hayato Araki
- Department of Neurosurgery, Araki Neurosurgical Hospital, Hiroshima, Japan.
| | - Osamu Araki
- Department of Neurosurgery, Araki Neurosurgical Hospital, Hiroshima, Japan.
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15
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Soulard J, Huber C, Baillieul S, Thuriot A, Renard F, Aubert Broche B, Krainik A, Vuillerme N, Jaillard A. Motor tract integrity predicts walking recovery: A diffusion MRI study in subacute stroke. Neurology 2020; 94:e583-e593. [PMID: 31896618 DOI: 10.1212/wnl.0000000000008755] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 08/12/2019] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE To identify candidate biomarkers of walking recovery with motor tract integrity measurements using fractional anisotropy (FA) from the corticospinal tract (CST) and alternative motor pathways in patients with moderate to severe subacute stroke. METHODS Walking recovery was first assessed with generalized linear mixed model (GLMM) with repeated measures of walking scores (WS) over 2 years of follow-up in a longitudinal study of 29 patients with subacute ischemic stroke. Baseline FA measures from the ipsilesional and contralesional CST (i-CST and c-CST), cortico-reticulospinal pathway (i-CRP and c-CRP), and cerebellar peduncles were derived from a 60-direction diffusion MRI sequence on a 3T scanner. We performed correlation tests between WS and FA measures. Third, we investigated using GLMM whether motor tract integrity contributes to predict walking recovery. RESULTS We observed significant improvements of WS over time with a plateau reached at ≈6 months after stroke. WS significantly correlated with FA measures from i-CST, c-CST, i-CRP, and bilateral cerebellar peduncles. Walking recovery was predicted by FA measures from 3 tracts: i-CST, i-CRP, and contralesional superior cerebellar peduncle (c-SCP). Diffusion tensor imaging (DTI) predictors captured 80.5% of the unexplained variance of the model without DTI. CONCLUSIONS We identified i-CST and alternative motor-related tracts (namely i-CRP and c-SCP) as candidate biomarkers of walking recovery. The role of the SCP in walk recovery may rely on cerebellar nuclei projections to the thalamus, red nucleus, and reticular formation. Our findings suggest that a set of white matter tracts, part of subcortical motor networks, contribute to walking recovery in patients with moderate to severe stroke.
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Affiliation(s)
- Julie Soulard
- From the Université Grenoble Alpes (J.S., A.T., F.R., A.B.B., N.V., A.J.), AGEIS, Faculté de Médecine; Stroke Unit (J.S., A.T.), Neurologie, Centre Hospitalier Universitaire Grenoble Alpes (CHUGA); Unité IRM 3T-Recherche-UMS IRMaGe-CHUGA (C.H., A.K., A.J.); IRMaGe-Inserm US-017 (C.H., A.K.), CNRS UMS-3552, UGA, Grenoble; Neuroradiologie-IRM-Pôle Imagerie-CHUGA (A.K.); Centre Hospitalier Métropole Savoie (C.H.), Chambéry; Laboratoire HP2 (S.B.), UGA; Pôle thorax et vaisseaux, CHUGA; Pôle Recherche (A.J.), CHUGA, Grenoble; and Institut Universitaire de France (N.V.), Paris, France
| | - Coline Huber
- From the Université Grenoble Alpes (J.S., A.T., F.R., A.B.B., N.V., A.J.), AGEIS, Faculté de Médecine; Stroke Unit (J.S., A.T.), Neurologie, Centre Hospitalier Universitaire Grenoble Alpes (CHUGA); Unité IRM 3T-Recherche-UMS IRMaGe-CHUGA (C.H., A.K., A.J.); IRMaGe-Inserm US-017 (C.H., A.K.), CNRS UMS-3552, UGA, Grenoble; Neuroradiologie-IRM-Pôle Imagerie-CHUGA (A.K.); Centre Hospitalier Métropole Savoie (C.H.), Chambéry; Laboratoire HP2 (S.B.), UGA; Pôle thorax et vaisseaux, CHUGA; Pôle Recherche (A.J.), CHUGA, Grenoble; and Institut Universitaire de France (N.V.), Paris, France
| | - Sebastien Baillieul
- From the Université Grenoble Alpes (J.S., A.T., F.R., A.B.B., N.V., A.J.), AGEIS, Faculté de Médecine; Stroke Unit (J.S., A.T.), Neurologie, Centre Hospitalier Universitaire Grenoble Alpes (CHUGA); Unité IRM 3T-Recherche-UMS IRMaGe-CHUGA (C.H., A.K., A.J.); IRMaGe-Inserm US-017 (C.H., A.K.), CNRS UMS-3552, UGA, Grenoble; Neuroradiologie-IRM-Pôle Imagerie-CHUGA (A.K.); Centre Hospitalier Métropole Savoie (C.H.), Chambéry; Laboratoire HP2 (S.B.), UGA; Pôle thorax et vaisseaux, CHUGA; Pôle Recherche (A.J.), CHUGA, Grenoble; and Institut Universitaire de France (N.V.), Paris, France
| | - Antoine Thuriot
- From the Université Grenoble Alpes (J.S., A.T., F.R., A.B.B., N.V., A.J.), AGEIS, Faculté de Médecine; Stroke Unit (J.S., A.T.), Neurologie, Centre Hospitalier Universitaire Grenoble Alpes (CHUGA); Unité IRM 3T-Recherche-UMS IRMaGe-CHUGA (C.H., A.K., A.J.); IRMaGe-Inserm US-017 (C.H., A.K.), CNRS UMS-3552, UGA, Grenoble; Neuroradiologie-IRM-Pôle Imagerie-CHUGA (A.K.); Centre Hospitalier Métropole Savoie (C.H.), Chambéry; Laboratoire HP2 (S.B.), UGA; Pôle thorax et vaisseaux, CHUGA; Pôle Recherche (A.J.), CHUGA, Grenoble; and Institut Universitaire de France (N.V.), Paris, France
| | - Felix Renard
- From the Université Grenoble Alpes (J.S., A.T., F.R., A.B.B., N.V., A.J.), AGEIS, Faculté de Médecine; Stroke Unit (J.S., A.T.), Neurologie, Centre Hospitalier Universitaire Grenoble Alpes (CHUGA); Unité IRM 3T-Recherche-UMS IRMaGe-CHUGA (C.H., A.K., A.J.); IRMaGe-Inserm US-017 (C.H., A.K.), CNRS UMS-3552, UGA, Grenoble; Neuroradiologie-IRM-Pôle Imagerie-CHUGA (A.K.); Centre Hospitalier Métropole Savoie (C.H.), Chambéry; Laboratoire HP2 (S.B.), UGA; Pôle thorax et vaisseaux, CHUGA; Pôle Recherche (A.J.), CHUGA, Grenoble; and Institut Universitaire de France (N.V.), Paris, France
| | - Bérengère Aubert Broche
- From the Université Grenoble Alpes (J.S., A.T., F.R., A.B.B., N.V., A.J.), AGEIS, Faculté de Médecine; Stroke Unit (J.S., A.T.), Neurologie, Centre Hospitalier Universitaire Grenoble Alpes (CHUGA); Unité IRM 3T-Recherche-UMS IRMaGe-CHUGA (C.H., A.K., A.J.); IRMaGe-Inserm US-017 (C.H., A.K.), CNRS UMS-3552, UGA, Grenoble; Neuroradiologie-IRM-Pôle Imagerie-CHUGA (A.K.); Centre Hospitalier Métropole Savoie (C.H.), Chambéry; Laboratoire HP2 (S.B.), UGA; Pôle thorax et vaisseaux, CHUGA; Pôle Recherche (A.J.), CHUGA, Grenoble; and Institut Universitaire de France (N.V.), Paris, France
| | - Alexandre Krainik
- From the Université Grenoble Alpes (J.S., A.T., F.R., A.B.B., N.V., A.J.), AGEIS, Faculté de Médecine; Stroke Unit (J.S., A.T.), Neurologie, Centre Hospitalier Universitaire Grenoble Alpes (CHUGA); Unité IRM 3T-Recherche-UMS IRMaGe-CHUGA (C.H., A.K., A.J.); IRMaGe-Inserm US-017 (C.H., A.K.), CNRS UMS-3552, UGA, Grenoble; Neuroradiologie-IRM-Pôle Imagerie-CHUGA (A.K.); Centre Hospitalier Métropole Savoie (C.H.), Chambéry; Laboratoire HP2 (S.B.), UGA; Pôle thorax et vaisseaux, CHUGA; Pôle Recherche (A.J.), CHUGA, Grenoble; and Institut Universitaire de France (N.V.), Paris, France
| | - Nicolas Vuillerme
- From the Université Grenoble Alpes (J.S., A.T., F.R., A.B.B., N.V., A.J.), AGEIS, Faculté de Médecine; Stroke Unit (J.S., A.T.), Neurologie, Centre Hospitalier Universitaire Grenoble Alpes (CHUGA); Unité IRM 3T-Recherche-UMS IRMaGe-CHUGA (C.H., A.K., A.J.); IRMaGe-Inserm US-017 (C.H., A.K.), CNRS UMS-3552, UGA, Grenoble; Neuroradiologie-IRM-Pôle Imagerie-CHUGA (A.K.); Centre Hospitalier Métropole Savoie (C.H.), Chambéry; Laboratoire HP2 (S.B.), UGA; Pôle thorax et vaisseaux, CHUGA; Pôle Recherche (A.J.), CHUGA, Grenoble; and Institut Universitaire de France (N.V.), Paris, France
| | - Assia Jaillard
- From the Université Grenoble Alpes (J.S., A.T., F.R., A.B.B., N.V., A.J.), AGEIS, Faculté de Médecine; Stroke Unit (J.S., A.T.), Neurologie, Centre Hospitalier Universitaire Grenoble Alpes (CHUGA); Unité IRM 3T-Recherche-UMS IRMaGe-CHUGA (C.H., A.K., A.J.); IRMaGe-Inserm US-017 (C.H., A.K.), CNRS UMS-3552, UGA, Grenoble; Neuroradiologie-IRM-Pôle Imagerie-CHUGA (A.K.); Centre Hospitalier Métropole Savoie (C.H.), Chambéry; Laboratoire HP2 (S.B.), UGA; Pôle thorax et vaisseaux, CHUGA; Pôle Recherche (A.J.), CHUGA, Grenoble; and Institut Universitaire de France (N.V.), Paris, France.
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Moura LM, Luccas R, de Paiva JPQ, Amaro E, Leemans A, Leite CDC, Otaduy MCG, Conforto AB. Diffusion Tensor Imaging Biomarkers to Predict Motor Outcomes in Stroke: A Narrative Review. Front Neurol 2019; 10:445. [PMID: 31156529 PMCID: PMC6530391 DOI: 10.3389/fneur.2019.00445] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 04/12/2019] [Indexed: 12/14/2022] Open
Abstract
Stroke is a leading cause of disability worldwide. Motor impairments occur in most of the patients with stroke in the acute phase and contribute substantially to disability. Diffusion tensor imaging (DTI) biomarkers such as fractional anisotropy (FA) measured at an early phase after stroke have emerged as potential predictors of motor recovery. In this narrative review, we: (1) review key concepts of diffusion MRI (dMRI); (2) present an overview of state-of-art methodological aspects of data collection, analysis and reporting; and (3) critically review challenges of DTI in stroke as well as results of studies that investigated the correlation between DTI metrics within the corticospinal tract and motor outcomes at different stages after stroke. We reviewed studies published between January, 2008 and December, 2018, that reported correlations between DTI metrics collected within the first 24 h (hyperacute), 2-7 days (acute), and >7-90 days (early subacute) after stroke. Nineteen studies were included. Our review shows that there is no consensus about gold standards for DTI data collection or processing. We found great methodological differences across studies that evaluated DTI metrics within the corticospinal tract. Despite heterogeneity in stroke lesions and analysis approaches, the majority of studies reported significant correlations between DTI biomarkers and motor impairments. It remains to be determined whether DTI results could enhance the predictive value of motor disability models based on clinical and neurophysiological variables.
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Affiliation(s)
- Luciana M. Moura
- Neurostimulation Laboratory, Neurology Department, Hospital das Clínicas/São Paulo University, São Paulo, Brazil
| | - Rafael Luccas
- Neurostimulation Laboratory, Neurology Department, Hospital das Clínicas/São Paulo University, São Paulo, Brazil
| | | | - Edson Amaro
- Hospital Israelita Albert Einstein, São Paulo, Brazil
- Lim 44, Department of Radiology and Oncology, Faculdade de Medicina, Hospital das Clínicas/São Paulo University, São Paulo, Brazil
| | - Alexander Leemans
- PROVIDI Lab, Image Sciences Institute, UMC Utrecht, Utrecht, Netherlands
| | - Claudia da C. Leite
- Lim 44, Department of Radiology and Oncology, Faculdade de Medicina, Hospital das Clínicas/São Paulo University, São Paulo, Brazil
| | - Maria C. G. Otaduy
- Lim 44, Department of Radiology and Oncology, Faculdade de Medicina, Hospital das Clínicas/São Paulo University, São Paulo, Brazil
| | - Adriana B. Conforto
- Neurostimulation Laboratory, Neurology Department, Hospital das Clínicas/São Paulo University, São Paulo, Brazil
- Hospital Israelita Albert Einstein, São Paulo, Brazil
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17
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Xi SD, Zhu YL, Chen C, Liu HQ, Wang WW, Li F. The plasticity of the corticospinal tract in children with obstetric brachial plexus palsy after Botulinum Toxin A treatment. J Neurol Sci 2018; 394:19-25. [PMID: 30196131 DOI: 10.1016/j.jns.2018.08.025] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2018] [Revised: 08/11/2018] [Accepted: 08/27/2018] [Indexed: 12/13/2022]
Abstract
Botulinum neurotoxin A (BTX-A) intervention has long-term benefits for children with obstetric brachial plexus palsy (OBPP). Although cortical plasticity has been widely studied, plasticity in white matter has not received as much attention. Here, six children with OBPP underwent functional magnetic resonance imaging (fMRI) and diffusion tensor imaging (DTI) before and 6 months after BTX-A treatment. Surface electromyography (EMG) was recorded. The aim was to investigate changes in the corticospinal tract (CST) as an example longitudinal observation of white matter plasticity. Deterministic fiber tracking with a Fiber Assignment by Continuous Tracking algorithm was used to reconstruct the CST. Fiber tracts passing through a region of interest (ROI) in the posterior limb of the internal capsule and a target ROI in the upper-limb representation of M1 (defined by task-related fMRI) were selected as the CST. Motor performances were improved while EMG showed no significant difference 6 months after the treatment. We observed a significant increase in mean fractional anisotropy and a significant decrease in fiber number after treatment. We analyzed the correlations between DTI metrics and clinical motor assessments. Although the correlation results were not statistically significant, they support the notion that BTX-A treatment causes white matter plasticity and has a positive long-term outcome. Peripheral deafferentation may lead to altered information flow, resulting in the positive adaptation of white matter. This study provides novel insight into cerebral plasticity following peripheral nerve regeneration and indicates that a combination of relatively non-invasive therapies can accelerate plasticity of sensorimotor circuits and promote functional recovery in OBPP.
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Affiliation(s)
- Si-da Xi
- Shanghai Medical College, Fudan University, Shanghai, China
| | - Yu-Lan Zhu
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Chan Chen
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Han-Qiu Liu
- Department of Radiology, Huashan Hospital, Fudan University, Shanghai, China
| | - Wei-Wei Wang
- Department of Radiology, Huashan Hospital, Fudan University, Shanghai, China
| | - Fang Li
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai, China; Department of Rehabilitation Medicine, Renhe Hospital, Baoshan District, Shanghai, China.
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18
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Liu Y, Chen L, Zeng J, Li W, Zeng S, Ye B, Liang Z. Proliferation of Bilateral Nerve Fibers Following Thalamic Infarction Contributes to Neurological Function Recovery: A Diffusion Tensor Imaging (DTI) Study. Med Sci Monit 2018; 24:1464-1472. [PMID: 29525809 PMCID: PMC5859668 DOI: 10.12659/msm.909071] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2018] [Accepted: 02/16/2018] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND The aim of this study was to investigate the reorganization in ipsilesional and contralesional thalamic radiation fibers after unilateral focal thalamic stroke in sensory disturbance patients. MATERIAL AND METHODS We recruited 12 patients with acute unilateral thalamic infarction and sensory disturbance and 12 healthy age- and sex-matched controls. All patients underwent diffusion tensor imaging (DTI) and were assessed with National Institutes of Health stroke scale (NIHSS), Barthel index (BI), and paragraph 8 of NIHSS (NIHSS8) at 1 week (W1), 4 weeks (W4), 3 months (M3), and 6 months (M6) after thalamic infraction. The relationship between FA changes and the clinical scores changes were then examined. RESULTS NIHSS and NIHSS8 scores decreased while BI scores increased gradually from W1 to M6 in patients, but not in controls. FA values of the patients gradually increased in ipsilesional and contralesional thalamic radiation fibers from W1 to M6. In addition, the FA values in patients were significantly higher at M3 and M6 compared to W1. No significant changes were observed in the controls. Regarding the relationship between FA changes and the clinical scores changes, the FA increases were negatively correlated with NIHSS and NIHSS8 decrease while FA increases were positively correlated with BI increases. CONCLUSIONS Our results indicate that reorganization occurred after unilateral focal thalamic infarct not only in ipsilesional, but also in contralesional thalamic radiation fibers in patients with sensory disturbance. In addition, the results suggested that the reorganization can support and promote stroke restoration.
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Affiliation(s)
- Yayuan Liu
- Department of Neurology, The First Affiliated Hospital, Guangxi Medical University, Nanning, Guanxi, P.R. China
| | - Li Chen
- Department of Neurology, The First Affiliated Hospital, Guangxi Medical University, Nanning, Guanxi, P.R. China
| | - Jinseng Zeng
- Department of Neurology and Stroke Center, The First Affiliated Hospital, SunYat-sen University, Guanzhou, Guangdong, P.R. China
| | - Wenmei Li
- Department of Radiology, The First Affiliated Hospital, Guangxi Medical University, Nanning, Guanxi, P.R. China
| | - Sudan Zeng
- Department of Neurology, The First Affiliated Hospital, Guangxi Medical University, Nanning, Guanxi, P.R. China
| | - Bin Ye
- Department of Neurology, The First Affiliated Hospital, Guangxi Medical University, Nanning, Guanxi, P.R. China
| | - Zhijian Liang
- Department of Neurology, The First Affiliated Hospital, Guangxi Medical University, Nanning, Guanxi, P.R. China
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19
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Kuceyeski A, Navi BB, Kamel H, Raj A, Relkin N, Toglia J, Iadecola C, O'Dell M. Structural connectome disruption at baseline predicts 6-months post-stroke outcome. Hum Brain Mapp 2016; 37:2587-601. [PMID: 27016287 DOI: 10.1002/hbm.23198] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Revised: 02/17/2016] [Accepted: 03/14/2016] [Indexed: 12/21/2022] Open
Abstract
In this study, models based on quantitative imaging biomarkers of post-stroke structural connectome disruption were used to predict six-month outcomes in various domains. Demographic information and clinical MRIs were collected from 40 ischemic stroke subjects (age: 68.1 ± 13.2 years, 17 female, NIHSS: 6.8 ± 5.6). Diffusion-weighted images were used to create lesion masks, which were uploaded to the Network Modification (NeMo) Tool. The NeMo Tool, using only clinical MRIs, allows estimation of connectome disruption at three levels: whole brain, individual gray matter regions and between pairs of gray matter regions. Partial Least Squares Regression models were constructed for each level of connectome disruption and for each of the three six-month outcomes: applied cognitive, basic mobility and daily activity. Models based on lesion volume were created for comparison. Cross-validation, bootstrapping and multiple comparisons corrections were implemented to minimize over-fitting and Type I errors. The regional disconnection model best predicted applied cognitive (R(2) = 0.56) and basic mobility outcomes (R(2) = 0.70), while the pairwise disconnection model best predicted the daily activity measure (R(2) = 0.72). These results demonstrate that models based on connectome disruption metrics were more accurate than ones based on lesion volume and that increasing anatomical specificity of disconnection metrics does not always increase model accuracy, likely due to statistical adjustments for concomitant increases in data dimensionality. This work establishes that the NeMo Tool's measures of baseline connectome disruption, acquired using only routinely collected MRI scans, can predict 6-month post-stroke outcomes in various functional domains including cognition, motor function and daily activities. Hum Brain Mapp, 2016. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Amy Kuceyeski
- Department of Radiology, Weill Cornell Medical College, New York, New York.,Feil Family Brain and Mind Research Institute, New York, New York
| | - Babak B Navi
- Feil Family Brain and Mind Research Institute, New York, New York.,Department of Neurology, Weill Cornell Medical College, New York, New York
| | - Hooman Kamel
- Feil Family Brain and Mind Research Institute, New York, New York.,Department of Neurology, Weill Cornell Medical College, New York, New York
| | - Ashish Raj
- Department of Radiology, Weill Cornell Medical College, New York, New York.,Feil Family Brain and Mind Research Institute, New York, New York
| | - Norman Relkin
- Feil Family Brain and Mind Research Institute, New York, New York.,Department of Neurology, Weill Cornell Medical College, New York, New York
| | - Joan Toglia
- Rehabilitation Medicine, New York, New York.,School of Health and Natural Sciences, Mercy College, New York, New York
| | - Costantino Iadecola
- Feil Family Brain and Mind Research Institute, New York, New York.,Department of Neurology, Weill Cornell Medical College, New York, New York
| | - Michael O'Dell
- Department of Neurology, Weill Cornell Medical College, New York, New York.,Rehabilitation Medicine, New York, New York
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