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Elameer M, Lumley H, Moore SA, Marshall K, Alton A, Smith FE, Gani A, Blamire A, Rodgers H, Price CIM, Mitra D. A prospective study of MRI biomarkers in the brain and lower limb muscles for prediction of lower limb motor recovery following stroke. Front Neurol 2023; 14:1229681. [PMID: 37941576 PMCID: PMC10628497 DOI: 10.3389/fneur.2023.1229681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 09/26/2023] [Indexed: 11/10/2023] Open
Abstract
The aim of this prospective observational longitudinal study was to explore and decipher the predictive value of prospective MRI biomarkers in the brain and lower limb muscles for 3-month lower limb motor recovery following stroke. In the brain, we measured the integrity of the corticospinal tract (fractional anisotropy/"FA"). In the muscles, we measured volume, fatty replacement (fat fraction analysis and proton spectroscopy) and oedema. Measurements were taken at two time points: (1) within 4 weeks of stroke (baseline measurement, clinical and imaging) and (2) 3 months following stroke (follow up measurement, clinical only). Clinical measurements consisted of assessments of functional ability and strength (Fugl-Meyer score, motor NIHSS, Functional Ambulation Category/"FAC", and muscle dynamometry). Twenty-three patients completed imaging and clinical assessments at baseline and follow-up; five patients had partial imaging assessment. The results provided some evidence that damage to the corticospinal tract would result in less motor recovery: recovery of the Fugl-Meyer score and dynamometric ankle plantarflexion, ankle dorsiflexion, and knee extension correlated positively and significantly with fractional anisotropy (0.406-0.457; p = 0.034-p = 0.016). However, fractional anisotropy demonstrated a negative correlation with recovery of the Functional Ambulation Category (-0.359, p = 0.046). For the muscle imaging, significant inverse correlation was observed between vastus lateralis fat fraction vs. NIHSS recovery (-0.401, p = 0.04), and a strong positive correlation was observed between ratio of intra- to extra-myocellular lipid concentrations and the recovery of knee flexion (0.709, p = 0.007). This study supports previous literature indicating a positive correlation between the integrity of the corticospinal tract and motor recovery post-stroke, expanding the limited available literature describing this relationship specifically for the lower limb. However, recovery of functional ambulation behaved differently to other clinical recovery markers by demonstrating an inverse relationship with corticospinal tract integrity. The study also introduces some muscle imaging biomarkers as potentially valuable in the prediction of 3-month lower limb motor recovery following stroke.
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Affiliation(s)
- Mat Elameer
- Department of Neuroradiology, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom
- Stroke Research Group, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Hannah Lumley
- Stroke Research Group, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Sarah A. Moore
- Stroke Research Group, Newcastle University, Newcastle upon Tyne, United Kingdom
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle upon Tyne, United Kingdom
| | - Katie Marshall
- Department of Medical Physics, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Abi Alton
- Stroke Research Group, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Fiona E. Smith
- Department of Neuroscience, Manchester Metropolitan University, Manchester, United Kingdom
| | - Akif Gani
- Department of Stroke Medicine, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom
| | - Andrew Blamire
- Newcastle Magnetic Resonance Centre, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Helen Rodgers
- Stroke Research Group, Newcastle University, Newcastle upon Tyne, United Kingdom
| | | | - Dipayan Mitra
- Department of Neuroradiology, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom
- Stroke Research Group, Newcastle University, Newcastle upon Tyne, United Kingdom
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Kong E, Park D, Chang MC. Prediction of motor outcome based on brain perfusion single photon emission computed tomography in corona radiata infarct. Int J Neurosci 2023:1-7. [PMID: 37812028 DOI: 10.1080/00207454.2023.2269476] [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: 06/30/2023] [Accepted: 10/06/2023] [Indexed: 10/10/2023]
Abstract
BACKGROUND There is limited information on brain perfusion single-photon emission computed tomography (SPECT) findings related to motor outcomes in patients with stroke. We aimed to investigate whether brain SPECT can be used to determine motor outcomes after corona radiata infarction. METHODS Eighty-nine patients were recruited in this study. Brain SPECT and diffusion tensor tractography (DTT) were conducted to evaluate the state of the corticospinal tract (CST) within 7-30 days of corona radiata infarct. Motor outcome was measured 6 months after infarct onset and was evaluated using the modified Brunnstrom classification (MBC) and functional ambulation category (FAC) for motor function of the upper and lower extremities, respectively. The presence of hypoperfusion on brain SPECT was evaluated in the frontal lobe, temporal lobe, parietal lobe, basal ganglia, thalamus, and cerebellum on both the ipsilesional and contralesional sides. Statistical analysis was performed using multivariate logistic regression, comparing patients in which CST was spared versus interrupted. RESULTS Hypoperfusion in the contralesional cerebellum was indicative of poor recovery in both the upper and lower extremities after corona radiata infarction when the CST was interrupted. Additionally, when the CST was preserved, hypoperfusion in the ipsilesional thalamus was indicative of poor recovery of the lower extremities. CONCLUSION Brain SPECT evaluation was shown to be a useful tool for predicting motor outcomes in patients with corona radiata infarcts.
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Affiliation(s)
- Eunjung Kong
- Department of Nuclear Medicine, College of Medicine, Yeungnam University, Daegu, Republic of Korea
| | - Donghwi Park
- Department of Rehabilitation Medicine, Daegu Fatima Hospital, Daegu, Korea
| | - Min Cheol Chang
- Department of Rehabilitation Medicine, College of Medicine, Yeungnam University, Daegu, Republic of Korea
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Shin H, Kim JK, Choo YJ, Choi GS, Chang MC. Prediction of Motor Outcome of Stroke Patients Using a Deep Learning Algorithm with Brain MRI as Input Data. Eur Neurol 2022; 85:460-466. [PMID: 35738236 DOI: 10.1159/000525222] [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: 03/10/2022] [Accepted: 05/22/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Deep learning techniques can outperform traditional machine learning techniques and learn from unstructured and perceptual data, such as images and languages. We evaluated whether a convolutional neural network (CNN) model using whole axial brain T2-weighted magnetic resonance (MR) images as input data can help predict motor outcomes of the upper and lower limbs at the chronic stage in stroke patients. METHODS We collected MR images taken at the early stage of stroke in 1,233 consecutive stroke patients. We categorized modified Brunnstrom classification (MBC) scores of ≥5 and functional ambulatory category (FAC) scores of ≥4 at 6 months after stroke as favorable outcomes in the upper and lower limbs, respectively, and MBC scores of <5 and FAC scores of <4 as poor outcomes. We applied a CNN to train the image data. Of the 1,233 patients, 70% (863 patients) were randomly selected for the training set and the remaining 30% (370 patients) were assigned to the validation set. RESULTS In the prediction of upper limb motor function on the validation dataset, the area under the curve (AUC) was 0.768, and for lower limb motor function, the AUC was 0.828. CONCLUSION We showed that a CNN model trained using whole-brain axial T2-weighted MR images of stroke patients would help predict upper and lower limb motor function at the chronic stage.
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Affiliation(s)
- Hyunkwang Shin
- Department of Information and Communication Engineering, Yeungnam University, Gyeongsan-si, Republic of Korea
| | - Jeoung Kun Kim
- Department of Business Administration, School of Business, Yeungnam University, Gyeongsan-si, Republic of Korea
| | - Yoo Jin Choo
- Department of Rehabilitation Medicine, College of Medicine, Yeungnam University, Daegu, Republic of Korea
| | - Gyu Sang Choi
- Department of Information and Communication Engineering, Yeungnam University, Gyeongsan-si, Republic of Korea
| | - Min Cheol Chang
- Department of Rehabilitation Medicine, College of Medicine, Yeungnam University, Daegu, Republic of Korea
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Kim JK, Lv Z, Park D, Chang MC. Practical Machine Learning Model to Predict the Recovery of Motor Function in Patients with Stroke. Eur Neurol 2022; 85:273-279. [PMID: 35350014 DOI: 10.1159/000522254] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 01/24/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Machine learning (ML) is an artificial intelligence technique in which a system learns patterns and rules from a given data. OBJECTIVES The objective of the study was to investigate the potential of ML for predicting motor recovery in stroke patients. METHODS We analyzed data from 833 consecutive stroke patients using 3 ML algorithms: deep neural network (DNN), random forest, and logistic regression. We created a practical ML model using the most common data measured in almost all rehabilitation hospitals as input data. Demographic and clinical data, including modified Brunnstrom classification (MBC) and functional ambulation classification (FAC), were collected when patients were transferred to the rehabilitation unit (8-30 days) and 6 months after stroke onset and were used as input data. Motor outcomes at 6 months after stroke onset of the affected upper and lower extremities were classified according to MBC and FAC, respectively. Patients with an MBC of <5 and an FAC of <4 at 6 months after stroke onset were considered to have a "poor" outcome, whereas those with MBC ≥5 and FAC ≥4 were considered to have a "good" outcome. RESULTS The area under the curve (AUC) for the DNN model for predicting motor function was 0.836 for the upper and lower limb motor functions. For the random forest and logistic regression models, the AUCs were 0.736 and 0.790 for the upper and lower limb motor functions, respectively. The AUCs for the random forest and logistic regression models were 0.741 and 0.795 for the upper and lower limb motor functions, respectively. CONCLUSION Although we used simple and common data that can be obtained in clinical practice as variables, our DNN algorithm was useful for predicting motor recovery of the upper and lower extremities in stroke patients during the recovery phase.
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Affiliation(s)
- Jeoung Kun Kim
- Department of Business Administration, School of Business, Yeungnam University, Gyeongsan-Si, Republic of Korea
| | - Zhihan Lv
- Department of Game Design, Faculty of Arts, Uppsala University, Uppsala, Sweden
| | - Donghwi Park
- Department of Physical Medicine and Rehabilitation, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea
| | - Min Cheol Chang
- Department of Rehabilitation Medicine, College of Medicine, Yeungnam University, Daegu, Republic of Korea
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Zhang C, Ge H, Zhang S, Liu D, Jiang Z, Lan C, Li L, Feng H, Hu R. Hematoma Evacuation via Image-Guided Para-Corticospinal Tract Approach in Patients with Spontaneous Intracerebral Hemorrhage. Neurol Ther 2021; 10:1001-1013. [PMID: 34515953 PMCID: PMC8571453 DOI: 10.1007/s40120-021-00279-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 08/25/2021] [Indexed: 11/30/2022] Open
Abstract
Introduction Corticospinal tract injury caused by direct hematoma compression and secondary damage induced from blood toxic substances might influence the outcomes in patients with intracerebral hemorrhage (ICH). This study aimed to evaluate the safety and efficacy of hematoma evacuation via image-guided para-corticospinal tract approach based on the protection of compressed or residual corticospinal tract. Methods Seventy-five patients with ICH who underwent the image-guided para-corticospinal tract approach were retrospectively collected into the surgery group. Diffusion tensor imaging or computed tomography angiography was performed to identify the relationship between important white matter tracts and hematoma. The neuronavigation system for the preoperative imaging data loaded was used to identify the location of the burr hole, insertion trajectory, and depth of insertion. Cortical entry points and insertion trajectories were kept parallel to the corticospinal tract route into the hematoma based on the protection of compressed or residual corticospinal tract. Hematoma was removed under the image-guided para-corticospinal tract approach. Seventy-five age-, sex-, hematoma site-, and volume-matched patients with ICH who underwent conservative treatment were selected as controls. Demographical, clinical, radiological, and treatment-related data were retrospectively analyzed. Functional outcome was evaluated by modified Rankin scale on day 90. Results A total of 150 patients with ICH were retrospectively enrolled. The median Glasgow coma scale (GCS) score on admission was 11 (IQR 8–13). Deep hematoma (thalamus and basal ganglion) was present in 86.7% (130 patients). The mean hematoma volume on admission was 47 ± 19 mL, and the postoperative hematoma volume was 11 ± 10 mL. A higher proportion of favorable outcome was observed in the surgery group than in conservative treatment group (32.0% versus 17.4%; p = 0.037). Conclusion Hematoma evacuation via image-guided para-corticospinal tract approach based on the protection of compressed or residual corticospinal tract seems to be safer in patients with ICH with a relatively higher functional independence.
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Affiliation(s)
- Chao Zhang
- Department of Neurosurgery and Key Laboratory of Neurotrauma, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, 400038, China
| | - Hongfei Ge
- Department of Neurosurgery and Key Laboratory of Neurotrauma, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, 400038, China
| | - Shuixian Zhang
- Department of Neurosurgery and Key Laboratory of Neurotrauma, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, 400038, China
| | - Dan Liu
- Department of Neurosurgery and Key Laboratory of Neurotrauma, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, 400038, China
| | - Zhouyang Jiang
- Department of Neurosurgery and Key Laboratory of Neurotrauma, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, 400038, China
| | - Chuan Lan
- Department of Neurosurgery and Key Laboratory of Neurotrauma, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, 400038, China
| | - Lan Li
- Department of Neurosurgery and Key Laboratory of Neurotrauma, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, 400038, China
| | - Hua Feng
- Department of Neurosurgery and Key Laboratory of Neurotrauma, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, 400038, China.
| | - Rong Hu
- Department of Neurosurgery and Key Laboratory of Neurotrauma, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, 400038, China.
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Does injury of the thalamocortical connection between the mediodorsal nucleus of the thalamus and the dorsolateral prefrontal cortex affect motor recovery after cerebral infarct? Acta Neurol Belg 2021; 121:921-926. [PMID: 32107716 DOI: 10.1007/s13760-020-01309-2] [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: 11/22/2019] [Accepted: 02/13/2020] [Indexed: 10/25/2022]
Abstract
We assessed the state of the thalamocortical connection between the mediodorsal nucleus (MD) and the dorsolateral prefrontal cortex (DLPFC) in patients with corona radiata infarct using diffusion tensor tractography (DTT). Altogether, 110 patients with corona radiata infarct were recruited, all of whom underwent DTT at an early stage following infarct onset. Based on the integrity of CST (CST+: CST was preserved around the infarct, CST-: CST was interrupted by the infarct) and the integrity of thalamocortical connection between the MD of thalamus and the DLPFC (DLPFC+: the connection was preserved, DLPFC-: the connection was interrupted), patients were divided into 4 groups: CST+/DLPFC+ (37 patients), CST+/DLPFC- (21 patients), CST-/DLPFC+ (25 patients), and CST-/DLPFC- (27 patients) groups. Motor function was evaluated using the upper Motricity Index (MI), lower MI, modified Brunnstrom classification, and the functional ambulation category at baseline and at 6 months post-onset. In patients with preserved CST integrity, the status of the thalamocortical connection had no impact on the assessed motor outcomes at 6 months post-stroke. However, in patients with disrupted CST integrity, those with preserved thalamocortical connection integrity had significantly higher motor function scores in all assessed outcomes 6 months post-stroke than those with disrupted thalamocortical connection integrity. The preservation or disruption of the thalamocortical connection between the MD of the thalamus and the DLPFC is an important factor for motor function recovery when CST integrity is also disrupted.
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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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Kim JK, Choo YJ, Chang MC. Prediction of Motor Function in Stroke Patients Using Machine Learning Algorithm: Development of Practical Models. J Stroke Cerebrovasc Dis 2021; 30:105856. [PMID: 34022582 DOI: 10.1016/j.jstrokecerebrovasdis.2021.105856] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 04/07/2021] [Accepted: 04/25/2021] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Machine learning (ML) techniques are being increasingly adopted in the medical field. OBJECTIVE We developed a deep neural network (DNN) model and applied 2 well-known ML algorithms, logistic regression and random forest, in predicting motor outcome at 6 months after stroke. METHODS In the present study, by using 14 input variables which are easily measured by clinicians, we developed ML models and investigated their applicability to predicting motor outcome in hemiplegic stroke patients. We retrospectively analyzed data of 1,056 consecutive stroke patients. Favorable outcomes of the upper and lower limbs were defined as a modified Brunnstrom classification (MBC) score of ≥5 (able to perform activities of daily living with the affected upper limb) and a functional ambulation category (FAC) score of ≥4 (able to walk without guardian's assistance), respectively. Poor outcomes of the upper and lower limbs were defined as MBC and FAC scores of <5 and <4, respectively. We developed 3 ML algorithms, namely the DNN, logistic regression, and random forest. RESULTS Regarding the prediction of upper limb function, for the DNN model, the area under the curve (AUC) was 0.906. For the logistic regression and random forest models, the AUC were 0.874 and 0.882, respectively. For the prediction of lower limb function, for the DNN, logistic regression, and random forest models, the AUCs were 0.822, 0.768, and 0.802, respectively. CONCLUSIONS We demonstrated that the ML algorithms, particularly the DNN, can be useful for predicting motor outcomes in the upper and lower limbs at 6 months after stroke.
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Affiliation(s)
- Jeoung Kun Kim
- Department of Business Administration, School of Business, Yeungnam University, Gyeongsan-si, Republic of Korea
| | - Yoo Jin Choo
- Department of Rehabilitation Medicine, College of Medicine, Yeungnam University, Daegu, Republic of Korea
| | - Min Cheol Chang
- Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University 317-1, Daemyungdong, Namku, Taegu, 705-717, Republic of Korea.
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Prediction of ambulatory outcome in patients with corona radiata infarction using deep learning. Sci Rep 2021; 11:7989. [PMID: 33846472 PMCID: PMC8041824 DOI: 10.1038/s41598-021-87176-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 03/22/2021] [Indexed: 11/08/2022] Open
Abstract
Deep learning (DL) is an advanced machine learning approach used in diverse areas such as bioinformatics, image analysis, and natural language processing. Here, using brain magnetic resonance imaging (MRI) data obtained at early stages of infarcts, we attempted to develop a convolutional neural network (CNN) to predict the ambulatory outcome of corona radiata infarction at six months after onset. We retrospectively recruited 221 patients with corona radiata infarcts. A favorable outcome of ambulatory function was defined as a functional ambulation category (FAC) score of ≥ 4 (able to walk without a guardian's assistance), and a poor outcome of ambulatory function was defined as an FAC score of < 4. We used a CNN algorithm. Of the included subjects, 69.7% (n = 154) were assigned randomly to the training set and the remaining 30.3% (n = 67) were assigned to the validation set to measure the model performance. The area under the curve was 0.751 (95% CI 0.649-0.852) for the prediction of ambulatory function with the validation dataset using the CNN model. We demonstrated that a CNN model trained using brain MRIs captured at an early stage after corona radiata infarction could be helpful in predicting long-term ambulatory outcomes.
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Essential Medical Information for Stroke Patients Undergoing Interhospital Transfer: A Delphi Study. Am J Phys Med Rehabil 2021; 100:354-358. [PMID: 32858536 DOI: 10.1097/phm.0000000000001573] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVE For improving the efficiency of transferring medical records for stroke patients undergoing interhospital transfer, we evaluated what is the essential medical information for physicians using the Delphi method. DESIGN We set up an expert panel of 31 physiatrists, who participated in this study. The 32 preliminary items of the transferred medical information were listed by a physiatrist for the first round of the Delphi method, and degree of necessity for these 32 items was evaluated using a 3-point scale ("very necessary," "necessary," and "not necessary"). We considered "very necessary" and "necessary" as "agreed to its necessity." According to the Delphi method, a satisfactory level of consensus can be achieved with the agreement of significant majority (≥80%) in the expert panel. RESULTS Based on the experts' feedback, some items were added as the preliminary items. After the second round of the Delphi method, the items confirmed to be necessary information during interhospital transfer were motor and sensory evoked potentials, Barthel Index, Mini-Mental State Examination/Global Deterioration Scale, Motor-Free Visual Perception Test, Manual Function Test, Purdue Pegboard Test, hand grip power, monofilament, 2-point discrimination test, Manual Muscle Test, Nottingham Scale, modified Brunnstrom Classification, functional ambulation category, Glasgow Coma Scale, language function test, imaging study, videofluoroscopic swallowing study, rehabilitation goal, previous medical history, comorbidity, and medication information. CONCLUSIONS If the previously mentioned necessary items are presented together at once during interhospital transfer, physicians who receive new stroke patients can evaluate patients' medical information more easily and completely.
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Current applications of diffusion tensor tractography analysis of corticospinal tracts for prognostication of motor outcomes or optimization of neurosurgical intervention in hypertensive intracranial hemorrhage. BRAIN HEMORRHAGES 2021. [DOI: 10.1016/j.hest.2021.04.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
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Lee AY, Choi KT, Chang MC. Prediction of muscle loss after stroke by analysis of corticospinal tract. Transl Neurosci 2020; 11:328-333. [PMID: 33335772 PMCID: PMC7712419 DOI: 10.1515/tnsci-2020-0114] [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: 12/10/2019] [Revised: 04/02/2020] [Accepted: 04/20/2020] [Indexed: 11/21/2022] Open
Abstract
Introduction Skeletal muscle loss induces a poor rehabilitation outcome after stroke. Little is known about the usefulness of diffusion tensor tractography (DTT) findings of the corticospinal tract (CST) in terms of predicting muscle loss in affected limbs after stroke. Methods This research was designed as a preliminary study. Forty-four patients, with stroke onset more than one year earlier, were recruited. DTT was performed within 7–30 days after stroke onset. The patients were classified into two groups based on the DTT findings: a DTT+ group, in which the CST was preserved, and a DTT− group, in which the CST was interrupted by the stroke lesion. Additionally, the patients’ functions were evaluated based on the modified Brunnstrom classification and functional ambulation category. Results In the DTT− group, the values of the lean tissue mass of the affected upper and lower limbs were smaller than those of the unaffected side. On the other hand, in the DTT+ group, the values of the lean tissue mass between the affected and unaffected limbs were not significantly different. Conclusion The DTT evaluation of CST at the early stage of stroke may be useful for predicting muscle loss of the affected limb at the chronic stage in stroke patients.
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Affiliation(s)
- Ah Young Lee
- Department of Rehabilitation Medicine, Daegu Veterans Health Service Medical Center, Daegu, Republic of Korea
| | - Kyu Tae Choi
- Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, 317-1, Daemyungdong, Namku, Daegu, 705-717, Republic of Korea
| | - Min Cheol Chang
- Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, 317-1, Daemyungdong, Namku, Daegu, 705-717, Republic of Korea
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Jang SH, Kwak SG, Chang MC. Diabetes does not affect motor recovery after intracerebral hemorrhage. Transl Neurosci 2020; 11:277-282. [PMID: 33312723 PMCID: PMC7706134 DOI: 10.1515/tnsci-2020-0125] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 07/20/2020] [Accepted: 08/04/2020] [Indexed: 12/22/2022] Open
Abstract
Background This retrospective study evaluated whether diabetes affects motor outcome after stroke by analyzing the effects of diabetes on motor prognosis by controlling for critical factors, including lesion type and location, corticospinal tract (CST) state, patient age, lesion volume, and treatment method during the stroke. Methodology We recruited 221 patients with intracerebral hemorrhage (ICH) of the basal ganglia. We used diffusion tensor tractography to investigate the CST state. We also evaluated the hemorrhage volume. We obtained information on the presence of diabetes and age by chart review. Motor outcomes at 6 months were measured using the upper and lower limb motricity index (MI), modified Brunnstrom classification (MBC), and functional ambulation category (FAC). We used multiple linear regression tests to investigate whether diabetes affected motor outcomes after stroke after adjusting for other factors, including CST state, age, lesion volume, and treatment method. Results The presence of diabetes was not correlated with motor outcome measurements, including upper and lower MIs, MBC, and FAC, at 6 months after the onset. However, the CST state, age, lesion volume, and treatment method were significantly correlated with nearly all motor outcomes. Conclusions We found that diabetes did not significantly affect motor outcomes after ICH.
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Affiliation(s)
- Seung Hwa Jang
- Department of Rehabilitation Medicine, College of Medicine, Yeungnam University, 317-1, Daemyungdong, Namku, 705-717, Daegu, Republic of Korea
| | - Sang Gyu Kwak
- Department of Medical Statistics, College of Medicine, Catholic University of Daegu, Daegu, Republic of Korea
| | - Min Cheol Chang
- Department of Rehabilitation Medicine, College of Medicine, Yeungnam University, 317-1, Daemyungdong, Namku, 705-717, Daegu, Republic of Korea
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Lv Y, Wei W. Clinical treatment progress of small amounts thalamus hemorrhage. BRAIN HEMORRHAGES 2020. [DOI: 10.1016/j.hest.2020.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Kwak SY, Kwak SG, Yoon TS, Kong EJ, Chang MC. Deterioration of Brain Neural Tracts in Elderly Women with Sarcopenia. Am J Geriatr Psychiatry 2019; 27:774-782. [PMID: 30981430 DOI: 10.1016/j.jagp.2019.02.018] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 02/21/2019] [Accepted: 02/27/2019] [Indexed: 12/18/2022]
Abstract
OBJECTIVES Sarcopenia is known to be associated with increased stiffness in brain arteries, which causes deterioration in brain structure and function. In this study, the authors evaluated the deterioration of neural tracts using diffusion tensor tractography (DTT) in elderly women with sarcopenia and investigated whether deterioration of neural tracts is consistent with clinical findings. METHODS Twenty elderly women with sarcopenia were recruited. Muscle mass was measured by dual energy x-ray absorptiometry. Hand-grip power and gait speed were also assessed. Memory function was evaluated using the Seoul Neuropsychological Screening Battery. Additionally, using DTT-Studio software, the authors evaluated eight neural tracts: the corticospinal tract (CST), corticoreticular pathway, fornix, cingulum, superior longitudinal fasciculus, inferior longitudinal fasciculus, inferior fronto-occipital fasciculus, and optic radiation. The authors measured the DTT parameters (fractional anisotropy [FA] and fiber volume [FV]) for each neural tract. RESULTS The FA and FV values were decreased in all the evaluated neural tracts, compared with those of the 20 normal comparison subjects. The FVs of the CST were significantly correlated with the hand-grip power of elderly women with sarcopenia. The FVs of the fornix and cingulum in elderly women with sarcopenia were significantly correlated with their memory function. CONCLUSION The authors found that the neural tracts in elderly women with sarcopenia were extensively deteriorated, and their hand-grip power and memory function were associated with related neural tracts. The DTT seems to be a useful tool for evaluating structural changes in the brains of people with sarcopenia.
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Affiliation(s)
- So Young Kwak
- Department of Physical Medicine and Rehabilitation (SYK), College of Medicine, Yeungnam University, Taegu, Republic of Korea
| | - Sang Gyu Kwak
- Department of Medical Statistics (SGK), College of Medicine, Catholic University of Daegu, Daegu, Republic of Korea
| | - Tae Sang Yoon
- Health and Exercise Science Laboratory (TSY), Institute of Sports Science, Seoul National University, Seoul, Korea
| | - Eun Jung Kong
- Department of Nuclear Medicine, College of Medicine (EJK), Yeungnam University, Taegu, Republic of Korea
| | - Min Cheol Chang
- Department of Physical Medicine and Rehabilitation (MCC), College of Medicine, Yeungnam University, Taegu, Republic of Korea.
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Moon JS, Chung SM, Jang SH, Won KC, Chang MC. Effects of Diabetes on Motor Recovery after Cerebral Infarct: A Diffusion Tensor Imaging Study. J Clin Endocrinol Metab 2019; 104:3851-3858. [PMID: 30946456 DOI: 10.1210/jc.2018-02502] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Accepted: 03/29/2019] [Indexed: 01/12/2023]
Abstract
PURPOSE Little is known about the effects of diabetes on motor recovery after cerebral infarct. To address this, we recruited patients with corona radiata infarct and controlled for the integrity of the corticospinal tract (CST) determined using diffusion tensor tractography (DTT). METHODS One hundred patients were recruited, and DTT was performed within 7-30 days of infarct onset. Based on the DTT findings (DTT+: CST was preserved around the infarct, DTT-: CST was interrupted by the infarct) and the presence (DM+) or absence (DM-) of diabetes, patients were divided into, DTT+/DM- (36 patients), DTT+/DM+ (19 patients), DTT-/DM- (32 patients), and DTT-/DM+ (13 patients) groups. Six months after cerebral infarct, motor function on the affected side was evaluated for each patient using the upper Motricity Index (MI), lower MI, modified Brunnstrom classification (MBC), and the functional ambulation category (FAC). RESULTS In the patients with a DTT+ finding, no motor function scores were significantly different between the DTT+/DM- and DTT+/DM+ groups at six-month evaluation. However, in patients with DTT- finding, all motor function scores at the six-month evaluation were significantly higher in the DTT-/DM- group than in the DTT-/DM+ group. CONCLUSION When the CST is interrupted by a corona radiata infarct, recovery of motor function in patients with diabetes is more impaired than those without diabetes.
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Affiliation(s)
- Jun Sung Moon
- Division of Endocrinology and Metabolism, Department of Internal Medicine, College of Medicine, Yeungnam University
| | - Seung Min Chung
- Division of Endocrinology and Metabolism, Department of Internal Medicine, College of Medicine, Yeungnam University
| | - Sung Ho Jang
- Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University
| | - Kyu Chang Won
- Division of Endocrinology and Metabolism, Department of Internal Medicine, College of Medicine, Yeungnam University
| | - Min Cheol Chang
- Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University
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Can the integrity of the corticospinal tract predict the long-term motor outcome in poststroke hemiplegic patients? Neuroreport 2019; 29:453-458. [PMID: 29481524 DOI: 10.1097/wnr.0000000000000994] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This study aimed to investigate the long-term motor outcome according to early diffusion tensor tractography findings for the affected corticospinal tract (CST) in poststroke hemiplegic patients. A total of 48 supratentorial subacute patients after stroke were enrolled, who had a brain MRI scan within 6 weeks from onset, and no stroke recurrence reported within the 2-year follow-up period. Diffusion tensor images were obtained and CSTs were reconstructed. The participants were classified into three groups: type A, the CST originating from the primary motor cortex was preserved around the lesion area; type B, the CST was similar to type A, except that the fiber originated from the area adjacent to the primary motor cortex; and type C, the CST was interrupted or not shown. Motor functions using Fugl-Meyer Motor Assessment (FMA), the Box and Block Test (BBT), and Functional Ambulation Category, and cognitive function using Mini-Mental Status Examination (MMSE) were measured at baseline and at 2 years from stroke onset. Changes in FMA and BBT were significantly different according to diffusion tensor tractography type at follow-up (P<0.05), but Functional Ambulation Category and Mini-Mental Status Examination were not. In post-hoc analysis, groups A and B showed greater significant improvements on the BBT and on the upper FMA subscale (shoulder/elbow, wrist, and hand) compared with group C (corrected P<0.05), but did not on lower FMA. This study showed the importance of CST integrity for stoke motor recovery. The early integrity of the CST may be useful in predicting long-term motor outcomes, specifically with motor recovery of the upper extremity and hand function.
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Lee HD, Chang MC. Detection of thinned corticospinal tract and corticoreticular pathway in a patient with a calf circumference discrepancy. Neural Regen Res 2018; 13:366-368. [PMID: 29557390 PMCID: PMC5879912 DOI: 10.4103/1673-5374.226427] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Affiliation(s)
- Han Do Lee
- Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Namku, Daegu, Republic of Korea
| | - Min Cheol Chang
- Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Namku, Daegu, Republic of Korea
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Smith MC, Barber PA, Stinear CM. The TWIST Algorithm Predicts Time to Walking Independently After Stroke. Neurorehabil Neural Repair 2017; 31:955-964. [PMID: 29090654 DOI: 10.1177/1545968317736820] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND AND OBJECTIVE The likelihood of regaining independent walking after stroke is of concern to patients and their families and influences hospital discharge planning. The objective of this study was to explore factors that could be combined in an algorithm for predicting whether and when a patient will walk independently after stroke. METHODS Adults with new lower limb weakness were recruited within 3 days of having a stroke. Clinical assessment, transcranial magnetic stimulation, and magnetic resonance imaging were completed 1 to 2 weeks poststroke. Classification and regression tree (CART) analysis was used to identify factors that predicted whether a patient achieved independent walking by 6 or 12 weeks, or remained dependent at 12 weeks. RESULTS We recruited 41 patients (24 women; median age 72 years, range 43-96 years). The CART analysis results were used to create the Time to Walking Independently after STroke (TWIST) algorithm, which made accurate predictions for 95% of patients. Patients with a trunk control test score >40 at 1 week walked independently within 6 weeks. Patients with a trunk control test score <40 only achieved independent walking by 12 weeks if they also had hip extension strength of Medical Research Council grade 3 or more. Neurophysiological and neuroimaging measures did not predict independent walking after stroke. CONCLUSIONS In this exploratory study, the TWIST algorithm accurately predicted whether and when an individual patient walked independently after stroke using simple bedside measures 1 week poststroke. Further work is required to develop and validate this algorithm in a larger study.
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Affiliation(s)
| | - P Alan Barber
- 1 University of Auckland, Auckland, New Zealand.,2 Auckland District Health Board, Auckland, New Zealand
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Choi GS, Chang MC. Effects of high-frequency repetitive transcranial magnetic stimulation on reducing hemiplegic shoulder pain in patients with chronic stoke: a randomized controlled trial. Int J Neurosci 2017; 128:110-116. [PMID: 28805107 DOI: 10.1080/00207454.2017.1367682] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Gyu-sik Choi
- Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Namku, Daegu, Republic of Korea
| | - Min Cheol Chang
- Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Namku, Daegu, Republic of Korea
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Chang MC. Reduced foot pain after spasticity control with alcohol block in a patient with chronic hemiparetic stroke: a case report. J Phys Ther Sci 2017; 29:767-770. [PMID: 28533627 PMCID: PMC5430290 DOI: 10.1589/jpts.29.767] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2016] [Accepted: 12/28/2016] [Indexed: 01/04/2023] Open
Abstract
[Purpose] This study report a case of a patient with hemiparetic stroke who showed significantly reduced foot pain when ankle spasticity was reduced using nerve and motor point blocks with 20% ethyl alcohol. [Subject and Methods] A 58-year-old woman with left hemiparesis following intracranial hemorrhage five years previously presented with pain in the left fifth metatarsal head for two years (numeric rating scale[NRS]: 8). Erythema and edema were observed on the lateral aspect of the head of the fifth metatarsal bone. She was diagnosed with a Tailor's bunion. Spasticity was observed in the left ankle plantar flexor and ankle supinator (Modified Ashworth Scale: 1+). Using 20% ethyl alcohol, a block in the medial and lateral motor branches to the gastrocnemius muscle of the left tibial nerve and the motor point of the left posterior tibialis muscle was performed. [Results] After the alcohol block, spasticity had almost disappeared and foot pain was significantly reduced (NRS: 1). Results from the foot pressure measurement system test showed foot contact pressure was highly distributed to the lateral forefoot pre-block. After the block, the distribution of foot contract pressure was similar to normal distribution. [Conclusion] Clinicians should consider the possibility that spasticity can contribute to foot pain.
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Affiliation(s)
- Min Cheol Chang
- Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Republic of Korea
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The Effects of 10-Hz Repetitive Transcranial Magnetic Stimulation on Depression in Chronic Stroke Patients. Brain Stimul 2017; 10:270-274. [PMID: 27839722 DOI: 10.1016/j.brs.2016.10.010] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Revised: 09/03/2016] [Accepted: 10/16/2016] [Indexed: 01/18/2023] Open
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Chang MC, Lee HD, Jang SH. Injury of the arcuate fasciculus in a patient with progressive bulbar palsy. Neural Regen Res 2017; 11:2031-2032. [PMID: 28197203 PMCID: PMC5270445 DOI: 10.4103/1673-5374.197149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Min Cheol Chang
- Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Daemyungdong, Namgu, Daegu, Republic of Korea
| | - Han Do Lee
- Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Daemyungdong, Namgu, Daegu, Republic of Korea
| | - Sung Ho Jang
- Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Daemyungdong, Namgu, Daegu, Republic of Korea
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Hong JS, Kim JM, Kim HS. Correlation between ambulatory function and clinical factors in hemiplegic patients with intact single lateral corticospinal tract: A pilot study. Medicine (Baltimore) 2016; 95:e4360. [PMID: 27495041 PMCID: PMC4979795 DOI: 10.1097/md.0000000000004360] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
To define the relationship between the complete destruction of 1 lateral corticospinal tract (CST), as demonstrated by diffusion tensor imaging (DTI) tractography, and ambulatory function 6 months following stroke.Twenty-six adults (17 male, 9 female) with poststroke hemiplegia who were transferred to the physical medicine and rehabilitation department. Participants underwent DTI tractography, which showed that 1 lateral CST had been clearly destroyed.Functional ambulation classification (FAC) scores at admission, discharge, and 6 months after discharge were used to evaluate the patients' ability to walk. The National Institutes of Health Stroke Scale (NIHSS) and the Korean version of the modified Barthel index (K-MBI) at admission, discharge, and 6 months after discharge were used to evaluate the degree of functional recovery.Of the 26 patients, 18 were nonambulatory (FAC level 1-3), and 8 were able to walk without support (FAC level 4-6). The type of stroke (infarction or hemorrhage), site of the lesion, spasticity of lower extremities, cranioplasty, and the time taken from onset to MRI were not statistically significantly correlated with the ability to walk. However, statistically significant correlations were found in relation to age, K-MBI scores, and initial NIHSS scores.Despite the complete damage to the lesion site and the preservation of 1 unilateral CST, as shown by DTI, good outcomes can be predicted on the basis of younger age, low NIHSS scores, and high MBI scores at onset.
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Affiliation(s)
| | | | - Hyoung Seop Kim
- Department of Physical Medicine and Rehabilitation, National Health Insurance Service Ilsan Hospital, Goyang, Korea
- Correspondence: Hyoung Seop Kim, National Health Insurance Service Ilsan Hospital, Ilsan-ro 100, ilsan-donggu, Goyang, Korea, 10444 (e-mail: )
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Kim BR, Moon WJ, Kim H, Jung E, Lee J. Transcranial Magnetic Stimulation and Diffusion Tensor Tractography for Evaluating Ambulation after Stroke. J Stroke 2016; 18:220-6. [PMID: 27283282 PMCID: PMC4901949 DOI: 10.5853/jos.2015.01767] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Revised: 04/25/2016] [Accepted: 04/27/2016] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND AND PURPOSE We aimed to investigate the usefulness of combining transcranial magnetic stimulation (TMS) and diffusion tensor tractography (DTT) to evaluate corticospinal tract (CST) integrity and subsequently predict ambulatory function after middle cerebral artery (MCA) stroke. METHODS Forty-three patients with first MCA stroke underwent TMS and DTT to evaluate CST integrity. Patients were classified into four groups according to the presence of motor-evoked potentials (MEPs) obtained from the tibialis anterior muscle and CST integrity. Motor impairment and functional status were assessed using the Fugl-Meyer Assessment, Functional Ambulation Category, and Korean modified Barthel Index, both at the time of admission and after 4 weeks of rehabilitation. RESULTS Patients with the presence of both measurable MEPs and a preserved CST showed better motor recovery and ambulatory function than other groups at the 4-week follow-up. Intact CSTs were not visualized in patients without detectable MEPs. Among the patients displaying MEPs, those with preserved CSTs showed better recovery of paretic lower extremities. CONCLUSIONS Combined assessment using TMS and DTT to evaluate CST integrity confers advantages in predicting motor and ambulation recovery in patients with MCA stroke.
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Affiliation(s)
- Bo-Ram Kim
- Department of Rehabilitation Medicine, Konkuk University School of Medicine and Konkuk University Medical Center, Seoul, Korea
| | - Won-Jin Moon
- Department of Radiology, Konkuk University School of Medicine and Konkuk University Medical Center, Seoul, Korea
| | - Hyuntae Kim
- Department of Rehabilitation Medicine, Konkuk University School of Medicine and Konkuk University Medical Center, Seoul, Korea
| | - Eunhwa Jung
- Department of Rehabilitation Medicine, The Graduate School of Konkuk University and Konkuk University Medical Center, Seoul, Korea
| | - Jongmin Lee
- Department of Rehabilitation Medicine, Konkuk University School of Medicine and Konkuk University Medical Center, Seoul, Korea
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Jang SH, Chang MC. Motor outcomes of patients with a complete middle cerebral artery territory infarct. Neural Regen Res 2013; 8:1892-7. [PMID: 25206498 PMCID: PMC4145972 DOI: 10.3969/j.issn.1673-5374.2013.20.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2013] [Accepted: 05/21/2013] [Indexed: 11/18/2022] Open
Abstract
Detailed knowledge of motor outcomes enables to establish proper goals and rehabilitation strategies for stroke patients. Several previous studies have reported functional or motor outcomes in patients with a middle cerebral artery territory infarct. However, little is known about motor outcome in patients with a complete middle cerebral artery territory infarct. In this study, we investigated the motor outcomes in 23 patients with a complete middle cerebral artery territory infarct. All of these patients received comprehensive rehabilitative management, including movement therapy and neuromuscular electrical stimulation of the affected finger extensors and ankle dorsiflexors, for more than 3 months. Motor outcomes were measured at 6 months after stroke onset using the Medical Research Council, Motricity Index, the modified Brunnstrom Classification, and Functional Ambulation Category scores. The motor function of the lower extremities was found to be better than that of the upper extremities. After receiving rehabilitation treatments for 3-6 months, about 70% of these patients were able to walk independently (Functional Ambulation Category scores > 3), but no patient achieved functional hand recovery.
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Affiliation(s)
- Sung Ho Jang
- Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Daegu 705-717, Korea
| | - Min Cheol Chang
- Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Daegu 705-717, Korea
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