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Corticospinal Tract Integrity and Lesion Volume Play Different Roles in Chronic Hemiparesis and Its Improvement Through Motor Practice

Published on May 1, 2014in Neurorehabilitation and Neural Repair3.757
· DOI :10.1177/1545968313510972
Annette Sterr33
Estimated H-index: 33
(University of Surrey),
Phil J. A. Dean3
Estimated H-index: 3
(University of Surrey)
+ 2 AuthorsShan Shen15
Estimated H-index: 15
(University of Reading)
Abstract
Background. Initial evidence suggests that the integrity of the ipsilesional corticospinal tract (CST) after stroke is strongly related to motor function in the chronic state but not the treatment gain induced by motor rehabilitation. Objective. We examined the association of motor status and treatment benefit by testing patients with a wide range of severity of hemiparesis of the left and right upper extremity. Method. Diffusion tensor imaging was performed in 22 patients beyond 12 months after onset of stroke with severe to moderate hemiparesis. Motor function was tested before and after 2 weeks of modified constraint-induced movement therapy. Results. CST integrity, but not lesion volume, correlated with the motor ability measures of the Wolf Motor Function Test and the Motor Activity Log. No differences were found between left and right hemiparesis. Motor performance improved significantly with the treatment regime, and did so equally for patients with left and right arm paresis. However, treatment benefit was not associated with either CST integrity or lesion volume. Conclusion. CST integrity correlated best in this small trial with chronic long-term status but not treatment-induced improvements. The CST may play a different role in the mechanisms mediating long-term outcome compared to those underlying practice-induced gains after a chronic plateau in motor function.
  • References (38)
  • Citations (32)
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References38
Newest
#1Nicki LangerH-Index: 1
#2Jürgen HänggiH-Index: 29
Last. Lutz JänckeH-Index: 84
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Objective: Little is known about the effects of reduced sensory input and motor output in the human brain. Therefore, we conducted a longitudinal study to investigate whether limb immobilization after unilateral arm injury is reflected in structural plastic changes in gray matter (cortical thickness) and white matter (fractional anisotropy [FA]). Methods: We examined 10 right-handed subjects with injury of the right upper extremity that required at least 14 days of limb immobilization. Subjects ...
97 CitationsSource
#1T. HattoriH-Index: 4
#2T. YuasaH-Index: 3
Last. Hidehiro MizusawaH-Index: 57
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BACKGROUND AND PURPOSE: Previous neuropathologic studies in chronic hydrocephalus have suggested the presence of white matter damage, presumably from mechanical pressure due to ventricular enlargement and metabolic derangement. This study aimed to investigate the diffusional properties of the CST in patients with iNPH by using DTI and to determine whether this method could be used as a new diagnostic tool to differentiate patients with iNPH from those with AD and PDD and control subjects. MATERI...
45 CitationsSource
Motor impairment is a common symptom of stroke. Several processes, such as innate neuroplasticity, are considered to underlie gains in motor function after stroke. In this article, Dimyan and Cohen provide a review of neuroplasticity associated with poststroke motor impairment and highlight the latest experimental interventions being developed to manipulate neuroplasticity to enhance motor rehabilitation.
259 CitationsSource
#1Peter LanghorneH-Index: 71
#2Julie BernhardtH-Index: 42
Last. G. KwakkelH-Index: 71
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Stroke is a common, serious, and disabling global health-care problem, and rehabilitation is a major part of patient care. There is evidence to support rehabilitation in well coordinated multidisciplinary stroke units or through provision of early supported provision of discharge teams. Potentially beneficial treatment options for motor recovery of the arm include constraint-induced movement therapy and robotics. Promising interventions that could be beneficial to improve aspects of gait include...
839 CitationsSource
#1Michelle L. Woodbury (UF: University of Florida)H-Index: 13
#2Craig A. Velozo (UF: University of Florida)H-Index: 29
Last. Steven L. Wolf (Emory University)H-Index: 69
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Background. Tools chosen to measure poststroke upper-extremity rehabilitation outcomes must match contemporary theoretical expectations of motor deficit and recovery because an assessment’s theoretical underpinning forms the conceptual basis for interpreting its score. Objective. The purpose of this study was to investigate the theoretical framework of the Wolf Motor Function Test (WMFT) by (1) determining whether all items measured a single underlying trait and (2) examining the congruency betw...
46 CitationsSource
#1Annette SterrH-Index: 33
#2Shan ShenH-Index: 15
Last. Katherine HerronH-Index: 6
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Background. With diffusion-tensor imaging (DTi) it is possible to estimate the structural characteristics of fiber bundles in vivo. This study used DTi to infer damage to the corticospinal tract (CST) and relates this parameter to (a) the level of residual motor ability at least 1 year poststroke and (b) the outcome of intensive motor rehabilitation with constraintinduced movement therapy (CIMT). Objective. To explore the role of CST damage in recovery and CIMT efficacy. Methods. Ten patients wi...
49 CitationsSource
Background In stroke patients, upper limb paresis affects many activities of daily life. Reducing disability is therefore a major aim of rehabilitation programmes for hemiparetic patients. Constraint-induced movement therapy (CIMT) is a current approach to stroke rehabilitation that implies the forced use and the massed practice of the affected arm by restraining the unaffected arm. Objectives To assess the efficacy of CIMT, modified CIMT (mCIMT), or forced use (FU) for arm management in hemipar...
150 CitationsSource
#1Lynne V. Gauthier (UAB: University of Alabama at Birmingham)H-Index: 13
#2Edward Taub (UAB: University of Alabama at Birmingham)H-Index: 76
Last. Gitendra Uswatte (UAB: University of Alabama at Birmingham)H-Index: 40
view all 5 authors...
Background and Purpose— Disruption of the corticospinal tract at various locations in the brain has been shown to predict worse spontaneous motor recovery after stroke. However, the anatomic specificity of previous findings was limited by the categorical classification of infarct locations. Here we used computational methods to more precisely determine the specific anatomic locations associated with impaired motor ability. More important, however, our study also used these techniques to evaluate...
31 CitationsSource
#1Theresa A. JonesH-Index: 44
#2Rachel P. AllredH-Index: 14
Last. Monica A. Maldonado (University of Texas at Austin)H-Index: 7
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Background and Purpose— Behavioral experience can drive brain plasticity, but we lack sufficient knowledge to optimize its therapeutic use after stroke. Methods— We outline recent findings from rodent models of cortical stroke of how experiences interact with postinjury events to influence synaptic connectivity and functional outcome. We focus on upper extremity function. Results— After unilateral cortical infarcts, behavioral experiences shape neuronal structure and activity in both hemispheres...
56 CitationsSource
#1Victor W. Mark (UAB: University of Alabama at Birmingham)H-Index: 24
#2Edward TaubH-Index: 76
Last. Gitendra UswatteH-Index: 40
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Purpose: To evaluate the effect of total cerebral infarction volume on motor status and treatment responses to Constraint-Induced Movement therapy (CI therapy) in patients with chronic post-stroke hemiparesis and limb nonuse. In most studies of clinical-radiological correspondences, infarct volume has been found to predict clinical status. Methods: 60 adult patients who met inclusion criteria for CI therapy underwent standard structural brain MRI around the time of treatment. We tested whether t...
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Cited By32
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#1Silvi Frenkel-Toledo (Ariel University)H-Index: 1
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The effect of stroke topography on the recovery of hemiparetic upper limb (HUL) function is unclear due to limitations in previous studies–examination of lesion effects only in one point of time, or grouping together patients with left and right hemispheric damage (LHD, RHD), or disregard to different lesion impact on proximal and distal operations. Here we used voxel-based lesion symptom mapping (VLSM) to investigate the impact of stroke topography on HUL function taking into consideration the ...
Source
#2Philipp Koch (EPFL: École Polytechnique Fédérale de Lausanne)H-Index: 4
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Abstract Stroke has long been regarded as focal disease with circumscribed damage leading to neurological deficits. However, advances in methods for assessing the human brain and in statistics have enabled new tools for the examination of the consequences of stroke on brain structure and function. Thereby, it has become evident that stroke has impact on the entire brain and its network properties and can therefore be considered as a network disease. The present review first gives an overview of ...
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#2Christoph Sperber (University of Tübingen)H-Index: 7
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Abstract Neuroscience has a long history of inferring brain function by examining the relationship between brain injury and subsequent behavioral impairments. The primary advantage of this method over correlative methods is that it can tell us if a certain brain region is necessary for a given cognitive function. In addition, lesion-based analyses provide unique insights into clinical deficits. In the last decade, statistical voxel-based lesion behavior mapping (VLBM) emerged as a powerful metho...
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#2Se-Hong Kim (Catholic University of Korea)H-Index: 10
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#2Edward Taub (UAB: University of Alabama at Birmingham)H-Index: 76
Last. Gitendra Uswatte (UAB: University of Alabama at Birmingham)H-Index: 40
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BACKGROUND:Infarct size and location account for only a relatively small portion of post-stroke motor impairment, suggesting that other less obvious factors may be involved. OBJECTIVE:Examine the relationship between white matter hyperintensity (WMH) load among other factors and upper extremity motor deficit in patients with mild to moderate chronic stroke. METHODS:The magnetic resonance images of 28 patients were studied. WMH load was assessed as total WMH volume and WMH overlap with the cortic...
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#1S. Feldman (UBC: University of British Columbia)H-Index: 2
#2Lara A. Boyd (UBC: University of British Columbia)H-Index: 39
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Abstract Background Information about the structural integrity of the corticospinal tract (CST) from diffusion-weighted imaging can improve our ability to understand motor outcomes in people with upper limb impairment after stroke, especially those with severe impairment. Yet, there is no consensus on which method of CST generation most accurately represents function and impairment in individuals with chronic stroke. New method The aim of the study was to compare different methods of CST reconst...
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#2Kohei MarumotoH-Index: 8
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#2Justin B. Rowe (UCI: University of California, Irvine)H-Index: 9
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BACKGROUND AND PURPOSE:Patient heterogeneity reduces statistical power in clinical trials of restorative therapies. Valid predictors of treatment responsiveness are needed, and several have been studied with a focus on corticospinal tract (CST) injury. We studied performance of 4 such measures for predicting behavioral gains in response to motor training therapy. METHODS:Patients with subacute-chronic hemiparetic stroke (n=47) received standardized arm motor therapy, and change in arm Fugl-Meyer...
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