Brain regions associated with Brunnstrom and functional independence measure scores in patients after a stroke: a tract-based spatial statistics study

Abstract

We aimed to assess diffusion tensor fractional anisotropy to outline the brain regions associated with the long-term motor and cognitive functional outcomes of patients with stroke. [Participants and Methods] Eighty patients from our previous study were enrolled. Fractional anisotropy maps were acquired on days 14-21 after stroke onset, and tract-based spatial statistics were applied. Outcomes were scored using the Brunnstrom recovery stage and Functional Independence Measure motor and cognition components. Fractional anisotropy images were assessed in relation to outcome scores using the general linear model. [Results] For both the right (n=37) and left (n=43) hemisphere lesion groups, the corticospinal tract and the anterior thalamic radiation were most strongly associated with the Brunnstrom recovery stage. In contrast, the cognition component involved large regions encompassing the anterior thalamic radiation, superior longitudinal fasciculus, inferior longitudinal fasciculus, uncinate fasciculus, cingulum bundle, forceps major, and forceps minor. The results for the motor component were intermediate between those for the Brunnstrom recovery stage and those for the cognition component. [Conclusion] Motorrelated outcomes were associated with fractional anisotropy decreases in the corticospinal tract, whereas cognitive outcomes were related to broad regions of association and commissural fibers. This knowledge will help scheduling appropriate rehabilitative treatments.

Clinical applicability of automated tractography for stroke rehabilitation: Z-score conversion of fractional anisotropy

“…Parameter estimates including FA values were extracted using a threshold set at 0.01, in line with our previous studies 8 , 9 , 10 , 11 ) . For clarity, we concentrated on the neural tracts that are frequently impaired by stroke lesions 15 , 16 , 17 ) : the corticospinal tract (CST), the superior longitudinal fasciculus parts 1, 2, and 3 (SLF1–3), the frontal aslant (FAS), the anterior thalamic radiation (ATR), the inferior fronto-occipital fasciculus (IFOF), the inferior longitudinal fasciculus (ILF), and the uncinate fasciculus (UNF).…”