The difference of gait pattern according to the state of the corticospinal tract in chronic hemiparetic stroke patients

Seo, Jeong Hyun; Hee, Kyung; Jung, Gil Su; Seo, Sang Wan; Kim, Kyoung; Son, Su Min; Kim, Yeung Ki; Jang, Sung Ho

doi:10.3233/nre-131046

Cited by 14 publications

(12 citation statements)

References 44 publications

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“…A previous study found that, in patients with a corona radiata infarct, the integrity of the CST, as assessed by DTI obtained during the early stage, appeared to be helpful in predicting motor outcomes on the affected side (20). Most previous reports have shown that damage to the CST is useful for predicting restoration of motor function in patients with stroke (20, 21, 27). We hypothesized that the normalized FA and FN values in a functionally recovered state would reflect a hand function status similar to that of chronic stroke patients of the same functional state.…”

Section: Discussionmentioning

confidence: 99%

“…We analyzed DTI integrity using FN, FA (mid-pons), and FA (pontomedullary junction) values using an established method (10, 22, 27). Among these, the mid-pons FA value was more strongly related to hand function than were the others.…”

Section: Discussionmentioning

confidence: 99%

“…Two ROIs were used for CST reconstruction. The first seed ROI was placed on the pontomedullary junction portion of the CST, and the second on the mid-pons portion of the CST (Figure 1) (26, 27). The termination criteria were fractional anisotropy (FA) < 0.2 and an angle change of >60 degrees (10).…”

Section: Dti Acquisitionmentioning

confidence: 99%

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Corticospinal Tract Integrity and Long-Term Hand Function Prognosis in Patients With Stroke

Yoo

Kim

et al. 2019

Front. Neurol.

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Background: The restoration of hand function is an important goal for patients with stroke. This study investigated the relationship between corticospinal tract (CST) integrity and the functional status of the hand in patients with stroke 6 months after onset and evaluated which of the following values would be useful for predicting hand function: fiber number (FN), fractional anisotropy (FA) at the mid-pons, and FA at the pontomedullary junction. Methods: The present retrospective cross-sectional observational study assessed 44 patients with stroke who were able to walk without using a walking aid or orthosis. The final hand function results were classified into three groups: no recovery (unable to grasp), partial recovery (able to grasp, unable to oppose), and full recovery (able to grasp and oppose). All subjects underwent diffusion tensor imaging (DTI) at 6 months after stroke onset. Values for FA at the mid-pons and pontomedullary junction and CST FN were measured. The normalization ratio for FN and FA was calculated using the following formula: data for affected hand/data for non-affected hand. Results: The normalized FN, FA (mid-pons), and FA (pontomedullary junction) DTI values differed significantly. The FA (mid-pons) value for the full recovery group was higher than those for the other groups. The FA (mid-pons) value for the partial recovery group was higher than that for the no recovery group. The normalized FA (mid-pons) value differed significantly among all three groups. Conclusions: The present study showed that CST integrity (at 6 months after onset) in patients with chronic stroke was related to functional hand status. In addition, the mid-pons FA value was more predictive of functional restoration of the hand than the FN or FA value at the pontomedullary junction. These results may be useful in predicting the functional restoration of the hand and understanding the functional prognosis of stroke.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Corticospinal Tract Integrity and Long-Term Hand Function Prognosis in Patients With Stroke

Yoo

Kim

et al. 2019

Front. Neurol.

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“…The relationship between DTI CST images and hand function has been evaluated several times8, 13,14,15,16 ) . Most reports have shown that damage to the CST is useful for predicting the restoration of motor function in patients with stroke13, 16,17,18 ) . Consistent with previous studies, the CST integrity reflected the functional status of the central pontine demyelination in our patients.…”

Section: Discussionmentioning

confidence: 99%

The effect of white matter integrity on functional outcome in central pontine demyelination

et al. 2019

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Central pontine demyelination is a common osmotic demyelination syndrome. Typically, central pontine demyelination shows high signal intensity with demyelination in the mid-pons. Despite severe imaging findings, patients usually recover. This study investigated the integrity of the corticospinal tract (CST) and corticoreticular pathway (CRP) in patients at 12 months after the onset of central pontine demyelination. [Participants and Methods] This retrospective cross-sectional observational study assessed two patients with central pontine demyelination, who were ultimately able to walk without using an aid or orthosis and to use both hands but with mild residual symptoms. All participants underwent diffusion tensor imaging (DTI) at 12 months after onset. [Results] Both patients had mild ataxia at 12 months after onset. The integrity of the CST was restored in both cases, while the integrity of the CRP recovered partially. [Conclusion] The integrity of the CST and CRP at 12 months after the onset of central pontine demyelination was similar in both cases as well as the recovery status of the hand function and ambulation. These results may be useful in planning therapy for patients with central pontine demyelination.

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“…Functional movements such as walking are present in individuals with chronic stroke even when the crossed lateral corticospinal tract to the paretic limb is completely destroyed (Ahn et al., 2006; Cho et al., 2012; Hong et al., 2016). The extent to which a stroke lesion impacts the crossed lateral corticospinal tract is not predictive of walking speed (Dawes et al., 2008) or change in walking speed with treadmill rehabilitative training in individuals with chronic subcortical stroke (Seo et al., 2014). Similarly, the presence or absence of contralateral responses to TMS in the paretic lower limb is not associated with walking speed in individuals with chronic stroke (Sivaramakrishnan & Madhavan, 2018).…”

Section: Crossed (Contralateral) Lateral Corticospinal Tractmentioning

confidence: 99%

Ipsilateral motor pathways to the lower limb after stroke: Insights and opportunities

Cleland

Madhavan

2021

J of Neuroscience Research

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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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The difference of gait pattern according to the state of the corticospinal tract in chronic hemiparetic stroke patients

Cited by 14 publications

References 44 publications

Corticospinal Tract Integrity and Long-Term Hand Function Prognosis in Patients With Stroke

Corticospinal Tract Integrity and Long-Term Hand Function Prognosis in Patients With Stroke

The effect of white matter integrity on functional outcome in central pontine demyelination

Ipsilateral motor pathways to the lower limb after stroke: Insights and opportunities

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