Walking performance and its recovery in chronic stroke in relation to extent of lesion overlap with the descending motor tract

Dawes, Helen; Enzinger, Christian; Johansen‐Berg, Heidi; Bogdanovič, Marko; Guy, Claire; Collett, Johnny; Izadi, Hooshang; Stagg, Charlotte J.; Wade, Derick T; Matthews, Paul M.

doi:10.1007/s00221-007-1237-0

Cited by 72 publications

(74 citation statements)

References 46 publications

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“…Past studies have suggested that residual corticospinal cord integrity is a predictor for recovery of upper limb function (Stinear et al 2007;Tombari et al 2004). In the present study, residual corticospinal integrity was not significantly correlated both to functional improvements and to changes in MEP size, which is in support of such studies targeting lower limb muscles (Dawes et al 2008). Lower limb muscles have been suggested to be under less cortical control compared with upper limb muscles (Peters 1990).…”

Section: Discussionsupporting

confidence: 74%

Efficient neuroplasticity induction in chronic stroke patients by an associative brain-computer interface

Mrachacz-Kersting

Jiang

Stevenson

et al. 2016

Journal of Neurophysiology

203

264

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Mrachacz-Kersting N, Jiang N, Stevenson AJ, Niazi IK, Kostic V, Pavlovic A, Radovanovic S, Djuric-Jovicic M, Agosta F, Dremstrup K, Farina D. Efficient neuroplasticity induction in chronic stroke patients by an associative brain-computer interface. J Neurophysiol 115: 1410 -1421, 2016. First published December 30, 2015 doi:10.1152/jn.00918.2015 have the potential to improve functionality in chronic stoke patients when applied over a large number of sessions. Here we evaluated the effect and the underlying mechanisms of three BCI training sessions in a double-blind sham-controlled design. The applied BCI is based on Hebbian principles of associativity that hypothesize that neural assemblies activated in a correlated manner will strengthen synaptic connections. Twenty-two chronic stroke patients were divided into two training groups. Movement-related cortical potentials (MRCPs) were detected by electroencephalography during repetitions of foot dorsiflexion. Detection triggered a single electrical stimulation of the common peroneal nerve timed so that the resulting afferent volley arrived at the peak negative phase of the MRCP (BCI associative group) or randomly (BCI nonassociative group). Fugl-Meyer motor assessment (FM), 10-m walking speed, foot and hand tapping frequency, diffusion tensor imaging (DTI) data, and the excitability of the corticospinal tract to the target muscle [tibialis anterior (TA)] were quantified. The TA motor evoked potential (MEP) increased significantly after the BCI associative intervention, but not for the BCI nonassociative group. FM scores (0.8 Ϯ 0.46 point difference, P ϭ 0.01), foot (but not finger) tapping frequency, and 10-m walking speed improved significantly for the BCI associative group, indicating clinically relevant improvements. Corticospinal tract integrity on DTI did not correlate with clinical or physiological changes. For the BCI as applied here, the precise coupling between the brain command and the afferent signal was imperative for the behavioral, clinical, and neurophysiological changes reported. This association may become the driving principle for the design of BCI rehabilitation in the future. Indeed, no available BCIs can match this degree of functional improvement with such a short intervention.

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Section: Discussionsupporting

confidence: 74%

Efficient neuroplasticity induction in chronic stroke patients by an associative brain-computer interface

Mrachacz-Kersting

Jiang

Stevenson

et al. 2016

Journal of Neurophysiology

203

264

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“…28 Patients had to score Ն3 on the Functional Ambulatory Capacity rating scale. 29 Residual gait impairment had also to be confirmed by an abnormal 10-m walk time with age-adjusted thresholds.…”

Section: Inclusion Criteriamentioning

confidence: 99%

“…20 We wanted to investigate functional reorganization subsequent to treadmill training 24 in patients with stroke with gait impairment using fMRI and a paradigm involving more distal active and passive lower limb movements (ie, ankle dorsiflexion). 22 Accounts of the cross-sectional fMRI findings from this cohort at baseline 27 and of the behavioral training data 28 already have been reported. Only patients with subcortical ischemic lesions that did not affect the cortex were included.…”

mentioning

confidence: 96%

Brain Activity Changes Associated With Treadmill Training After Stroke

Enzinger

Dawes²,

Johansen‐Berg³

et al. 2009

Stroke

135

107

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Background and Purpose-The mechanisms underlying motor recovery after stroke are not fully understood. Several studies used functional MRI longitudinally to relate brain activity changes with performance gains of the upper limb after therapy, but research into training-induced recovery of lower limb function has been relatively neglected thus far. Methods-We investigated functional reorganization after 4 weeks of treadmill training with partial body weight support in 18 chronic patients (mean age, 59.9Ϯ13.5 years) with mild to moderate paresis (Motricity Index affected leg: 77.7Ϯ10.5; range, 9 to 99) and gait impairment (Functional Ambulation Category: 4.4Ϯ0.6; range, 3 to 5) due to a single subcortical ischemic stroke using repeated 3.0-T functional MRI and an ankle-dorsiflexion paradigm. Results-Walking endurance improved after training (2-minute timed walking distance: 121.5Ϯ39.0 versus pre:105.1Ϯ38.1 m; Pϭ0.0001). For active movement of the paretic foot versus rest, greater walking endurance correlated with increased brain activity in the bilateral primary sensorimotor cortices, the cingulate motor areas, and the caudate nuclei bilaterally and in the thalamus of the affected hemisphere. Conclusions-Despite the strong subcortical contributions to gait control, rehabilitation-associated walking improvements are associated with cortical activation changes. This is similar to findings in upper limb rehabilitation with some differences in the involved cortical areas. We observed bihemispheric activation increases with greater recovery both in cortical and subcortical regions with movement of the paretic foot. However, although the dorsal premotor cortex appears to play an important role in recovery of hand movements, evidence for the involvement of this region in lower extremity recovery was not found.

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“…These intuitive findings are in line with previous studies mapping corticospinal tract lesions to motor impairment and motor function recovery in patients with ischemic stroke. [23][24][25][26][27] Using a similar methodological approach, Lo et al 10 identified areas in the corona radiata critical for motor function recovery measured by the Arm Motor Ability Test. The mRS broadly assesses the degree of disability or dependence in the daily activities, which strongly depend on intact motor functions.…”

Section: June 2014mentioning

confidence: 99%

Influence of Stroke Infarct Location on Functional Outcome Measured by the Modified Rankin Scale

Cheng

Forkert

Zavaglia

et al. 2014

Stroke

197

201

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P rognosis of functional outcome after ischemic stroke is influenced by a variety of factors already assessable in the acute phase and within the first days after symptom onset. In clinical trials, stroke outcome is most commonly rated by the modified Rankin Scale (mRS) 1 because of the validity and rapid application of this rating scale and its ability to discriminate clinically relevant levels of disability and recovery.2-4 Brain imaging in the early phase after stroke onset provides valuable information related to individual functional recovery. 5,6 In particular, structural MRI identifies injured brain regions and allows for assessment of extent and location, both known to influence and predict functional outcome measured by the mRS.3 However, infarct volume from early MRI correlates only moderately with the mRS at later time points, 7,8 indicating that additional factors, such as lesion location, influence functional outcome. It is therefore of major interest to elucidate the relationship between early lesion patterns and functional impairment in the later course of stroke.Clinical impact of lesion locations can be inferred from voxel-based lesion symptom mapping (VLSM). This statistical method examines effects of brain lesions on behavioral scores on a voxel-by-voxel base. Therefore, a statistical test is conducted for each voxel to detect differences in a behavioral score based on the presence or absence of injury.9 VLSM produces statistical results that map structural lesions to a behavioral scale. In patients with chronic stroke, it has been Background and Purpose-In the early days after ischemic stroke, information on structural brain damage from MRI supports prognosis of functional outcome. It is rated widely by the modified Rankin Scale that correlates only moderately with lesion volume. We therefore aimed to elucidate the influence of lesion location from early MRI (days 2-3) on functional outcome after 1 month using voxel-based lesion symptom mapping. Methods-We analyzed clinical and MRI data of patients from a prospective European multicenter stroke imaging study (I-KNOW). Lesions were delineated on fluid-attenuated inversion recovery images on days 2 to 3 after stroke onset. We generated statistic maps of lesion contribution related to clinical outcome (modified Rankin Scale) after 1 month using voxel-based lesion symptom mapping. Results-Lesion maps of 101 patients with middle cerebral artery infarctions were included for analysis (right-sided stroke, 47%). Mean age was 67 years, median admission National Institutes of Health Stroke Scale was 11. Mean infarct volumes were comparable between both sides (left, 37.5 mL; right, 43.7 mL). Voxel-based lesion symptom mapping revealed areas with high influence on higher modified Rankin Scale in regions involving the corona radiata, internal capsule, and insula. In addition, asymmetrically distributed impact patterns were found involving the right inferior temporal gyrus and left superior temporal gyrus. Conclusions-In this group of patients with strok...

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Walking performance and its recovery in chronic stroke in relation to extent of lesion overlap with the descending motor tract

Cited by 72 publications

References 46 publications

Efficient neuroplasticity induction in chronic stroke patients by an associative brain-computer interface

Efficient neuroplasticity induction in chronic stroke patients by an associative brain-computer interface

Brain Activity Changes Associated With Treadmill Training After Stroke

Influence of Stroke Infarct Location on Functional Outcome Measured by the Modified Rankin Scale

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