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Mesencephalic corticospinal atrophy predicts baseline deficit but not response to unilateral or bilateral arm training in chronic stroke

Mesencephalic corticospinal atrophy predicts baseline deficit but not response to unilateral or bilateral arm training in chronic stroke
Mesencephalic corticospinal atrophy predicts baseline deficit but not response to unilateral or bilateral arm training in chronic stroke
OBJECTIVE:
Stroke survivors with motor deficits often have pyramidal tract atrophy caused by degeneration of corticospinal fibers. The authors hypothesized that the degree of atrophy correlates with severity of motor impairment in patients with chronic stroke and predicts the response to rehabilitation training.

METHODS:
They performed a post hoc analysis of 42 hemiparetic patients (>6 months) who had been randomized to either 6 weeks of bilateral arm training with rhythmic auditory cueing (BATRAC) or dose-matched therapeutic exercise (DMTE). Arm function was measured using the Fugl-Meyer (FM) and modified Wolf Motor Function Test (WMFT). Structural MRI and diffusion tensor imaging (DTI) on the pontine level measured corticospinal tract (CST) atrophy by planimetric measurement of the mesencephalon (mesencephalic atrophy ratio) and fractional anisotropy (FA), respectively. Voxel-based lesion symptom mapping (VLSM) was used to determine the lesions associated with highest degrees of atrophy. The predictive value of CST atrophy for impairment and training response was analyzed.

RESULTS:
CST atrophy predicted baseline motor arm function measured by the FM and WMFT. The authors found only a trend for the correlation with FA. No measure of atrophy predicted response to either BATRAC or DMTE. CST atrophy was higher with larger lesions and those that affected the CST. VLSM identified internal capsule lesions as being associated with highest CST atrophy.

CONCLUSION:
Larger lesions, internal capsule lesions, and those overlapping the pyramidal tract are associated with greater CST atrophy. CST atrophy explains in part the variability of baseline deficits but does not seem to predict the response to BATRAC or unilateral arm training on upper-extremity function.
1545-9683
81-87
Globas, Christoph
31b6cadb-acc0-4b4a-a179-55634948e822
Lam, Judith
d253ac96-b465-4936-9ccb-bfbe7b5e9f7d
Zhang, Weihong
6950fe62-ab8a-4f3a-ae2c-a2226c808c52
Imanbayev, Anuar
4a4bf482-1668-472d-8db3-a12b9a820f20
Hertler, Benjamin
47240bd5-6661-473b-a21f-04a9439388d5
Becker, Clemens
e5dc3345-f194-475b-9cb3-368cdd90def9
Whitall, Jill
9761aefb-be80-4270-bc1f-0e726399376e
McCombe-Waller, Sandy
6c931ed9-48d3-4356-9db7-790ad6d134ba
Mori, Susumu
372a0e06-4c3e-400a-8193-cafcca35affd
Hanley, Daniel F.
eedff09c-b115-4f05-bd76-012397e1adbd
Luft, Andreas R.
7d63411e-0ae7-4b6b-9455-b43ba702238c
Globas, Christoph
31b6cadb-acc0-4b4a-a179-55634948e822
Lam, Judith
d253ac96-b465-4936-9ccb-bfbe7b5e9f7d
Zhang, Weihong
6950fe62-ab8a-4f3a-ae2c-a2226c808c52
Imanbayev, Anuar
4a4bf482-1668-472d-8db3-a12b9a820f20
Hertler, Benjamin
47240bd5-6661-473b-a21f-04a9439388d5
Becker, Clemens
e5dc3345-f194-475b-9cb3-368cdd90def9
Whitall, Jill
9761aefb-be80-4270-bc1f-0e726399376e
McCombe-Waller, Sandy
6c931ed9-48d3-4356-9db7-790ad6d134ba
Mori, Susumu
372a0e06-4c3e-400a-8193-cafcca35affd
Hanley, Daniel F.
eedff09c-b115-4f05-bd76-012397e1adbd
Luft, Andreas R.
7d63411e-0ae7-4b6b-9455-b43ba702238c

Globas, Christoph, Lam, Judith, Zhang, Weihong, Imanbayev, Anuar, Hertler, Benjamin, Becker, Clemens, Whitall, Jill, McCombe-Waller, Sandy, Mori, Susumu, Hanley, Daniel F. and Luft, Andreas R. (2011) Mesencephalic corticospinal atrophy predicts baseline deficit but not response to unilateral or bilateral arm training in chronic stroke. Neurorehabilitation and Neural Repair, 25 (1), 81-87. (doi:10.1177/1545968310382001). (PMID:20947492)

Record type: Article

Abstract

OBJECTIVE:
Stroke survivors with motor deficits often have pyramidal tract atrophy caused by degeneration of corticospinal fibers. The authors hypothesized that the degree of atrophy correlates with severity of motor impairment in patients with chronic stroke and predicts the response to rehabilitation training.

METHODS:
They performed a post hoc analysis of 42 hemiparetic patients (>6 months) who had been randomized to either 6 weeks of bilateral arm training with rhythmic auditory cueing (BATRAC) or dose-matched therapeutic exercise (DMTE). Arm function was measured using the Fugl-Meyer (FM) and modified Wolf Motor Function Test (WMFT). Structural MRI and diffusion tensor imaging (DTI) on the pontine level measured corticospinal tract (CST) atrophy by planimetric measurement of the mesencephalon (mesencephalic atrophy ratio) and fractional anisotropy (FA), respectively. Voxel-based lesion symptom mapping (VLSM) was used to determine the lesions associated with highest degrees of atrophy. The predictive value of CST atrophy for impairment and training response was analyzed.

RESULTS:
CST atrophy predicted baseline motor arm function measured by the FM and WMFT. The authors found only a trend for the correlation with FA. No measure of atrophy predicted response to either BATRAC or DMTE. CST atrophy was higher with larger lesions and those that affected the CST. VLSM identified internal capsule lesions as being associated with highest CST atrophy.

CONCLUSION:
Larger lesions, internal capsule lesions, and those overlapping the pyramidal tract are associated with greater CST atrophy. CST atrophy explains in part the variability of baseline deficits but does not seem to predict the response to BATRAC or unilateral arm training on upper-extremity function.

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e-pub ahead of print date: 13 October 2010
Published date: January 2011
Organisations: Faculty of Health Sciences

Identifiers

Local EPrints ID: 358069
URI: http://eprints.soton.ac.uk/id/eprint/358069
ISSN: 1545-9683
PURE UUID: 389896d9-25c2-4413-a0f3-47e2b6ceb4e2

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Date deposited: 03 Oct 2013 16:08
Last modified: 14 Mar 2024 15:00

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Contributors

Author: Christoph Globas
Author: Judith Lam
Author: Weihong Zhang
Author: Anuar Imanbayev
Author: Benjamin Hertler
Author: Clemens Becker
Author: Jill Whitall
Author: Sandy McCombe-Waller
Author: Susumu Mori
Author: Daniel F. Hanley
Author: Andreas R. Luft

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