Brain lesions affecting gait recovery in stroke patients

Abstract

ObjectivesGait recovery is an important goal in stroke patients. Several studies have sought to uncover relationships between specific brain lesions and the recovery of gait, but the effects of specific brain lesions on gait remain unclear. Thus, we investigated the effects of stroke lesions on gait recovery in stroke patients.Materials and MethodsIn total, 30 subjects with stroke were assessed in a retrograde longitudinal observational study. To assess gait function, the functional ambulation category (FAC) was tested four times: initially (within 2 weeks) and 1, 3, and 6 months after the onset of the stroke. Brain lesions were analyzed via overlap, subtraction, and voxel‐based lesion symptom mapping (VLSM).ResultsAmbulation with FAC improved significantly with time. Subtraction analysis showed that involvement of the corona radiata, internal capsule, globus pallidus, and putamen were associated with poor recovery of gait throughout 6 months after onset. The caudate nucleus did influence poor recovery of gait at 6 months after onset. VLSM revealed that corona radiata, internal capsule, globus pallidus, putamen and cingulum were related with poor recovery of gait at 3 months after onset. Corona radiata, internal capsule, globus pallidus, putamen, primary motor cortex, and caudate nucleus were related with poor recovery of gait at 6 months after onset.ConclusionResults identified several important brain lesions for gait recovery in patients with stroke. These results may be useful for planning rehabilitation strategies for gait and understanding the prognosis of gait in stroke patients.

Effect of Brain Lesions on Voluntary Cough in Patients with Supratentorial Stroke: An Observational Study

“…Voxel-based lesion-symptom mapping is a neuroimaging technique that can be used to study the relationship between tissue damage and behavior on a voxel-by-voxel basis. VLSM has been widely used to identify lesion-symptom relationships in stroke patients, and has been used extensively to study, among other functions, language [ 16 ], gait [ 17 ], and spasticity [ 18 ]. A recent study a recent study by Suntrup-Krueger et al [ 19 ] demonstrated via VLSM the role of specific cortical lesions with impaired RC in stroke patients.…”

Exoskeleton-Robot Assisted Therapy in Stroke Patients: A Lesion Mapping Study

“…In a recent meta-analysis of 24 studies using fMRI of motor tasks, Favre et al ( 2014 ) affirmed that the activity in ipsilateral primary motor cortex is one of the best predictors of the good motor recovery in chronic stroke patients. Similarly, connectivity (i.e., DTI) as well as lesion mapping studies demonstrated that the disruption of the capsula interna, corona radiata, globus pallidus, and putamen predict the functional recovery (Shelton and Reding, 2001 ; Rehme et al, 2011 ; Stinear et al, 2012 ; Stinear and Ward, 2013 ; Hannanu et al, 2017 ; Lee et al, 2017 ). The pathway along the pedunculopontine nucleus, cerebellum, striatum and the motor cortex contributes to motor initiation, modulation of motor rhythm and postural muscle tone during motor behaviors (Takakusaki, 2013 ).…”

“…In fact, some biomarkers have been effectively demonstrated to predict therapeutic response or recovery following stroke (Burke Quinlan et al, 2015 ). Generally, research has focused on the neural substrate of motor recovery obtained with a conventional neurorehabilitation approach (Shelton and Reding, 2001 ; Murphy and Corbett, 2009 ; Carrera and Tononi, 2014 ; Choo et al, 2015 ; Lee et al, 2017 ; Siegel et al, 2018 ), whereas little attention has been paid to robotic-assisted therapy with exoskeleton devices (Formaggio et al, 2013 ; Fan et al, 2016 ; Gandolfi et al, 2018 ). Overall, preservation of the corticospinal tract is considered as a hallmark for good recovery of impaired motor function in patients with brain injury (Hendricks et al, 2002 ; Swayne et al, 2008 ; Stinear, 2010 ).…”

“…Mounting evidence from functional magnetic resonance imaging (fMRI), diffusion tensor imaging (DTI) as well as resting-state functional connectivity studies have demonstrated that the increased activity in ipsilateral primary motor cortex and the morphological integrity of the posterior limb of the capsula interna predict the positive clinical outcome (Shelton and Reding, 2001 ; Stinear et al, 2012 ; Stinear and Ward, 2013 ; Favre et al, 2014 ; Rehme et al, 2015 ). Moreover, lesions in the globus pallidus, and putamen (together with corona radiata, internal capsule) were also associated with poor recovery (Lee et al, 2017 ).…”

Effect of brain lesions on voluntary cough in patients with supratentorial stroke: an observational study

“…To increase the statistical power for identification of the lesion pattern, which showed a significant contribution to PCF independent of hemispheric lateralization, the volume-of-interest (VOI) images were transformed to the right hemisphere. To analyze the mutual lesion maps, segmentation and normalization were employed [17].…”