Correlation between ambulatory function and clinical factors in hemiplegic patients with intact single lateral corticospinal tract

Abstract

To define the relationship between the complete destruction of 1 lateral corticospinal tract (CST), as demonstrated by diffusion tensor imaging (DTI) tractography, and ambulatory function 6 months following stroke.Twenty-six adults (17 male, 9 female) with poststroke hemiplegia who were transferred to the physical medicine and rehabilitation department. Participants underwent DTI tractography, which showed that 1 lateral CST had been clearly destroyed.Functional ambulation classification (FAC) scores at admission, discharge, and 6 months after discharge were used to evaluate the patients’ ability to walk. The National Institutes of Health Stroke Scale (NIHSS) and the Korean version of the modified Barthel index (K-MBI) at admission, discharge, and 6 months after discharge were used to evaluate the degree of functional recovery.Of the 26 patients, 18 were nonambulatory (FAC level 1–3), and 8 were able to walk without support (FAC level 4–6). The type of stroke (infarction or hemorrhage), site of the lesion, spasticity of lower extremities, cranioplasty, and the time taken from onset to MRI were not statistically significantly correlated with the ability to walk. However, statistically significant correlations were found in relation to age, K-MBI scores, and initial NIHSS scores.Despite the complete damage to the lesion site and the preservation of 1 unilateral CST, as shown by DTI, good outcomes can be predicted on the basis of younger age, low NIHSS scores, and high MBI scores at onset.

The tracts, cytoarchitecture, and neurochemistry of the spinal cord

“…Further, functional imaging studies showed activation of the ipsilateral sensorimotor cortex; ipsilateral parietal region, and bilateral pre-frontal regions in stroke patients tasked with a finger-thumb opposition task (Marshall et al, 2000); again, this implicates the activation of the ipsilateral aspect, but also recruitment of additional cortical areas to regain function over time. Additional, similar studies in patients over the course of their recovery report recruitment of the ipsilateral, lateral corticospinal tract and reogranisation of the motor cortex in the unlesioned hemisphere (Ahn et al, 2006;Hong et al, 2016;Peters et al, 2021;Yeo & Jang, 2012). However, others report that these ipsilateral contributions may be overstated and that they may even be maladaptive (Fregni & Pascual-Leone, 2006;Madhavan et al, 2010;Zaaimi et al, 2012).…”

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

“…Despite the importance of the crossed lateral corticospinal tract for lower limb movement and recovery after stroke, other studies question the importance of this tract. 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).…”