Prediction of Upper Limb Motor Recovery after Subacute Ischemic Stroke Using Diffusion Tensor Imaging: A Systematic Review and Meta-Analysis

Abstract

Early evaluation of the pyramidal tract using Diffusion Tensor Imaging (DTI) is a prerequisite to decide the optimal treatment or to assess appropriate rehabilitation. The early predictive value of DTI for assessing motor and functional recovery in ischemic stroke (IS) has yielded contradictory results. The purpose is to systematically review and summarize the current available literature on the value of Fractional Anisotropy (FA) parameter of the DTI in predicting upper limb motor recovery after sub-acute IS. MEDLINE, PubMed, EMBASE, Google Scholar and Cochrane CENTRAL searches were conducted from January 1, 1950, to July 31, 2015, which was supplemented with relevant articles identified in the references. Correlation between FA and upper limb motor recovery measure was done. Heterogeneity was examined using Higgins I-squared, Tau-squared. Summary of correlation coefficient was determined using Random Effects model. Out of 166 citations, only eleven studies met the criteria for inclusion in the systematic review and six studies were included in the meta-analysis. A random effects model revealed that DTI parameter FA is a significant predictor for upper limb motor recovery after sub-acute IS [Correlation Coefficient=0.82; 95% Confidence Interval-0.66 to 0.90, P value<0.001]. Moderate heterogeneity was observed (Tau-squared=0.12, I-squared=62.14). The studies reported so far on correlation between DTI and upper limb motor recovery are few with small sample sizes. This meta-analysis suggests strong correlation between DTI parameter FA and upper limb motor recovery. Well-designed prospective trials embedded with larger sample size are required to establish these findings.

Prediction of Walking and Arm Recovery after Stroke: A Critical Review

“…Two systematic reviews have been conducted on the prediction of arm recovery [3,6] and several more systematic reviews have investigated the prognostic value of neurophysiological and neuroimaging predictors on arm recovery [105,106,107]. The reviews conclude there is sufficient evidence to suggest neurophysiological and neuroimaging data have the potential to predict arm recovery [3,6,105,106,107].…”

“…The reviews conclude there is sufficient evidence to suggest neurophysiological and neuroimaging data have the potential to predict arm recovery [3,6,105,106,107]. However it remains debatable whether neurophysiological and neuroimaging data provide sufficient additional predictive information, compared to clinical data alone, to justify their use for prediction of arm recovery in clinical practice.…”

“…While many studies suggest neurophysiology and neuroimaging data can be helpful in predicting arm recovery [3,6,105,106,107], there is no strong evidence that models containing neurophysiology or neuroimaging data predict arm recovery better than models containing clinical data, or that the addition of neurophysiology or neuroimaging data to models containing clinical predictors provide sufficient increase in predictive accuracy to warrant their use. Researchers who develop prediction models based on neurophysiological or neuroimaging data should routinely investigate whether the neurophysiological or neuroimaging data provide better predictive accuracy than models based on clinical data alone.…”

Contribution of Neuro-Imaging for Prediction of Functional Recovery after Ischemic Stroke

“…Damage to the posterior limb of the internal capsule within 12 h of symptom onset correlated well with motor impairment at 30-90 days; the sensitivity and specificity of the DTI parameters were superior to lesion volume in the corona radiata or the cortex and to baseline clinical scores [55]. A random effects model developed on the results from 11 selected studies revealed that the DTI parameter FA is a significant predictor of upper limb motor recovery after ischemic stroke [56]. …”

Robotic and Mechanotherapeutic Technology to Restore the Functions of the Upper Limbs: Prospects for Development (Review)

“…At an early stage after the stroke, when recovery of the lost function could have the greatest impact, these problems can lead to reduced effectiveness of rehabilitation and are often the reason for its limited success. It is the intensity of rehabilitation, and an early and comprehensive approach to the recovery of lost functions that are indispensable for a successful rehabilitation process [18][19][20][21][22][23][24][25]. Modern approaches to motor training are based either on the concept of taskoriented approaches.…”