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Title: Observational Study of Neuroimaging Biomarkers of Severe Upper Limb Impairment After Stroke.
Austin Authors: Hayward, Kathryn S ;Ferris, Jennifer K;Lohse, Keith R;Borich, Michael R;Borstad, Alexandra;Cassidy, Jessica M;Cramer, Steven C;Dukelow, Sean P;Findlater, Sonja E;Hawe, Rachel L;Liew, Sook-Lei;Neva, Jason L;Stewart, Jill C;Boyd, Lara A
Affiliation: The Florey Institute of Neuroscience and Mental Health
Medicine (University of Melbourne)
Department of Physiotherapy, The University of Melbourne, Heidelberg VIC 3084 Australia
Physical Therapy and Neurology. Washington University School of Medicine in Saint Louis, 4444 Forest Park, Saint Louis, MO, 63110, USA
Division of Physical Therapy, Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, GA USA
School of Health Sciences, Department of Physical Therapy, College of St. Scholastica, Duluth, MN USA, 55812
Department of Allied Health Sciences, University of North Carolina at Chapel Hill, Chapel Hill, NC USA, 27514
Department of Neurology, University of California, Los Angeles; California Rehabilitation Institute; Los Angeles, CA USA
Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, T2N2T9 Canada
School of Kinesiology, University of Minnesota, Minneapolis, MN, 55455, USA
Chan Division of Occupational Science and Occupational Therapy, Biokinesiology and Physical Therapy, Biomedical Engineering, and Neurology, USC Stevens Neuroimaging and Informatics Institute, University of Southern California, Los Angeles, CA 90089-9003
Université de Montréal, École de kinésiologie et des sciences de l'activité physique, Faculté de médecine, and Centre de recherche de l'institut universitaire de gériatrie de Montréal, Montréal, QC, Canada
Physical Therapy Program, Department of Exercise Science, University of South Carolina, Columbia, SC USA, 29208
Rehabilitation Sciences Graduate Research Program, University of British Columbia, Vancouver BC V6T1B2 Canada
Issue Date: 12-May-2022 2022
Publication information: Neurology 2022; 10.1212/WNL.0000000000200517.
Abstract: It is difficult to predict post-stroke outcome for people with severe motor impairment, as both clinical tests and corticospinal tract (CST) microstructure may not reliably indicate severe motor impairment. Here, we test whether imaging biomarkers beyond the CST relate to severe upper limb impairment post-stroke by evaluating white matter microstructure in the corpus callosum (CC). In an international, multisite hypothesis-generating observational study we determined if: a) CST asymmetry index can differentiate between individuals with mild-moderate and severe upper limb impairment; and b) CC biomarkers relate to upper limb impairment within individuals with severe impairment post-stroke. We hypothesised that CST asymmetry index would differentiate between mild-moderate and severe impairment, but CC microstructure would relate to motor outcome for individuals with severe upper limb impairment. Seven cohorts with individual diffusion imaging and motor impairment (Fugl Meyer-Upper Limb) data were pooled. Hand-drawn regions-of-interest were used to seed probabilistic tractography for CST (ipsilesional/contralesional) and CC (prefrontal/premotor/motor/sensory/posterior) tracts. Our main imaging measure was mean fractional anisotropy. Linear mixed-effect regression explored relationships between candidate biomarkers and motor impairment, controlling for observations nested within cohorts, as well as age, sex, time post-stroke and lesion volume. Data from 110 individuals (30 mild-moderate, 80 with severe motor impairment) were included. In the full sample, greater CST asymmetry index (i.e., lower fractional anisotropy in the ipsilesional hemisphere, p<.001) and larger lesion volume (p=.139) were negatively related to impairment. In the severe subgroup, CST asymmetry index was not reliably associated with impairment across models. Instead, lesion volume and CC microstructure explained impairment in the severe group beyond CST asymmetry index (p's<.010). Within a large cohort of individuals with severe upper limb impairment, CC microstructure related to motor outcome post-stroke. Our findings demonstrate that CST microstructure does relate to upper limb outcome across the full range of motor impairment but was not reliably associated within the severe subgroup. Therefore, CC microstructure may provide a promising biomarker for severe upper limb outcome post-stroke, which may advance our ability to predict recovery in people with severe motor impairment after stroke.
DOI: 10.1212/WNL.0000000000200517
Journal: Neurology
PubMed URL: 35550551
PubMed URL:
Type: Journal Article
Appears in Collections:Journal articles

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