Neural function, injury, and stroke subtype predict treatment gains after stroke.
Neural function, injury, and stroke subtype predict treatment gains after stroke.
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DOI：
10.1002/ana.24309
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发表时间：
2015-01
影响因子：
11.2
通讯作者：
Cramer, Steven C.
中科院分区：
文献类型：
--
作者：
Quinlan, Erin Burke;Dodakian, Lucy;See, Jill;McKenzie, Alison;Le, Vu;Wojnowicz, Mike;Shahbaba, Babak;Cramer, Steven C.
To better understand the high variability in response seen when treating human subjects with restorative therapies post-stroke. Preclinical studies suggest that neural function, neural injury, and clinical status each influence treatment gains, therefore the current study hypothesized that a multivariate approach incorporating these three measures would have the greatest predictive value. Patients 3-6 months post-stroke underwent a battery of assessments before receiving 3-weeks of standardized upper extremity robotic therapy. Candidate predictors included measures of brain injury (including to gray and white matter), neural function (cortical function and cortical connectivity), and clinical status (demographics/medical history, cognitive/mood, and impairment). Among all 29 patients, predictors of treatment gains identified measures of brain injury (smaller corticospinal tract (CST) injury), cortical function (greater ipsilesional motor cortex (M1) activation), and cortical connectivity (greater inter-hemispheric M1-M1 connectivity). Multivariate modeling found that best prediction was achieved using both CST injury and M1-M1 connectivity (r2=0.44, p=0.002), a result confirmed using Lasso regression. A threshold was defined whereby no subject with >63% CST injury achieved clinically significant gains. Results differed according to stroke subtype: gains in patients with lacunar stroke were exclusively predicted by a measure of intra-hemispheric connectivity. Response to a restorative therapy after stroke is best predicted by a model that includes measures of both neural injury and function. Neuroimaging measures were the best predictors and may have an ascendant role in clinical decision-making for post-stroke rehabilitation, which remains largely reliant on behavioral assessments. Results differed across stroke subtypes, suggesting utility of lesion-specific strategies.
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影响因子：
14.5
作者：
Crafton, KR;Mark, AN;Cramer, SC
通讯作者：
Cramer, SC
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