Does stroke location predict walk speed response to gait rehabilitation?
Does stroke location predict walk speed response to gait rehabilitation?
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DOI：
10.1002/hbm.23059
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发表时间：
2016-02
影响因子：
4.8
通讯作者：
SWIFT-Cast investigators
中科院分区：
文献类型：
--
作者：
Jones PS;Pomeroy VM;Wang J;Schlaug G;Tulasi Marrapu S;Geva S;Rowe PJ;Chandler E;Kerr A;Baron JC;SWIFT-Cast investigators
中风后恢复独立行走是一个主要目标。然而，哪种康复方案对每个人最有利，目前尚不清楚，目前的决定是基于主观的。对特定治疗反应的预测将指导最适合每个患者的治疗类型。虽然病变地形图是上肢反应的一个强有力的预测因子，但步行涉及更多的分布式功能。早期评估皮质脊髓束(CST)的研究都是阴性的，表明其他结构可能是重要的。实验设计：使用CST病变负荷的体积测量和基于体素的病变症状图(VLSM)来评估非CST结构，以评估50名成人发病患者的病变地形与步行速度对标准康复的反应之间的关系。同时采用功能步行分类(FAC)和改良Rivermead活动指数(MRMI)两种功能活动评定量表进行评定。在研究开始时(中风后3-42天)和在为期6周的疗程结束时都进行了绩效评估。基线评分、年龄、卒中起病时间和脑白质高信号评分被包括在回归模型中作为滋扰协变量。主要观察：CST损伤独立预测FAC和MRMI的治疗反应，但不能预测步行速度。然而，使用VLSM可以通过壳核、脑岛、外囊和邻近白质的损害来预测后者。康复后的步行速度反应受到壳核和邻近结构损伤的影响，而不是CST损伤，而后者对一般活动和步态的日常功能有轻微但显著的影响。Hum Brain Mapp 37：689-703,2016。©2015 Wiley期刊，Inc.
Recovery of independent ambulation after stroke is a major goal. However, which rehabilitation regimen best benefits each individual is unknown and decisions are currently made on a subjective basis. Predictors of response to specific therapies would guide the type of therapy most appropriate for each patient. Although lesion topography is a strong predictor of upper limb response, walking involves more distributed functions. Earlier studies that assessed the cortico‐spinal tract (CST) were negative, suggesting other structures may be important. Experimental Design: The relationship between lesion topography and response of walking speed to standard rehabilitation was assessed in 50 adult‐onset patients using both volumetric measurement of CST lesion load and voxel‐based lesion–symptom mapping (VLSM) to assess non‐CST structures. Two functional mobility scales, the functional ambulation category (FAC) and the modified rivermead mobility index (MRMI) were also administered. Performance measures were obtained both at entry into the study (3–42 days post‐stroke) and at the end of a 6‐week course of therapy. Baseline score, age, time since stroke onset and white matter hyperintensities score were included as nuisance covariates in regression models. Principal Observations: CST damage independently predicted response to therapy for FAC and MRMI, but not for walk speed. However, using VLSM the latter was predicted by damage to the putamen, insula, external capsule and neighbouring white matter. Walk speed response to rehabilitation was affected by damage involving the putamen and neighbouring structures but not the CST, while the latter had modest but significant impact on everyday functions of general mobility and gait. Hum Brain Mapp 37:689–703, 2016. © 2015 Wiley Periodicals, Inc.