A multimodal approach to understanding motor impairment and disability after stroke

被引:41
作者
Burke, Erin [1 ]
Dodakian, Lucy [2 ]
See, Jill [2 ]
McKenzie, Alison [3 ]
Riley, Jeff D. [2 ]
Le, Vu [2 ]
Cramer, Steven C. [1 ,2 ]
机构
[1] Univ Calif Irvine, Dept Anat & Neurobiol, Irvine, CA 92697 USA
[2] Univ Calif Irvine, Dept Neurol, Irvine, CA 92697 USA
[3] Chapman Univ, Dept Phys Therapy, Orange, CA 92866 USA
基金
美国国家卫生研究院;
关键词
Neuroimaging; Impairment; Disability; Stratification; Biomarker; Motor system; TRANSCRANIAL MAGNETIC STIMULATION; BDNF VAL66MET POLYMORPHISM; FUNCTIONAL OUTCOME POSTSTROKE; CORTICOSPINAL TRACT; ISCHEMIC-STROKE; CLINICAL-TRIALS; BRAIN REORGANIZATION; RECOVERY MECHANISMS; CORTICAL PLASTICITY; REHABILITATION;
D O I
10.1007/s00415-014-7341-8
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Many different measures have been found to be related to behavioral outcome after stroke. Preclinical studies emphasize the importance of brain injury and neural function. However, the measures most important to human outcomes remain uncertain, in part because studies often examine one measure at a time or enroll only mildly impaired patients. The current study addressed this by performing multimodal evaluation in a heterogeneous population. Patients (n = 36) with stable arm paresis 3-6 months post-stroke were assessed across 6 categories of measures related to stroke outcome: demographics/medical history, cognitive/mood status, genetics, neurophysiology, brain injury, and cortical function. Multivariate modeling identified measures independently related to an impairment-based outcome (arm Fugl-Meyer motor score). Analyses were repeated (1) identifying measures related to disability (modified Rankin Scale score), describing independence in daily functions and (2) using only patients with mild deficits. Across patients, greater impairment was related to measures of injury (reduced corticospinal tract integrity) and neurophysiology (absence of motor evoked potential). In contrast, (1) greater disability was related to greater injury and poorer cognitive status (MMSE score) and (2) among patients with mild deficits, greater impairment was related to cortical function (greater contralesional motor/premotor cortex activation). Impairment after stroke is most related to injury and neurophysiology, consistent with preclinical studies. These relationships vary according to the patient subgroup or the behavioral endpoint studied. One potential implication of these results is that choice of biomarker or stratifying variable in a clinical stroke study might vary according to patient characteristics.
引用
收藏
页码:1178 / 1186
页数:9
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