Does stroke location predict walk speed response to gait rehabilitation?

P. Simon Jones, Valerie Pomeroy, Jasmine Wang, Gottfried Schlaug, Siva Marrapu, Sharon Geva, Philip Rowe, Elizabeth Chandler, Andrew Kerr, Jean-Claude Baron

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Abstract

Objectives: 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.

Conclusions: 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.
Original languageEnglish
Pages (from-to)689–703
Number of pages15
JournalHuman Brain Mapping
Volume37
Issue number2
Early online date19 Nov 2015
DOIs
Publication statusPublished - Feb 2016

Keywords

  • MRI
  • VLSM
  • cortico-spinal tract
  • recovery
  • ambulation

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