FUNCTIONAL IMAGING BIOMARKERS PREDICTING UPPER LIMB RECOVERY FROM SEVERE MOTOR IMPAIRMENT AFTER STROKE PDF Download
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Author: Yun-Hee Kim
Publisher:
ISBN:
Category :
Languages : en
Pages :
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Book Description
IntroductionUnderstanding recovery mechanism and predicting recovery outcome after stroke are important to implicate individually-tailored rehabilitation strategy. In case of recovery of upper extremity (UE) motor function, most biomarkers demonstrate low predictive power in severe stroke. This study focused on investigation of functional imaging biomarkers optimally predicting recovery of UE motor function in severe stroke patients.MethodsForty-two subacute ischemic stroke patients (24 males, mean age 57.2u00b112.4 years) with severe motor impairment participated. They underwent T1-weighted, diffusion tensor imaging, resting-state functional MRI at 2 weeks after stroke. Motor function was assessed using the Fugl-Meyer Assessment scale at 2 weeks and 3 months after stroke. Participants were divided into the Fitter and Non-fitter groups according to whether the UE motor recovery achieves 70% of initial impairment based on proportional recovery. Important neuroimaging measures were investigated; fractional anisotropy (FA) values of the corticospinal tract (CST), corpus callosum (CC), superior cerebellar peduncle (SCP), lesion load of the CST, and interhemispheric connectivity were extracted. ResultsFA value of the SCP was considered as a significant predictive biomarker for UE motor recovery in the Fitter group. FA value of the CC and strength of functional connectivity between visual and auditory areas were predictive biomarkers in the Non-fitter group.ConclusionsDomains of predictive biomarkers were different according to the recovery pattern in severe stroke. Especially, non-motor domains were considered as predictive biomarkers for UE recovery in Non-fitter group. This study implies the need to develop different strategy for UE motor recovery in severe stroke patients with highly unpredictable individuals. AcknowledgementThis study was supported by a National Research Foundation of Korea (NRF) grant funded by the Korean government (MSIP; NRF-2017R1A2A1A05000730, NRF-2017R1D1A1B03034109, NRF-2017M3A9G5083690) and a grant from the Korea Health Technology R&D Project through the Korea Health Industry Development Institute (KHIDI), funded by the Ministry of Health & Welfare, Republic of Korea (HI17C1501).
Author: Yun-Hee Kim
Publisher:
ISBN:
Category :
Languages : en
Pages :
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Book Description
IntroductionUnderstanding recovery mechanism and predicting recovery outcome after stroke are important to implicate individually-tailored rehabilitation strategy. In case of recovery of upper extremity (UE) motor function, most biomarkers demonstrate low predictive power in severe stroke. This study focused on investigation of functional imaging biomarkers optimally predicting recovery of UE motor function in severe stroke patients.MethodsForty-two subacute ischemic stroke patients (24 males, mean age 57.2u00b112.4 years) with severe motor impairment participated. They underwent T1-weighted, diffusion tensor imaging, resting-state functional MRI at 2 weeks after stroke. Motor function was assessed using the Fugl-Meyer Assessment scale at 2 weeks and 3 months after stroke. Participants were divided into the Fitter and Non-fitter groups according to whether the UE motor recovery achieves 70% of initial impairment based on proportional recovery. Important neuroimaging measures were investigated; fractional anisotropy (FA) values of the corticospinal tract (CST), corpus callosum (CC), superior cerebellar peduncle (SCP), lesion load of the CST, and interhemispheric connectivity were extracted. ResultsFA value of the SCP was considered as a significant predictive biomarker for UE motor recovery in the Fitter group. FA value of the CC and strength of functional connectivity between visual and auditory areas were predictive biomarkers in the Non-fitter group.ConclusionsDomains of predictive biomarkers were different according to the recovery pattern in severe stroke. Especially, non-motor domains were considered as predictive biomarkers for UE recovery in Non-fitter group. This study implies the need to develop different strategy for UE motor recovery in severe stroke patients with highly unpredictable individuals. AcknowledgementThis study was supported by a National Research Foundation of Korea (NRF) grant funded by the Korean government (MSIP; NRF-2017R1A2A1A05000730, NRF-2017R1D1A1B03034109, NRF-2017M3A9G5083690) and a grant from the Korea Health Technology R&D Project through the Korea Health Industry Development Institute (KHIDI), funded by the Ministry of Health & Welfare, Republic of Korea (HI17C1501).
Author: Richard L. Harvey, MD
Publisher: Demos Medical Publishing
ISBN: 1935281054
Category : Medical
Languages : en
Pages : 817
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Book Description
A Doody's Core Title 2012 Stroke Recovery and Rehabilitation is the new gold standard comprehensive guide to the management of stroke patients. Beginning with detailed information on risk factors, epidemiology, prevention, and neurophysiology, the book details the acute and long-term treatment of all stroke-related impairments and complications. Additional sections discuss psychological issues, outcomes, community reintegration, and new research. Written by dozens of acknowledged leaders in the field, and containing hundreds of tables, graphs, and photographic images, Stroke Recovery and Rehabilitation features: The first full-length discussion of the most commonly-encountered component of neurorehabilitation Multi-specialty coverage of issues in rehabilitation, neurology, PT, OT, speech therapy, and nursing Focus on therapeutic management of stroke related impairments and complications An international perspective from dozens of foremost authorities on stroke Cutting edge, practical information on new developments and research trends Stroke Recovery and Rehabilitation is a valuable reference for clinicians and academics in rehabilitation and neurology, and professionals in all disciplines who serve the needs of stroke survivors.
Author: Donald L. Schomer
Publisher: Lippincott Williams & Wilkins
ISBN: 1451153155
Category : Medical
Languages : en
Pages : 1308
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Book Description
The leading reference on electroencephalography since 1982, Niedermeyer's Electroencephalography is now in its thoroughly updated Sixth Edition. An international group of experts provides comprehensive coverage of the neurophysiologic and technical aspects of EEG, evoked potentials, and magnetoencephalography, as well as the clinical applications of these studies in neonates, infants, children, adults, and older adults. This edition's new lead editor, Donald Schomer, MD, has updated the technical information and added a major new chapter on artifacts. Other highlights include complete coverage of EEG in the intensive care unit and new chapters on integrating other recording devices with EEG; transcranial electrical and magnetic stimulation; EEG/TMS in evaluation of cognitive and mood disorders; and sleep in premature infants, children and adolescents, and the elderly. A companion website includes fully searchable text and image bank.
Author:
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ISBN: 9789464583458
Category :
Languages : en
Pages : 0
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Book Description
Stroke is one of the main causes of serious adult disability in Europe. Around 80% of stroke survivors suffer from motor impairment, typically affecting unilateral motor control of the face, arm, and leg. Especially upper limb impairments limit patient’s activities of daily living. While the majority of patients shows some level of spontaneous neurological recovery, about 20-30% do not recover at all. Most of the observed improvements in upper limb function occur in the first 10 weeks after stroke. However, the mechanisms underlying motor recovery are poorly understood. While primary and secondary prevention measures aim to reduce the number of stroke patients and to detect and treat the stroke as soon as possible, investing in tertiary prevention is important to predict, accelerate, and enhance post-stroke recovery. Chapter 1 discusses two issues. First, the inability to monitor neurological recovery after stroke due to the absence of adequate quantification of neurological state. Secondly, the demand for additional prognostic biomarkers of motor recovery in more severely affected stroke patients. Adequate quantification of neurological recovery is required to investigate whether neurorehabilitation interventions can induce neurological motor recovery after stroke. Unfortunately, neurological motor recovery cannot be measured directly. Therefore, derivatives of neurological state associated with behavioural recovery should be identified, referred to as biomarkers. In this thesis, we investigate biomarkers derived from observed behaviour and biomarkers derived from brain activity. A clinical assessment which is often used in scientific research to monitor behavioural recovery after stroke is the Fugl-Meyer motor assessment of the upper extremity (FM-UE). The FM-UE reflects the ability to perform movements dissociated from abnormal muscle synergies and originates from the different stages of motor recovery after stroke.
Author: Erin Burke Quinlan
Publisher:
ISBN: 9781321367768
Category :
Languages : en
Pages : 143
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Book Description
Stroke is a leading cause of long-term adult disability and many therapies are under study aiming to improve post-stroke motor function. Unfortunately, patient response to therapy is highly variable and the reasons for this are unknown. Clinical assessments are typically used to guide therapeutic decision-making after stroke. However, neuroimaging research over the last 15 years suggests that probes of neural injury and neural function provide crucial insight into post-stroke motor status. Limited research has examined how such measures could predict the likelihood of therapy-induced motor recovery and serve as biomarkers of treatment gains. Therefore, the current dissertation examined several neuroimaging measures of neural injury and neural function, as well as clinical and demographic variables, to 1) characterize our patient sample and understand the factors related to pre-therapy motor impairment and disability; 2) identify predictors of motor gains from a 3-week course of robotic arm therapy; and 3) elucidate potential biomarkers of motor gains from therapy. At baseline, reduced corticospinal tract (CST) integrity and neurophysiology (no motor evoked potential from transcranial magnetic stimulation) were correlated with greater pre-therapy motor impairment. Among less impaired patients, greater contralesional primary motor cortex (M1) and dorsal premotor cortex (PMd) activation correlated with greater motor impairment. The factors related to greater disability were reduced CST integrity and poorer cognitive status. The baseline measures predictive of greater motor gains from therapy were smaller CST injury (CST-lesion overlap) and greater interhemispheric functional connectivity. A notable finding was that predictors of gains varied according to lacunar stroke subtype: greater ipsilesional M1 activation and intrahemispheric functional connectivity predicted larger motor gains. Lastly, functional connectivity measures proved stronger biomarker candidates of treatment gains than changes in regional measures of motor cortex activation or an exploratory susceptibility-weighted imaging measure of peri-infarct tissue perfusion/angiogenesis. Furthermore, biomarkers differed according to stroke severity. Among less impaired patients, reductions in intra- and interhemispheric functional connectivity with therapy correlated with greater motor gains whereas in more impaired patients decreases in interhemispheric functional connectivity correlated with smaller gains. The current findings illustrate that measures of neural injury and neural function provide great insight into motor status after stroke, the likelihood of gains from therapy, and the heterogeneity of patient response to therapy. Ultimately, these measures should be incorporated into clinical trials of restorative stroke therapies to stratify patients to appropriate therapies and guide therapeutic decision-making for maximal patient gains.
Author: John W. Krakauer
Publisher: MIT Press
ISBN: 0262545837
Category : Medical
Languages : en
Pages : 288
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Book Description
An account of the neurobiology of motor recovery in the arm and hand after stroke by two experts in the field. Stroke is a leading cause of disability in adults and recovery is often difficult, with existing rehabilitation therapies largely ineffective. In Broken Movement, John Krakauer and S. Thomas Carmichael, both experts in the field, provide an account of the neurobiology of motor recovery in the arm and hand after stroke. They cover topics that range from behavior to physiology to cellular and molecular biology. Broken Movement is the only accessible single-volume work that covers motor control and motor learning as they apply to stroke recovery and combines them with motor cortical physiology and molecular biology. The authors cast a critical eye at current frameworks and practices, offer new recommendations for promoting recovery, and propose new research directions for the study of brain repair. Krakauer and Carmichael discuss such subjects as the behavioral phenotype of hand and arm paresis in human and non-human primates; the physiology and anatomy of the motor system after stroke; mechanisms of spontaneous recovery; the time course of early recovery; the challenges of chronic stroke; and pharmacological and stem cell therapies. They argue for a new approach in which patients are subjected to higher doses and intensities of rehabilitation in a more dynamic and enriching environment early after stroke. Finally they review the potential of four areas to improve motor recovery: video gaming and virtual reality, invasive brain stimulation, re-opening the sensitive period after stroke, and the application of precision medicine.
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Languages : en
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For many, the recovery of arm and hand movements is incomplete, even after undergoing standard stroke rehabilitation care. The concurrent application of transcranial direct current stimulation (tDCS) with upper limb exercises improves motor recovery more than exercises alone. However, not every person with stroke appears to benefit from this adjunctive therapy. This may relate to inter-subject variability in response to tDCS, stroke lesion characteristics and the use of one-size-fits-all protocols. Our study will determine how motor stroke severity, defined by the amount of corticospinal tract (CST) injury on magnetic resonance imaging, and tDCS type, influence motor learning responses in people with stroke. We will recruit individuals greater than 3 months after stroke with mild to severe motor deficits. They will practice goal-directed reaching while concurrently receiving tDCS. Each person will receive three types of tDCS (anodal, cathodal, sham) to the contralesional motor cortex, applied on a different days and separated by washout periods. Primary outcomes will be kinematic measures of reaching performance obtained before and after each tDCS+reaching session, and 24-hours later to assess retention. This study will elucidate which type of tDCS helps each person to optimize their own motor learning, and whether CST injury predicts these improvements. This knowledge will determine the effectiveness of the imaging biomarker, CST injury, for predicting individual responses to tDCS. The identification of such a biomarker is required for the development of personalized tDCS interventions in stroke rehabilitation clinical trials, which may yield more successful trial results.
Author: Steven C. Cramer
Publisher: Cambridge University Press
ISBN: 1139490656
Category : Medical
Languages : en
Pages : 307
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Book Description
Increasing evidence identifies the possibility of restoring function to the damaged brain via exogenous therapies. One major target for these advances is stroke, where most patients can be left with significant disability. Treatments have the potential to improve the victim's quality of life significantly and reduce the time and expense of rehabilitation. Brain Repair After Stroke reviews the biology of spontaneous brain repair after stroke in animal models and in humans. Detailed chapters cover the many forms of therapy being explored to promote brain repair and consider clinical trial issues in this context. This book provides a summary of the neurobiology of innate and treatment-induced repair mechanisms after hypoxia and reviews the state of the art for human therapeutics in relation to promoting behavioral recovery after stroke. Essential reading for stroke physicians, neurologists, rehabilitation physicians and neuropsychologists.
Author: Geoffrey Donnan
Publisher: OUP Oxford
ISBN: 0191583049
Category : Medical
Languages : en
Pages : 468
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Book Description
Subcortical Stroke is a new and fully revised edition of Lacunar and Other Subcortical Infarctions (OUP, 1995). Stroke is one of the most common causes of death and subcortical stroke accounts for 20-30% of all cerebrovascular infarctions. Our understanding of stroke processes in general, and subcortical stroke in particular, has advanced considerably in recent years. Research findings from the fields of neurochemistry, imaging and genetics have provided insight and input to our understanding of this condition, and this new edition provides an opportunity to describe these advances, and to relate the findings to the clinical expression, neural mechanism, prognosis and treatment of subcortical stroke. In addition, new subcortical syndromes such as CADASIL are covered, as is subcortical haemorrhage. This book presents a comprehensive and authoritative review of the field with contributions from the leading international experts. Subcortical Stroke is for stroke physicians, neurologists and those researching cerebrovascular diseases.
Author: Thomas Platz
Publisher: Springer Nature
ISBN: 3030585050
Category : Medical
Languages : en
Pages : 284
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Book Description
This open access book focuses on practical clinical problems that are frequently encountered in stroke rehabilitation. Consequences of diseases, e.g. impairments and activity limitations, are addressed in rehabilitation with the overall goal to reduce disability and promote participation. Based on the available best external evidence, clinical pathways are described for stroke rehabilitation bridging the gap between clinical evidence and clinical decision-making. The clinical pathways answer the questions which rehabilitation treatment options are beneficial to overcome specific impairment constellations and activity limitations and are well acceptable to stroke survivors, as well as when and in which settings to provide rehabilitation over the course of recovery post stroke. Each chapter starts with a description of the clinical problem encountered. This is followed by a systematic, but concise review of the evidence (RCTs, systematic reviews and meta-analyses) that is relevant for clinical decision-making, and comments on assessment, therapy (training, technology, medication), and the use of technical aids as appropriate. Based on these summaries, clinical algorithms / pathways are provided and the main clinical-decision situations are portrayed. The book is invaluable for all neurorehabilitation team members, clinicians, nurses, and therapists in neurology, physical medicine and rehabilitation, and related fields. It is a World Federation for NeuroRehabilitation (WFNR) educational initiative, bridging the gap between the rapidly expanding clinical research in stroke rehabilitation and clinical practice across societies and continents. It can be used for both clinical decision-making for individuals and as well as clinical background knowledge for stroke rehabilitation service development initiatives.
