The locations of stroke lesions next to the posterior internal capsule may predict the recovery of the related proprioceptive deficits

Frontiers in Neuroscience

Neuroscience

Mircea Ariel Schoenfeld¹  Thomas Hassa²  Joachim Liepert²  Christian Salzmann³  Olivier Lambercy⁴  Roger Gassert⁴  Monika Zbytniewska-Mégret⁴ 

[1] Department of Neurology, Otto-von-Guericke-University Magdeburg, Magdeburg, Germany;Department of Behavioral Neurology, Leibniz-Institute for Neurobiology, Magdeburg, Germany;Neurological Rehabilitation Center Kliniken Schmieder, Heidelberg, Germany;Lurija Institute for Rehabilitation and Health Sciences, University of Konstanz, Konstanz, Germany;Neurological Rehabilitation Center Kliniken Schmieder, Allensbach, Germany;Neurological Rehabilitation Center Kliniken Schmieder, Allensbach, Germany;Rehabilitation Engineering Laboratory, Department of Health Sciences and Technology, Institute of Robotics and Intelligent Systems, ETH Zurich, Zurich, Switzerland;Future Health Technologies, Singapore-ETH Centre, Campus for Research Excellence and Technological Enterprise (CREATE), Singapore, Singapore;

关键词: stroke rehabilitation;    sensorimotor performance;    voxel-based lesion-symptom mapping (VLSM);    somatosensory evoked potentials (SSEP);    robotic assessment;    proprioception;    predictor;    recovery;   

DOI  :  10.3389/fnins.2023.1248975

 received in 2023-06-27, accepted in 2023-09-12,  发布年份 2023

来源: Frontiers

【 摘 要 】

BackgroundSomatosensory deficits after stroke correlate with functional disabilities and impact everyday-life. In particular, the interaction of proprioception and motor dysfunctions affects the recovery. While corticospinal tract (CST) damage is linked to poor motor outcome, much less is known on proprioceptive recovery. Identifying a predictor for such a recovery could help to gain insights in the complex functional recovery processes thereby reshaping rehabilitation strategies.Methods50 patients with subacute stroke were tested before and after neurological rehabilitation. Proprioceptive and motor impairments were quantified with three clinical assessments and four hand movement and proprioception measures using a robotic device. Somatosensory evoked potentials (SSEP) to median nerve stimulation and structural imaging data (MRI) were also collected. Voxel-based lesion-symptom mapping (VLSM) along with a region of interest (ROI) analysis were performed for the corticospinal tract (CST) and for cortical areas.ResultsBefore rehabilitation, the VLSM revealed lesion correlates for all clinical and three robotic measures. The identified voxels were located in the white matter within or near the CST. These regions associated with proprioception were located posterior compared to those associated with motor performance. After rehabilitation the patients showed an improvement of all clinical and three robotic assessments. Improvement in the box and block test was associated with an area in anterior CST. Poor recovery of proprioception was correlated with a high lesion load in fibers towards primary sensorymotor cortex (S1 and M1 tract). Patients with loss of SSEP showed higher lesion loads in these tracts and somewhat poorer recovery of proprioception. The VSLM analysis for SSEP loss revealed a region within and dorsal of internal capsule next to the posterior part of CST, the posterior part of insula and the rolandic operculum.ConclusionLesions dorsal to internal capsule next to the posterior CST were associated with proprioceptive deficits and may have predictive value. Higher lesion load was correlated with poorer restoration of proprioceptive function. Furthermore, patients with SSEP loss trended towards poor recovery of proprioception, the corresponding lesions were also located in the same location. These findings suggest that structural imaging of the internal capsule and CST could serve as a recovery predictor of proprioceptive function.

【 授权许可】

Unknown   
Copyright © 2023 Hassa, Zbytniewska-Mégret, Salzmann, Lambercy, Gassert, Liepert and Schoenfeld.