Damage to fronto-parietal networks impairs motor imagery ability after stroke : a voxel-based lesion symptom mapping study

Background: mental practice with motor imagery has been shown to promote motor skill acquisition in healthy subjects and patients. Although lesions of the common motor imagery and motor execution neural network are expected to impair motor imagery ability, functional equivalence appears to be at least partially preserved in stroke patients.Aim: to identify brain regions that are mandatory for preserved motor imagery ability after stroke.Method: thirty-seven patients with hemiplegia after a first time stroke participated. Motor imagery ability was measured using a Motor Imagery questionnaire and temporal congruence test. A voxelwise lesion symptom mapping approach was used to identify neural correlates of motor imagery in this cohort within the first year post-stroke.Results: poor motor imagery vividness was associated with lesions in the left putamen, left ventral premotor cortex and long association fibres linking parieto-occipital regions with the dorsolateral premotor and prefrontal areas. Poor temporal congruence was otherwise linked to lesions in the more rostrally located white matter of the superior corona radiata. Conclusion: This voxel-based lesion symptom mapping study confirms the association between white matter tract lesions and impaired motor imagery ability, thus emphasizing the importance of an intact fronto-parietal network for motor imagery. Our results further highlight the crucial role of the basal ganglia and premotor cortex when performing motor imagery tasks

Wearable fusion system for assessment of motor function in lesion-symptom mapping studies

Lesion-symptom mapping studies are a critical component of addressing the relationship between brain and behaviour. Recent developments have yielded significant improvements in the imaging and detection of lesion profiles, but the quantification of motor outcomes is still largely performed by subjective and low-resolution standard clinical rating scales. This mismatch means than lesion-symptom mapping studies are limited in scope by scores which lack the necessary accuracy to fully quantify the subcomponents of motor function. The first study conducted aimed to develop a new automated system of motor function which addressed the limitations inherent in the clinical rating scales. A wearable fusion system was designed that included the attachment of inertial sensors to record the kinematics of upper extremity. This was combined with the novel application of mechanomyographic sensors in this field, to enable the quantification of hand/wrist function. Novel outputs were developed for this system which aimed to combine the validity of the clinical rating scales with the high accuracy of measurements possible with a wearable sensor system. This was achieved by the development of a sophisticated classification model which was trained on series of kinematic and myographic measures to classify the clinical rating scale. These classified scores were combined with a series of fine-grained clinical features derived from higher-order sensor metrics. The developed automated system graded the upper-extremity tasks of the Fugl-Meyer Assessment with a mean accuracy of 75\% for gross motor tasks and 66\% for the wrist/hand tasks. This accuracy increased to 85\% and 74\% when distinguishing between healthy and impaired function for each of these tasks. Several clinical features were computed to describe the subcomponents of upper extremity motor function. This fine-grained clinical feature set offers a novel means to complement the low resolution but well-validated standardised clinical rating scales. A second study was performed to utilise the fine-grained clinical feature set calculated in the previous study in a large-scale region-of-interest lesion-symptom mapping study. Statistically significant regions of motor dysfunction were found in the corticospinal tract and the internal capsule, which are consistent with other motor-based lesion-symptom mapping studies. In addition, the cortico-ponto-cerebellar tract was found to be statistically significant when testing with a clinical feature of hand/wrist motor function. This is a novel finding, potentially due to prior studies being limited to quantifying this subcomponent of motor function using standard clinical rating scales. These results indicate the validity and potential of the clinical feature set to provide a more detailed picture of motor dysfunction in lesion-symptom mapping studies.Open Acces

Distinguishing transient from persistent tactile agnosia after partial anterior circulation infarcts - Behavioral and neuroimaging evidence for white matter disconnection.

From a cohort of 36 patients presenting apperceptive tactile agnosia after first cortical ischemic stroke, 14 showed temporary impairment at admission. A previous multi-voxel analysis of the cortical lesions, using as explanatory variable the course of tactile object recognition performance over the recovery period of 9 months, partitioned the cohort into three subgroups. Of the 14 patients constituting two of the subgroups, 7 recovered from their impairment whereas 7 did not. These two subgroups could not be distinguished at admission. The primary aim of the present study is to present two assessments that can do so. The first assessment comprises a pattern of behavioral measures, determined via principal component analysis, encoded in three tests: picking small objects, macrogeometrical discrimination and tactile object recognition. The receiver operating characteristic curve derived from permutation of the behavioral test scores yielded an 80% probability of correct identification of the patient subgroup and an 8% probability for false identification. As done with the permuted scores, the pattern could predict the persistence of affliction of new stroke patients with tactile agnosia. The second predictive assessment extends our previous evaluation of cortical MRI lesion maps to include subcortical regions. Confirming our previous study, the lesions of the persistently impaired subgroup disrupted significantly the anterior arcuatus fasciculus and associated superior longitudinal fasciculus III in the ipsilesional hemisphere, impeding reciprocal information transfer between supramarginal gyrus and both the ventral premotor cortex and Brodmann area 44. Due to the importance of interhemispheric information transfer in tactile agnosia, we performed a supplementary analysis of tactile object recognition scores. It showed that haptic information transfer from the non-affected to the affected hands in the persistent cases partly restored function during the nine months, possibly following restoration of functional interhemispheric haptic information transfer at the border of posterior corpus callosum and splenium. In conclusion, the combined findings of the cortical lesion at subarea PFt of the inferior parietal lobule and the associated subcortical tract lesions permit almost perfect prediction of persistent impairment of tactile object recognition. The study substantiates the need for combined analysis of both cortical lesions and white matter tract disconnections

Assessing and mapping language, attention and executive multidimensional deficits in stroke aphasia.

There is growing awareness that aphasia following a stroke can include deficits in other cognitive functions and that these are predictive of certain aspects of language function, recovery and rehabilitation. However, data on attentional and executive (dys)functions in individuals with stroke aphasia are still scarce and the relationship to underlying lesions is rarely explored. Accordingly in this investigation, an extensive selection of standardized non-verbal neuropsychological tests was administered to 38 individuals with chronic post-stroke aphasia, in addition to detailed language testing and MRI. To establish the core components underlying the variable patients' performance, behavioural data were explored with rotated principal component analyses, first separately for the non-verbal and language tests, then in a combined analysis including all tests. Three orthogonal components for the non-verbal tests were extracted, which were interpreted as shift-update, inhibit-generate and speed. Three components were also extracted for the language tests, representing phonology, semantics and speech quanta. Individual continuous scores on each component were then included in a voxel-based correlational methodology analysis, yielding significant clusters for all components. The shift-update component was associated with a posterior left temporo-occipital and bilateral medial parietal cluster, the inhibit-generate component was mainly associated with left frontal and bilateral medial frontal regions, and the speed component with several small right-sided fronto-parieto-occipital clusters. Two complementary multivariate brain-behaviour mapping methods were also used, which showed converging results. Together the results suggest that a range of brain regions are involved in attention and executive functioning, and that these non-language domains play a role in the abilities of patients with chronic aphasia. In conclusion, our findings confirm and extend our understanding of the multidimensionality of stroke aphasia, emphasize the importance of assessing non-verbal cognition in this patient group and provide directions for future research and clinical practice. We also briefly compare and discuss univariate and multivariate methods for brain-behaviour mapping