Long-term functional outcome after stroke: the impact of MRI-detected lesion characteristics

The objective of this thesis was to gain a better understanding of the relationship between ischemic lesion characteristics and long-term functional outcome of stroke survivors. The relationship between volume and localization of the ischemic cerebral lesion and the long-term functional outcome of first-ever ischemic middle cerebral artery stroke survivors was studied. Volume and localization was obtained with conventional Magnetic Resonance Imaging (MRI) scans. Outcome was assessed at the levels of body functions, activities and participation according to the International Classification of Functioning, Disability and Health (ICF). (1) In a systematic review, we found that previous studies showed a strong relationship between lesion volume and short-term outcome. However, earlier studies investigated only short follow-up periods up till 3-6 months, although functional improvement still occurs after 6 months. Furthermore, it was not clear if lesion volume related to all different levels of functional outcome (ICF) . (2) In the second week after stroke a strong relationship between lesion volume and neurological deficits was found as well as moderate correlations between lesion volume and body functions and limitations in activities. (3) Moderate relationships between lesion volume and functional outcome and quality of life after one year poststroke were demonstrated. A clinical model with clinical variables only predicted outcome of Activities of Daily Living of the stroke survivor after one year with an accuracy of 77%. Adding neuro-imaging variables to the clinical model increased the accuracy to 83%, but this difference was not statistically significant. (4) Involvement of structures with a greater density of corticofugal fibres (internal capsule) was associated with poor recovery of hand motor function after 1-year poststroke. The probability of recovery of some or all of the hand function ranged from 51% for those patients in whom the motor cortex was affected, to only 13% for those patients in whom both motor cortex and internal capsule were affected. (5) Our study showed that hemispheric lesion side, level and volume were weak to moderate predictors of verbal memory. Performance on visual recognition could not be predicted by lesion characteristics. (6) Stroke volume is a reflection of damaged brain tissue. A larger infarction leads to more deterioration of body functions, more activity limitations and a lesser capacity to participate, as well as an impaired Quality of Life. The strength of correlation between lesion characteristics and functional outcome weakens after a longer follow-up period post stroke. (7) Besides to its volume, the location of the lesion is important, especially for the outcome of motor function of the upper paretic limb. Long-term poststroke, the effect of localization was seen for hand motor recovery as well as for long-term episodic memory disorders

Predicting long-term independency in activities of daily living after middle cerebral artery stroke: does information from MRI have added predictive value compared with clinical information?

Contains fulltext : 49251.pdf (publisher's version ) (Closed access)BACKGROUND AND PURPOSE: To investigate whether neuroimaging information has added predictive value compared with clinical information for independency in activities of daily living (ADL) 1 year after stroke. METHODS: Seventy-five first-ever middle cerebral artery stroke survivors were evaluated in logistic regression analyses. Model 1 was derived on the basis of clinical variables; for model 2, neuroimaging variables were added to model 1. Independent variables were stroke severity (National Institutes of Health Stroke Scale), consciousness (Glasgow Coma Scale), urinary continence, demographic variables (age, gender, relationship, educational level), hospital of admission, and clinical instruments: sitting balance (trunk control test), motor functioning (Motricity Index), and ADL (Barthel Index). Neuroimaging variables, determined on conventional MRI scans, included: number of days to scanning, lesion volume, lesion localization (cortex/subcortex), hemisphere, and the presence of white matter lesions. ADL independency was defined as 19 and 20 points on Barthel Index. Differences in accuracy of prediction of ADL independence between models 1 and 2 were analyzed by comparing areas under the curve (AUC) in a receiver operating characteristic analysis. RESULTS: Model 1 contained as significant predictors: age and ADL (AUC 0.84), correctly predicting 77%. In model 2, number of days to scanning, hemisphere, and lesion volume were added to model 1, increasing the AUC from 0.84 to 0.87, accurately predicting 83% of the surviving patients. CONCLUSIONS: Clinical variables in the second week after stroke are good predictors for independency in ADL 1 year after stroke. Neuroimaging variables on conventional MRI scans do not have added value in long-term prediction of ADL

Impact of internal capsule lesions on outcome of motor hand function at one year post-stroke

Objective: To investigate the association between damage to different levels of the corticofugal tract and long-term hand motor recovery. Design: Prospective cohort study. Patients: Seventy-five first-ever middle cerebral artery stroke survivors. Methods: Hand motor function was assessed with the Fugl-Meyer Motor Assessment Scale at one year post-stroke. Localization of the corticofugal tract was assessed on axial magnetic resonance imaging slices using a corticofugal mask defining involvement of the motor cortex, corona radiata or internal capsule and combinations of these structures, adjusted for lesion volume. Results: Longitudinal involvement of all 3 levels of the corticofugal tract and partial involvement of the internal capsule were associated with a significant probability of poor motor hand function recovery. The probability of regaining hand function ranged from 54% if the corticofugal tract was only partly affected to 13% if both motor cortex and internal capsule were affected. Conclusion: At one year post-stroke, lesions of the internal capsule were associated with a significantly lower probability of return of isolated hand motor function than lesions of the cortex, subcortex and corona radiata. Since recovery of isolated hand and finger movements is important for regaining a functional upper limb in everyday living, these patients should be identified early post-stroke in order to evaluate specific hand function training. © 2007 The Authors. Journal Compilation © 2007 Foundation of Rehabilitation Information

Ischemic lesion volume correlates with long-term functional outcome and quality of life of middle cerebral artery stroke survivors

PURPOSE: Previous studies investigating relationships between stroke lesion volume and outcome were restricted to short follow-up periods (3-6 months) and outcome measures of stroke severity and activities only, whereas functional improvement has been found to extend far beyond six months. Therefore, this study investigated relationships between infarct volume and a broad range of outcomes of stroke survivors at a long follow-up period. METHODS: Correlations between lesion volumes (determined by conventional MRI scans in the second week post-stroke) and outcomes after one year of 75 first-ever ischemic stroke survivors were investigated. RESULTS: Moderate Spearman Rank correlation coefficients were found between lesion volume and motor impairment (Motricity Index (MI): -0.43, p <0.01; Fugl Meyer Motor Assessment Scale (FM): -0.43; p <0.01). Correlation coefficients with activities of daily living were moderate but low associated with Barthel Index (r(s) = 0.30; p <0.01), modified Rankin Scale (r(s) = 0.39; p <0.01) and Frenchay Activities Index (r(s) = -0.35; p <0.01). Lesion volume had a significant but low association (r(s) = 0.27; p = 0.02) with patient's health status measured with Sickness Impact Profile 68 (SIP68)) and a moderate correlation with well-being assessed with Life Satisfaction Questionnaire (LSQ; r(s) = -0.45; p <0.01). Found correlation coefficients were slightly stronger after correction for mixed (cortical/subcortical) and purely subcortical lesion location. CONCLUSIONS: It can be concluded that infarct volume moderately correlates with long-term motor impairment, functional outcome and quality of life of patients surviving strok

Ankle-Foot-Orthosis “Hermes” Compensates Pathological Ankle Stiffness of Chronic Stroke—A Proof of Concept

Individuals with an upper motor neuron syndrome, e.g., stroke survivors, may have a pathological increase of passive ankle stiffness due to spasticity, that impairs ankle function and activities such as walking. To improve mobility, walking aids such as ankle-foot orthoses and orthopaedic shoes are prescribed. However, these walking aids generally limit the range of motion (ROM) of the foot and may therewith negatively influence activities that require a larger ROM. Here we present a new ankle-foot orthosis 'Hermes', and its first experimental results from four hemiparetic chronic stroke patients. Hermes was designed to facilitate active ankle dorsiflexion by mechanically compensating the passive ankle stiffness using a negative-stiffness mechanism. Four levels of the Hermes' stiffness compensation (0%, 35%, 70% and 100%) were applied to evaluate active ROM in a robotic ankle manipulator and to test walking feasibility on an instrumented treadmill, in a single session. The robotic tests showed that Hermes successfully compensated the ankle joint stiffness in all four patients and improved the active dorsiflexion ROM in three patients. Three patients were able to walk with Hermes at one or more Hermes' stiffness compensation levels and without reducing their preferred walking speeds compared to those with their own walking aids. Despite a small sample size, the results show that Hermes holds great promise to support voluntary ankle function and to benefit walking and daily activities.Biomechatronics & Human-Machine ControlSupport Biomechanical EngineeringBiomechanical Engineerin

Short-term outpatient follow-up of COVID-19 patients: A multidisciplinary approach

Background: Short-term follow-up of COVID-19 patients reveals pulmonary dysfunction, myocardial damage and severe psychological distress. Little is known of the burden of these sequelae, and there are no clear recommendations for follow-up of COVID-19 patients. In this multi-disciplinary evaluation, cardiopulmonary function and psychological impairment after hospitalization for COVID-19 are mapped.Methods: We evaluated patients at our outpatient clinic 6 weeks after discharge. Cardiopulmonary function was measured by echocardiography, 24-hours ECG monitoring and pulmonary function testing. Psychological adjustment was measured using questionnaires and semi-structured clinical interviews. A comparison was made between patients admitted to the general ward and Intensive care unit (ICU), and between patients with a high versus low functional status.Findings: Eighty-one patients were included of whom 34 (41%) had been admitted to the ICU. New York Heart Association class II-III was present in 62% of the patients. Left ventricular function was normal in 78% of patients. ICU patients had a lower diffusion capacity (mean difference 12,5% P = 0.01), lower forced expiratory volume in one second and forced vital capacity (mean difference 14.9%; P<0.001; 15.4%; P<0.001; respectively). Risk of depression, anxiety and PTSD were 17%, 5% and 10% respectively and similar for both ICU and non-ICU patients.Interpretation: Overall, most patients suffered from functional limitations. Dyspnea on exertion was most frequently reported, possibly related to decreased DLCOc. This could be caused by pulmonary fibrosis, which should be investigated in long-term follow-up. In addition, mechanical ventilation, deconditioning, or pulmonary embolism may play an important role. (C) 2021 The Author(s). Published by Elsevier Ltd.Immunogenetics and cellular immunology of bacterial infectious disease