Brain regions associated with Brunnstrom and functional independence measure scores in patients after a stroke: a tract-based spatial statistics study.
Yuki Uchiyama, Kazuhisa Domen, Tetsuo Koyama
PMID 36866011WHAT IT FOUND
After stroke, motor severity was linked to damage in main motor pathways, while cognitive independence was linked to damage in wider connecting pathways.
This suggests motor and cognitive deficits involve partly separate brain systems.
Key findings
01BRS-total scores were associated with significant FA decrease in the corticospinal tract and anterior thalamic radiation in both hemisphere lesion groups.
02FIM-cognition scores were associated with significant FA decrease across wider association and commissural fibers, including the anterior thalamic radiation, superior longitudinal fasciculus, inferior longitudinal fasciculus, uncinate fasciculus, cingulum bundle, forceps major, and forceps minor.
03BRS-total and FIM-motor scores were significantly correlated, but BRS-total and FIM-cognition scores were not significantly correlated.
STILL TO COME
How it was doneWhat they foundWhat it means for OTs
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What it does not show
It was a single-centre reanalysis of previously published data, so it adds imaging associations rather than a new clinical trial. The sample was 80 patients, with 37 right-hemisphere and 43 left-hemisphere lesion groups, and the authors noted it was not large. FIM-cognition is not specific to stroke cognitive symptoms such as aphasia, apraxia, neglect, or memory disturbance. Patients with subarachnoid hemorrhage or infratentorial lesions were excluded, so findings may not apply to all stroke populations. The study did not test an intervention, so it cannot show that therapy changed brain tracts or outcomes. Hemorrhagic and ischemic stroke patients were analysed together, although the authors note FA-symptom relationships might differ by stroke type.
Declared interests
This work was partially supported by a Grant-in-Aid for Scientific Research (B) from the Japan Society for the Promotion of Science (JSPS KAKENHI JP16H03209). The authors have no conflicts of interest to declare.
The easy way to misread this
Do not conclude that specific brain tract damage causes the motor or cognitive scores or that therapy changes those tracts. This was an association study at one time point after stroke, and FIM-cognition was not specific to aphasia, apraxia, neglect, or memory.