Lesion location may attenuate response to strategy training in acute stroke.
Elizabeth R Skidmore, Minmei Shih, Lauren Terhorst and 1 others
PMID 33728742WHAT IT FOUND
Strategy training helped fewer patients when stroke damaged specific deep brain regions linked to goal-setting.
This lesion pattern was rare, found in only 25 of 173 patients. The finding is an association, not proof that location causes the poor response.
Key findings
01Among patients receiving strategy training, response rates differed significantly depending on whether the stroke lesion affected the anterior cingulate, nucleus accumbens, or medial dorsal thalamic nuclei.
02Patients with lesions in these specific regions were less likely to meet the criteria for intervention response compared to those with lesions outside these areas.
03In the control group receiving reflective listening, response rates did not differ based on lesion location.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTsWhat it means for SLPs
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What it does not show
This is a secondary analysis, not a prospective trial designed to test this specific hypothesis. Only 25 participants had lesions in the regions of interest, making the sample size for the key finding very small. Patients with more severe impairments were more likely to have these specific lesions, so it is difficult to separate the effect of the lesion location from the effect of greater baseline disability. MRI scans were missing for nearly half of the original trial participants (102 excluded), and those excluded were more chronic and had different education levels, introducing potential selection bias. The study identifies an association but cannot prove that the lesion location caused the reduced response. A single neuroradiologist reviewed the images without blinding to clinical details, though they were blinded to group allocation.
Declared interests
The authors have no commercial interests to disclose. The work was supported by NIH grants.
The easy way to misread this
Do not assume that lesion location is the sole reason for poor response in these patients. The group with these specific lesions also had significantly higher stroke severity and disability at baseline, and the small sample size (25 patients) prevents statistical control for these differences. The finding is an association, not a proven causal mechanism.