Prediction of prognosis of upper-extremity function following stroke-related paralysis using brain imaging.
Akira Nakashima, Takefumi Moriuchi, Wataru Mitsunaga and 7 others
PMID 28878479WHAT IT FOUND
In 12 stroke patients with partly intact motor tract fibers, a diffusion MRI tract ratio was related to upper-limb motor and use scores at 3 months.
Two cases did not follow this pattern, and all received physical, occupational, and speech therapy.
Key findings
01In the 12 type A patients, the fractional anisotropy ratio was significantly correlated with Fugl-Meyer, amount-of-use, and quality-of-use scores (r=0.67, r=0.66, and r=0.64).
02Five patients were excluded from the main analysis because tractography showed a completely disrupted corticospinal tract, which the authors associated with poor prognosis.
03In the patient with a high fractional anisotropy ratio but low Fugl-Meyer score, voxel-based morphometry showed significant precentral gyrus degeneration compared with controls (p=0.003).
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTs
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What it does not show
The study included only 17 patients, and only 12 remained for the main analysis, so it is not a tested predictor for your patients. The 5 patients with completely disrupted tractography were excluded, so the results do not address patients with severe corticospinal tract disruption. Patients received physical therapy, occupational therapy, and speech therapy during hospitalization, so any single treatment's contribution to 3-month function cannot be separated. The study looked for correlations at one time point, 3 months after onset, and did not test whether imaging could predict outcomes in new patients. Voxel-based morphometry was only shown for two patients, so it cannot be used as a general way to predict recovery from this paper. The text does not say whether the occupational therapist who assessed outcomes was blinded to imaging results. The authors state that age was not restricted, so age-related brain degeneration may have affected results. The authors state that some cases could not be analyzed because it was impossible to distinguish between cerebral ischemic injury and cerebral hemorrhage.
Declared interests
The supplied text does not report funding or conflict-of-interest declarations.
The easy way to misread this
Do not use these imaging results to predict an individual patient's recovery or to choose a specific therapy. The study analyzed only 12 patients, found correlations rather than tested prediction, and all patients received physical therapy, occupational therapy, and speech therapy, so the contribution of any one treatment cannot be separated.