Stroke Lesions in a Large Upper Limb Rehabilitation Trial Cohort Rarely Match Lesions in Common Preclinical Models.
Matthew A Edwardson, Ximing Wang, Brent Liu and 8 others
PMID 28337932WHAT IT FOUND
ICARE did not show a difference in its main motor outcome between rehabilitation groups.
The analyzed strokes were small, and common cortical models captured 16% of participants; a subcortical model captured 33%.
Key findings
01ICARE found no significant difference in its primary outcome measure between groups at 1 year.
02The analyzed ICARE strokes were small, with median ischemic infarct volume 1.8 mL and median ICH volume 12.5 mL.
03Photocoagulation or endothelin-1 sensorimotor cortex models captured 40 participants (16%). A subcortical ischemic model captured 85 participants (33%).
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
Only 82% of ICARE participants had interpretable neuroimaging, so the lesion findings describe a subset of the trial population. The images were obtained during routine clinical care, not research-quality MRI, and lesion characterization had to accommodate CT and MRI scans taken at different times after stroke. The authors could not quantify corticospinal tract overlap without diffusion tensor tractography. Preclinical comparisons relied on selected published models and estimated relative lesion sizes, not direct measurements from the same animal models used in this cohort. The trial participants were selected for mild stroke, moderate upper extremity impairment, and no significant neglect, aphasia, or other cognitive impairments, so the findings do not describe the broader stroke population. The paper states that the relationship between lesion characteristics and recovery remains controversial.
The easy way to misread this
Do not read this as evidence that matching animal models to patient lesions improves therapy outcomes. The ICARE trial did not show a difference in its main motor outcome between rehabilitation groups, and this paper only describes lesion characteristics.