Predicting functional gains in a stroke trial

Steven C. Cramer, Todd B. Parrish, Robert M. Levy, Glenn T. Stebbins, Sean D. Ruland, David W. Lowry, Theodore "Ted" Trouard, Scott W. Squire, Martin E Weinand, Cary R. Savage, Steven B. Wilkinson, Jenifer Juranek, Szu Yun Leu, David M. Himes

Research output: Contribution to journalArticle

88 Citations (Scopus)

Abstract

BACKGROUND AND PURPOSE - A number of therapies in development for patients with central nervous system injury aim to reduce disability by improving function of surviving brain elements rather than by salvaging tissue. The current study tested the hypothesis that, after adjusting for a number of clinical assessments, a measure of brain function at baseline would improve prediction of behavioral gains after treatment. METHODS - Twenty-four patients with chronic stroke underwent baseline clinical and functional MRI assessments, received 6 weeks of rehabilitation therapy with or without investigational motor cortex stimulation, and then had repeat assessments. Thirteen baseline clinical/radiological measures were evaluated for ability to predict subsequent trial-related gains. RESULTS - Across all patients, bivariate analyses found that greater trial-related functional gains were predicted by (1) smaller infarct volume, (2) greater baseline clinical status, and (3) lower degree of activation in stroke-affected motor cortex on baseline functional MRI. When these 3 variables were further assessed using multivariate linear regression modeling, only lower motor cortex activation and greater clinical status at baseline remained significant predictors. Note that lower baseline motor cortex activation was also associated with larger increases in motor cortex activation after treatment. CONCLUSIONS - Lower motor cortex activity at baseline predicted greater behavioral gains after therapy, even after controlling for a number of clinical assessments. The boosts in cortical activity that paralleled behavioral gains suggest that in some patients, low baseline cortical activity represents underuse of surviving cortical resources. A measure of brain function might be important for optimal clinical decision-making in the context of a restorative intervention.

Original languageEnglish (US)
Pages (from-to)2108-2114
Number of pages7
JournalStroke
Volume38
Issue number7
DOIs
StatePublished - Jul 2007

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Motor Cortex
Stroke
Brain
Magnetic Resonance Imaging
Nervous System Trauma
Therapeutics
Aptitude
Linear Models
Motor Activity
Rehabilitation
Central Nervous System

Keywords

  • Functional MRI
  • Plasticity
  • Recovery
  • Stroke

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Neuroscience(all)

Cite this

Cramer, S. C., Parrish, T. B., Levy, R. M., Stebbins, G. T., Ruland, S. D., Lowry, D. W., ... Himes, D. M. (2007). Predicting functional gains in a stroke trial. Stroke, 38(7), 2108-2114. https://doi.org/10.1161/STROKEAHA.107.485631

Predicting functional gains in a stroke trial. / Cramer, Steven C.; Parrish, Todd B.; Levy, Robert M.; Stebbins, Glenn T.; Ruland, Sean D.; Lowry, David W.; Trouard, Theodore "Ted"; Squire, Scott W.; Weinand, Martin E; Savage, Cary R.; Wilkinson, Steven B.; Juranek, Jenifer; Leu, Szu Yun; Himes, David M.

In: Stroke, Vol. 38, No. 7, 07.2007, p. 2108-2114.

Research output: Contribution to journalArticle

Cramer, SC, Parrish, TB, Levy, RM, Stebbins, GT, Ruland, SD, Lowry, DW, Trouard, TT, Squire, SW, Weinand, ME, Savage, CR, Wilkinson, SB, Juranek, J, Leu, SY & Himes, DM 2007, 'Predicting functional gains in a stroke trial', Stroke, vol. 38, no. 7, pp. 2108-2114. https://doi.org/10.1161/STROKEAHA.107.485631
Cramer SC, Parrish TB, Levy RM, Stebbins GT, Ruland SD, Lowry DW et al. Predicting functional gains in a stroke trial. Stroke. 2007 Jul;38(7):2108-2114. https://doi.org/10.1161/STROKEAHA.107.485631
Cramer, Steven C. ; Parrish, Todd B. ; Levy, Robert M. ; Stebbins, Glenn T. ; Ruland, Sean D. ; Lowry, David W. ; Trouard, Theodore "Ted" ; Squire, Scott W. ; Weinand, Martin E ; Savage, Cary R. ; Wilkinson, Steven B. ; Juranek, Jenifer ; Leu, Szu Yun ; Himes, David M. / Predicting functional gains in a stroke trial. In: Stroke. 2007 ; Vol. 38, No. 7. pp. 2108-2114.
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AU - Trouard, Theodore "Ted"

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