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. 2017 Oct 25;7(11):e00868.
doi: 10.1002/brb3.868. eCollection 2017 Nov.

Brain lesions affecting gait recovery in stroke patients

Kyoung Bo Lee  1 , Joon Sung Kim  1 , Bo Young Hong  1 , Bomi Sul  1 , Seojin Song  1 , Won Jin Sung  1 , Byong Yong Hwang  2 , Seong Hoon Lim  1
Affiliations

Brain lesions affecting gait recovery in stroke patients

Kyoung Bo Lee et al. Brain Behav. .

Abstract

Objectives: Gait recovery is an important goal in stroke patients. Several studies have sought to uncover relationships between specific brain lesions and the recovery of gait, but the effects of specific brain lesions on gait remain unclear. Thus, we investigated the effects of stroke lesions on gait recovery in stroke patients.

Materials and methods: In total, 30 subjects with stroke were assessed in a retrograde longitudinal observational study. To assess gait function, the functional ambulation category (FAC) was tested four times: initially (within 2 weeks) and 1, 3, and 6 months after the onset of the stroke. Brain lesions were analyzed via overlap, subtraction, and voxel-based lesion symptom mapping (VLSM).

Results: Ambulation with FAC improved significantly with time. Subtraction analysis showed that involvement of the corona radiata, internal capsule, globus pallidus, and putamen were associated with poor recovery of gait throughout 6 months after onset. The caudate nucleus did influence poor recovery of gait at 6 months after onset. VLSM revealed that corona radiata, internal capsule, globus pallidus, putamen and cingulum were related with poor recovery of gait at 3 months after onset. Corona radiata, internal capsule, globus pallidus, putamen, primary motor cortex, and caudate nucleus were related with poor recovery of gait at 6 months after onset.

Conclusion: Results identified several important brain lesions for gait recovery in patients with stroke. These results may be useful for planning rehabilitation strategies for gait and understanding the prognosis of gait in stroke patients.

Keywords: brain lesion; gait; lesion symptom mapping; recovery; stroke.

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Figures

Figure 1
Figure 1
Clinical gait recovery using the functional ambulation category in all subjects (n = 30). FAC, Functional ambulation category, * indicates a significant post hoc difference (p < .0167)
Figure 2
Figure 2
Overlay of lesions in all the subjects with stroke (n = 30). The color indicates the frequency of overlap
Figure 3
Figure 3
Subtraction analysis, where the overlay of patients without independent walking ability was subtracted from the overlay of those with independent walking ability. The top represents the subtraction analysis where the overlay of patients without independent walking ability was subtracted from the overlay of those with independent walking ability at 3 months post stroke. The bottom represents subtraction analysis where the overlay of patients without independent walking ability was subtracted from the overlay of those with independent walking ability at 6 months post stroke
Figure 4
Figure 4
Voxel based lesion symptom mapping for gait. The figure represent direct statistical comparison of lesions between able‐walking patient and unable‐walking patient groups using a voxel based lesion symptom mapping (VLSM) method implemented in the nonparametric mapping software included into the MRIcron software. The top represents VLSM for patients without independent walking ability at 3 months poststroke. We set minimum Z score of 2.96(false discovery rate threshold) and maximum range of the Z score as 4, which be shown as being the maximum brightness. The bottom represents VLSM for patients. Minimum Z score of 1.9740 (false discovery rate threshold) and maximum range of the Z score as 6
See this image and copyright information in PMC

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