This Article Full Text Full Text (PDF) All Versions of this Article: 38/7/2108    most recent STROKEAHA.107.485631v1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Cramer, S. C. Articles by Himes, D. M. Search for Related Content PubMed PubMed Citation Articles by Cramer, S. C. Articles by Himes, D. M. Pubmed/NCBI databases Medline Plus Health Information Stroke Related Collections Other Stroke Treatment - Medical Acute Stroke Syndromes Rehabilitation, Stroke Related Article

(Stroke. 2007;38:2108.)
© 2007 American Heart Association, Inc.

Original Contributions

Predicting Functional Gains in a Stroke Trial

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

From the Departments of Anatomy and Neurobiology (S.C.C., J.J.) and the General Clinical Research Center Biostatistics (S.-Y.L.), University of California, Irvine; Irvine, Calif; the Departments of Radiology (T.B.P.) and Neurological Surgery (R.M.L.), Northwestern University Feinberg School of Medicine, Chicago, Ill; the Department of Neurological Sciences (G.T.S.), Rush University Medical Center, Chicago, Ill; the Departments of Neurology and Rehabilitation (S.D.R.), University of Illinois at Chicago; Chicago, Ill; The Brain and Spine Center (D.W.L.); Holland, Mich; the Arizona Research Labs–Interdisciplinary (T.P.T.) and the Departments of Radiology (S.W.S.) and Neurosurgery (M.E.W.), University of Arizona; Tucson, Ariz; the Hoglund Brain Imaging Center and the Department of Psychiatry (C.R.S.), University of Kansas Medical Center, Kansas City, Kan; Midwest Brain and Spine Associates (S.B.W.), Independence, Mo; and Northstar Neuroscience, Inc (D.M.H.), Seattle, Wash

Correspondence to Steven C. Cramer, MD, University of California, Irvine Medical Center, 101 The City Drive South, Building 53 Room 203, Orange, CA 92868-4280. E-mail scramer{at}uci.edu

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.

Key Words: functional MRI • plasticity • recovery • stroke

Related Article:

Can fMRI Measures of Brain Motor Activation Add Significantly to Other Variables in the Prediction of Treatment Response?

Isabelle Loubinoux
Stroke 2007 38: 2032-2033. [Full Text] [PDF]

This article has been cited by other articles:

				C. Enzinger, H. Johansen-Berg, H. Dawes, M. Bogdanovic, J. Collett, C. Guy, S. Ropele, U. Kischka, D. Wade, F. Fazekas, et al. Functional MRI Correlates of Lower Limb Function in Stroke Victims With Gait Impairment Stroke, May 1, 2008; 39(5): 1507 - 1513. [Abstract] [Full Text] [PDF]

				C. D. Takahashi, L. Der-Yeghiaian, V. Le, R. R. Motiwala, and S. C. Cramer Robot-based hand motor therapy after stroke Brain, February 1, 2008; 131(2): 425 - 437. [Abstract] [Full Text] [PDF]

				S. C. Cramer The EXCITE Trial: A Major Step Forward for Restorative Therapies in Stroke Stroke, July 1, 2007; 38(7): 2204 - 2205. [Full Text] [PDF]