title: Does stroke location predict walk speed response to gait rehabilitation?
abstract: OBJECTIVE
  Recovery of independent ambulation after stroke is a major goal. However, which rehabilitation regimen best benefits each individual is unknown and decisions are currently made on a subjective basis. Predictors of response to specific therapies would guide the type of therapy most appropriate for each patient. Although lesion topography is a strong predictor of upper limb response, walking involves more distributed functions. Earlier studies that assessed the cortico-spinal tract (CST) were negative, suggesting other structures may be important.
  
  
  METHODS
  The relationship between lesion topography and response of walking speed to standard rehabilitation was assessed in 50 adult-onset patients using both volumetric measurement of CST lesion load and voxel-based lesion-symptom mapping (VLSM) to assess non-CST structures. Two functional mobility scales, the functional ambulation category (FAC) and the modified rivermead mobility index (MRMI) were also administered. Performance measures were obtained both at entry into the study (3-42 days post-stroke) and at the end of a 6-week course of therapy. Baseline score, age, time since stroke onset and white matter hyperintensities score were included as nuisance covariates in regression models.
  
  
  RESULTS
  CST damage independently predicted response to therapy for FAC and MRMI, but not for walk speed. However, using VLSM the latter was predicted by damage to the putamen, insula, external capsule and neighbouring white matter.
  
  
  CONCLUSIONS
  Walk speed response to rehabilitation was affected by damage involving the putamen and neighbouring structures but not the CST, while the latter had modest but significant impact on everyday functions of general mobility and gait. Hum Brain Mapp 37:689-703, 2016. © 2015 Wiley Periodicals, Inc.
authors.affiliation: Stroke Research Group, Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom.
authors.forename: P Simon
authors.initials: PS
authors.lastname: Jones
authors.affiliation: Acquired Brain Injury Rehabilitation Alliance, School of Health Sciences, University of East Anglia, Norwich, United Kingdom.
authors.forename: Valerie M
authors.initials: VM
authors.lastname: Pomeroy
authors.affiliation: Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
authors.forename: Jasmine
authors.initials: J
authors.lastname: Wang
authors.affiliation: Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
authors.forename: Gottfried
authors.initials: G
authors.lastname: Schlaug
authors.affiliation: Stroke Research Group, Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom.
authors.forename: S
authors.initials: S
authors.lastname: Tulasi Marrapu
authors.affiliation: Stroke Research Group, Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom.
authors.forename: Sharon
authors.initials: S
authors.lastname: Geva
authors.affiliation: Bioengineering Unit, University of Strathclyde, Glasgow, United Kingdom.
authors.forename: Philip J
authors.initials: PJ
authors.lastname: Rowe
authors.affiliation: Acquired Brain Injury Rehabilitation Alliance, School of Health Sciences, University of East Anglia, Norwich, United Kingdom.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Chandler
authors.affiliation: Bioengineering Unit, University of Strathclyde, Glasgow, United Kingdom.
authors.forename: Andrew
authors.initials: A
authors.lastname: Kerr
authors.affiliation: Stroke Research Group, Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom.|Centre Hospitalier Sainte-Anne, Inserm U894, Sorbonne Paris Cité, Paris, France.
authors.forename: Jean-Claude
authors.initials: JC
authors.lastname: Baron
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001921:Brain / Q000473:pathology*; D004185:Disability Evaluation; D005080:Exercise Test; D005260:Female; D061826:Foot Orthoses; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D020127:Recovery of Function; D012044:Regression Analysis; D020521:Stroke / Q000175:diagnosis / Q000473:pathology* / Q000503:physiopathology; D000071939:Stroke Rehabilitation; D016896:Treatment Outcome; D016138:Walking; D066127:White Matter / Q000473:pathology
keywords: MRI; ambulation; cortico-spinal tract; recovery; voxel-based lesion-symptom mapping