Sensorimotor, Attentional, and Neuroanatomical Predictors of Upper Limb Motor Deficits and Rehabilitation Outcome after Stroke

Abstract

The rehabilitation of motor deficits following stroke relies on both sensorimotor and cognitive abilities, thereby involving large-scale brain networks. However, few studies have investigated the integration between motor and cognitive domains, as well as its neuroanatomical basis. In this retrospective study, upper limb motor responsiveness to technology-based rehabilitation was examined in a sample of 29 stroke patients (18 with right and 11 with left brain damage). Pretreatment sensorimotor and attentional abilities were found to influence motor recovery. Training responsiveness increased as a function of the severity of motor deficits, whereas spared attentional abilities, especially visuospatial attention, supported motor improvements. Neuroanatomical analysis of structural lesions and white matter disconnections showed that the poststroke motor performance was associated with putamen, insula, corticospinal tract, and frontoparietal connectivity. Motor rehabilitation outcome was mainly associated with the superior longitudinal fasciculus and partial involvement of the corpus callosum. The latter findings support the hypothesis that motor recovery engages large-scale brain networks that involve cognitive abilities and provides insight into stroke rehabilitation strategies.

Figure 1

Enrollment flowchart. MRI: Magnetic Resonance Imaging; TB: Technology-based; F-M UE: Fugl-Meyer Upper Extremity test.

Figure 2

Overlay maps of lesions (a) and white-matter disconnections (b) on a standard brain MNI template. The color scale represents the number of patients.

Figure 3

Significant brain-behavior associations observed between the pretreatment F-M UE scores and lesions (a) or white-matter disconnections (b).

Figure 4

Significant brain-behavior associations observed between F-M UE recovery index and white-matter disconnections.