Abstract
Objective: Structural changes related to recovery of sensory function are not well understood. Previously, we demonstrated a relationship between improved sensory function and increased cortical thickness in ipsilesional occipitoparietal and contralesional temporoparietal areas following rehabilitation of patients with chronic stroke(Pundik et al, 2018). The objective of the current work was to evaluate changes in white matter (WM) tracts originating in these cortical regions where thickness changes were related to enhanced sensory function after rehabilitation in chronic stroke. Methods: Chronic stroke survivors (n=18) received 12 weeks of upper limb sensory-motor rehabilitation. Outcome measures were sensory acuity (monofilament test, a sum over 9 locations on the hand; best score 25.47) and DTI measures of diffusivity [mean (MD), radial (RD), axial (AD)] and fractional anisotropy (FA). DTI analysis included: probabilistic tractography from seeds where cortical thickness changes correlated with sensory recovery, creation of a group-based tract by combining individual tracts, tract-based analysis using Spearman correlation, significance at p<0.05 with Bonferroni correction, and voxel-based analysis permutation inference for general linear modeling. Results: Subjects were 53.9±12.1 years old, 1.9±1.2 years after stroke and 27.8% female. Monofilament score improved from 46.6±13.1 to 43.9±12.9. Improved sensory acuity correlated with increased AD (rho=0.69, p=0.002), RD (rho=0.59, p=0.0093) and MD (rho=0.63, p=0.005) in the tract originating in the ipsilesional occipital pole. Voxel-based analysis between changes in MD and in monofilament identified a statistically significant cluster (family-wise error corrected p=0.03) within a subcortical region of the tract originating in the ipsilesional occipital pole. Conclusion: Improved sensory acuity after rehabilitation was related to DTI-measured microstructural changes in WM tracts. These findings further support the notion of structural plasticity associated with sensory function improvement during rehabilitation in chronic stroke.
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