Abstract
Gait dysfunction is a leading cause of long-term disability after stroke. The mechanisms underlying recovery of gait function are unknown. We retrospectively evaluated the association between structural connectivity and gait function in 127 patients with unilateral supratentorial stroke (>1 month after stroke). All patients underwent T1-weighted, diffusion tensor imaging and functional ambulation categorization. Voxel-wise linear regression analyses of the images were conducted using fractional anisotropy, mean diffusivity, and mode of anisotropy mapping as dependent variables, while the functional ambulation category was used as an independent variable with age and days after stroke as covariates. The functional ambulation category was positively associated with increased fractional anisotropy in the lesioned cortico-ponto-cerebellar system, corona radiata of the non-lesioned corticospinal tract pathway, bilateral medial lemniscus in the brainstem, and the corpus callosum. The functional ambulation category was also positively associated with increased mode of anisotropy in the lesioned posterior corpus callosum. In conclusion, structural connectivity associated with motor coordination and feedback affects gait function after stroke. Diffusion tensor imaging for evaluating structural connectivity can help to predict gait recovery and target rehabilitation goals after stroke.
Highlights
Gait dysfunction is one of the most common symptoms after stroke, affecting 26–33% of stroke victims
Gait function is one of most complex motor skills in humans, and the control of gait relies on multiple brain areas, including the cerebral cortex, brainstem, cerebellum, and basal ganglia [3]
Premotor cortex, supplementary motor area in the cerebral cortex, and cerebellum have been correlated with poor gait function after stroke [7,8,9]
Summary
Gait dysfunction is one of the most common symptoms after stroke, affecting 26–33% of stroke victims. Premotor cortex, supplementary motor area in the cerebral cortex, and cerebellum have been correlated with poor gait function after stroke [7,8,9]. These studies only assessed the direct effects of lesions primarily in cortical areas, and control of human gait depends on the connections and coordination of multiple brain regions. Since the execution of human gait involves multiple cortical brain areas as well as the cerebellum, disruption of their connections by stroke likely affects gait function. Previous studies could not elucidate a definitive association between brain connectivity and gait function after stroke
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