The clinical characteristics of motor function in chronic hemiparetic stroke patients with complete corticospinal tract injury

Abstract

Clarification of the clinical characteristics of motor function in stroke patients with complete corticospinal tract (CST) injury would be of importance in stroke rehabilitation. However, this topic has not been clearly elucidated. We conducted an investigation of the clinical characteristics of motor function in chronic hemiparetic stroke patients with complete CST injury, as confirmed by transcranial magnetic stimulation and diffusion tensor imaging. Forty-one consecutive chronic hemiparetic stroke patients who showed an absence of motor evoked potential in muscles of the upper and lower extremities upon transcranial magnetic stimulation and in whom the integrity of the CST discontinued around stroke lesion on diffusion tensor imaging tractography were recruited. Mean Medical Research Council scores for distal musculature were lower than those for proximal musculature (P< 0.001). Mean Medical Research Council scores for upper extremity muscles were lower than those for lower extremity muscles (P< 0.001). The mean Motricity Index score for muscles of the upper extremities was lower than that for muscles of the lower extremities (P< 0.001). None of the patients had a functional hand; in contrast, 56% of patients were able to walk independently. We found that motor weaknesses of distal joint musculature and upper extremities were more severe than those of proximal joint musculature and lower extremities following complete injury of the CST in stroke, respectively. As a result, despite the absence of a functional hand in all patients, more than half were able to walk independently.