Differences In Hand Function Research Articles

Long-term follow-up of thumb reconstruction with a heterotopic replanted finger: case report and literature review

ObjectivesThis work aimed to study the long-term outcome and function of a heterotopic replanted finger.MethodsRetrospective analysis of two cases of successful finger reconstruction after finger heterotopic replantation. One case was a severed thumb, and the other case was a severed finger. The average follow-up time was 10 years. The clinical outcome and function of the heterotopic replanted finger, including range of motion, grip strength, and sensory recovery, were analyzed,. A comparative analysis was conducted with patients who underwent thumb replantation in the same period.ResultsThe two heterotopically replanted fingers survived. Five months after the heterotopic replantation surgery, a new thumb was reconstructed using the heterotopically replanted thumb and the free tarsometatarsal joint from the foot. In the other case, the finger was reconstructed 1 year later with a free anterolateral thigh flap and the heterotopically replanted finger. The movement of the thumb, the pinching of the fingers, the clenching of the fist, and the feeling recovery were all good. The patient was capable of independently performing daily life and work activities such as eating, dressing, writing, and so on. There was no significant difference in hand function between the patients who received in situ finger replantation and heterotopic replantation during the same period.ConclusionFor severed fingers that cannot be replanted in situ in an emergency situation, heterotopic replantation and secondary reconstruction may be a feasible and practical surgical method.

Trapeziometacarpal total joint arthroplasty, with or without supervised hand rehabilitation: A quasi-experimental trial.

Aim of this study was to determine whether postoperative supervised rehabilitation improves functional outcomes after trapeziometacarpal (TMC) total joint arthroplasty (TJA), compared to education alone. A quasi-experimental before-after trial included 31 women (≥40years) per group diagnosed with trapeziometacarpal osteoarthritis who underwent TJA. A cohort (n = 31) who was given education alone was compared to a cohort (n = 31) who were subjected to supervised rehabilitation. Primary outcome was the difference in hand function 3months postoperatively, measured by the Michigan Hand Outcomes Questionnaire (MHOQ). Other outcomes were the MHOQ subscale scores, the active range of motion, strength, time to return to work, satisfaction and complications. Patients in the education group had a significantly higher median delta MHOQ score when compared to the rehabilitation group at 3 months; 28.5 (20.5-31.3) versus 15.8 (1.9-21.1), (p = <0.01) and at 12 months 36.6 (26.8 - 47.2) versus 27.4 (14.5 - 33.0), (p = 0.01). Only the secondary outcomes the MHOQ subscales hand function, ADL and satisfaction revealed significant differences in favor of the education group. The education method reduced the median number of hand therapy sessions with eight visits. The present study does not show a significant or clinically relevant benefit from supervised rehabilitation in terms of functional outcomes following TJA compared to education alone. Based on this, it seems safe to leave patients unsupervised in their recovery following TJA and to suffice with just education, however further exploration of effectiveness and safety of this intervention is recommend in larger trials.

The Use of ABILHAND-Kids in Children with Unilateral Congenital Below-Elbow Deficiencies and Acquired Amputation: An Italian Cross-Sectional Study.

Congenital or acquired hand differences, including unilateral below-elbow deficiencies, present complex challenges in pediatric rehabilitation. Surgical management and prosthetic provision represent a big challenge to find a good balance for guaranteeing optimal hand function. There is no specific assessment tool for measuring these aspects in the Italian context. The present study investigates the psychometric properties of the ABILHAND-Kids in children with congenital unilateral below-elbow deficiencies and acquired amputation of the upper limb. We measure internal consistency using Cronbach coefficient alpha and the intraclass correlation coefficient (ICC) for measuring test-retest reliability. Differences in hand function in both children with acquired or congenital diseases were also investigated. Participants to the study were 107 (49 F and 58 M) children, with a mean (SD) age of 8.88 (4.25). For test retest reliability, conducted on a sub-sample of 58 children, the ICC was 0.92, while for internal consistency, the Cronbach coefficient alpha was 0.90. We did not find statistically significant differences in scoring (p = 0.33) in the use (mean 29.25 SD 6.58) or non-use of a prosthetic device (mean 30.74 SD 7.43), while statistically significant differences were found in hand function (p < 0.01) for children who had a congenital impairment (mean 31.87 SD 6.49) and children who had an acquired amputation (mean 27.77 SD 6.60). In conclusion, the ABILHAND-Kids showed good internal consistency and reliability and can capture differences in hand function in children with both congenital and acquired hand disorders.

A Study of Different Frequencies of Repetitive Transcranial Magnetic Stimulation on Upper Extremity Muscle Activity and Hand Function in Chronic Stroke Patients

The purpose of this study was to compare the use of different frequencies of repetitive transcranial magnetic stimulation (rTMS) on the upper extremity muscle activity and hand function of chronic stroke patients. The study subjects comprised 18 chronic stroke patients: the 5 Hz rTMS group (HFG), which included nine patients who received rTMS to the affected cerebral hemisphere, and the 1 Hz low-frequency group (LFG), which had nine patients who received rTMS to the nonaffected cerebral hemisphere. The intervention was conducted three times a week for four weeks. Electromyography was used to check muscle activity, and the stroke upper extremity function test (MFT) and grip strength test were performed to check hand function. Pre- and post-evaluations were performed for both groups. A comparison between the two groups showed a significant difference in the activity of the trapezius anterior and triceps brachii muscle for the muscle activities in the HFG group (p 0.05) as well as a significant difference in the MFT results for hand function (p 0.05). In the LFG group, a significant difference was noted in the triceps brachii muscle for muscle activity (p 0.05), but no significant difference was evident in hand function (p 0.05). The comparison of the two groups showed a significant difference in muscle activity in the triceps brachii muscle (p 0.05) but no significant difference in hand function (p 0.05). This study confirmed that high-frequency rTMS has a positive effect on upper extremity muscle activity and hand function in chronic stroke patients.

Relationship Between Smoking Cigarettes and Hand Function After Tendon Repair in Men

Background and Aims: A proper hand function is essential for performing activities of daily living. Hand injuries can significantly affect participation in these activities. Therefore, any factors that interferes with the treatment of hand injuries and postoperative recovery such as smoking should be controlled. Smoking cigarettes use is a public health problem worldwide. The present study aims to investigate the relationship between smoking cigarettes and hand function after tendon repair in men. Methods: This cross-sectional study was conducted on 40 men (20 smokers and 20 non-smokers) who had undergone at least 10 sessions of physiotherapy and 10 sessions of occupational therapy one and a half months after tendon surgery. In order to collect the information, a demographical form and the shortened disabilities of the arm, shoulder and hand questionnaire (QuickDASH) were used. The collected data were analyzed in SPSS software, version 22. Results: There was a significant difference in hand function after tendon repair between smokers and non-smokers (P=0.006). There was no significant relationship between the number of cigarette consumed per day and hand function (P=0.3) Conclusion: It seems that there is a significant relationship between smoking and hand function after tendon repair, but there is no significant relationship between the number of cigarettes smoked per day and hand function. Individual counseling to smokers with hand injuries and expressing the possible negative effects of smoking on their hand function can increase the effectiveness of rehabilitation in them.

Involvement in a Personal Injury Claim Is Associated With More Pain and Delayed Return to Work After Elective Nonsurgical or Surgical Treatment for Hand or Wrist Disorders: A Propensity Score-matched Comparative Study.

Involvement in a Personal Injury Claim Is Associated With More Pain and Delayed Return to Work After Elective Nonsurgical or Surgical Treatment for Hand or Wrist Disorders: A Propensity Score-matched Comparative Study.

Assessment of Rheumatoid Hand Function as a Characteristic Feature of Rheumatoid Arthritis in Patients Treated with Methotrexate or Methotrexate with Biological Agents with or without Deformation of Hands.

The hand is an excellent work tool that provides the functional ability to mechanical work. The hand is affected in rheumatoid arthritis (RA) patients, it is a significant problem in the functional sphere as a result of deformities, the grasping function limitation and muscle strength. The aim of the study was the assessment of grip strength, endurance and manipulation abilities of rheumatoid hands with or without deformities treated with methotrexate (MTX) or MTX plus biologics (MTX+BIO). The study involved 80 RA women, (40 received MTX+BIO, 40 MTX), treated at the Rheumatology Department of the Central Clinical Hospital of Interior Affairs in Warsaw. VASpain, DAS28, SDAI, HAQ, HAQ hands, estimation of hand grip strength, endurance, and manipulation ability were analyzed. In group MTX+BIO, values of DAS28 (3.7±1.3 vs. 4.3±1.2, p=0.019), HAQ (0.72 ± 0.57 vs. 1.08± 0.87, p=0.011) and HAQ-hand (0.85±0.65 vs. 1.19±0.68, p=0.024) were statistically lower than in MTX group. Hand deformations were recorded in 35 (43.7%) cases, 16 (40%) in MTX group, 19 (47.5%) in MTX+BIO. Comparison of grip strength, endurance, and manipulation ability showed better results in MTX+BIO group with deformities (significance level from 0.013 to 0.046) than in MTX group. Relative differences in hand function in MTX + BIO group ranged from 10.8% (maximal power grip strength) to 127.6% (minimal hand endurance), after disease duration adjustment - from 28.2% (maximal power grip strength) to 148.4% (minimal hand endurance). Measuring grip strength, hand endurance, manipulation abilities are useful in RA patients with hand deformities.

The Effect of Constraint-Induced Movement Therapy Combined With Repetitive Transcranial Magnetic Stimulation on Hand Function in Preschool Children With Unilateral Cerebral Palsy: A Randomized Controlled Preliminary Study.

Constraint-induced movement therapy (CIMT) combined with repetitive transcranial magnetic stimulation (rTMS) have shown great potential in improving function in schoolchildren with unilateral cerebral palsy attributed to perinatal stroke. However, the prospect of application in preschool children with unilateral cerebral palsy (UCP) attributed to various brain disorders remains unclear. In this prospective, assessor-blinded, randomized controlled study, 40 preschool children with UCP (aged 2.5–6 years) were randomized to receive 10 days of CIMT combined with active or sham rTMS. Assessments were performed at baseline, 2 weeks, and 6 months post-intervention to investigate upper limb extremity, social life ability, and perceived changes by parents and motor-evoked potentials. Overall, 35 participants completed the trial. The CIMT plus active stimulation group had greater gains in the affected hand function (range of motion, accuracy, and fluency) than the CIMT plus sham stimulation group (P < 0.05), but there was no significant difference in muscular tone, social life ability, and perceived changes by parents between the two groups (P > 0.05). In addition, there was no significant difference in hand function between children with and without motor-evoked potential (P > 0.05). No participants reported severe adverse events during the study session. In short, the treatment of CIMT combined with rTMS is safe and feasible for preschool children with UCP attributed to various brain disorders. Randomized controlled studies with large samples and long-term effects are warranted.

Measuring Hand Sensory Function and Force Control in Older Adults: Are Current Hand Assessment Tools Enough?

The ability to grasp and manipulate objects is essential for performing activities of daily living. However, there is limited information regarding age-related behavioral differences in hand sensorimotor function due, in part, to the lack of assessment tools capable of measuring subtle but important differences in hand function. The purpose of this study was to demonstrate performance differences in submaximal force control and tactile pattern recognition in healthy older adults using 2 custom-designed sensorimotor assessment tools. Sensorimotor function was assessed in 13 healthy older adults (mean age 72.2 ± 5.5 years, range: 65-84 years) and 13 young adults (mean age 20 ± 1.4 years, range: 19-23 years). Clinical assessments included the Montreal Cognitive Assessment (MoCA), monofilament testing, maximum voluntary contraction (MVC), and Grooved Pegboard Test. Sensorimotor assessments included submaximal (5, 20% MVC) grip force step-tracking and tactile pattern recognition tasks. Clinical assessments revealed no or minimal group differences in MVC, monofilament thresholds, and MoCA. However, sensorimotor assessments showed that older adults took longer to discriminate tactile patterns and had poorer accuracy than young adults. Older adults also produced submaximal forces less smoothly than young adults at the 20% force level while greater variability in force maintenance was seen at 5% but not 20% MVC. These results demonstrate the ability to integrate higher-order tactile information and control low grip forces is impaired in older adults despite no differences in grip strength or cognition. These findings underscore the need for more sensitive evaluation methods that focus on sensorimotor ability reflective of daily activities.

ËFFECTS OF A 12-WEEK WUQINXI INTERVENTION ON HAND FUNCTION OF PATIENTS WITH PARKINSON'S DISEASE

PURPOSE: This study was to compare the effects of 12-week’s Wuqinxi exercise versus stretching on hand function (including hand dexterity and hand-eye coordination) in patients with idiopathic Parkinson’s disease (PD). METHODS: This study used a randomized, controlled trial design, where46 patients (23 women) with stage 1 through 3 Parkinson’s on the Hoehn and Yahr staging scale were randomly and evenly assigned into a Wuqinxi exercise group or a stretching group. All participants practiced either 60-minute Wuqinxi or stretching exercise sessions twice a week for 12 weeks. The Purdue Pegboard test (PPT) and the Soda Pop test (SPT) were performed to assess hand dexterity (timed speed and flexibility), and hand-eye coordination, respectively, before and after the 12-week exercise intervention. Mixed-model (group by time) repeated measures ANOVAs using SPSS 24.0 were conducted to determine the differences in hand function between the Wuqinxi and stretching groups before and after the intervention. Statistical significance level was set at p<0.05. RESULTS: After the 12-week’s exercise intervention, the post-intervention PPT score performed by both hands was greater (P=0.003) in the Wuqinxi group than the stretching group; whereas the post-intervention SPT scores were significantly increased (P<0.01) for both groups through the intervention, with no group difference being observed (P=0.734). (Table 1) CONCLUSIONS: The Wuqinxi exercise routine could improve hand dexterity following the 12-week’s training in patients with mild-to-moderate PD.Table 1: Scores of PPT and SPT before vs after 12-week intervention

Anatomical and Functional Characterization in Children With Unilateral Cerebral Palsy: An Atlas-Based Analysis

Background. Variability in hand function among children with unilateral cerebral palsy (UCP) might reflect the type of brain injury and resulting anatomical sequelae. Objective. We used atlas-based analysis of structural images to determine whether children with periventricular (PV) versus middle cerebral artery (MCA) injuries might exhibit unique anatomical characteristics that account for differences in hand function. Methods. Forty children with UCP underwent structural brain imaging using 3-T magnetic resonance imaging. Brain lesions were classified as PV or MCA. A group of 40 typically developing (TD) children served as comparison controls. Whole brains were parcellated into 198 structures (regions of interest) to obtain volume estimates. Dexterity and bimanual hand function were assessed. Unbiased, differential expression analysis was performed to determine volumetric differences between PV and MCA groups. Principal component analysis (PCA) was performed and the top 3 components were extracted to perform regression on hand function. Results. Children with PV had significantly better hand function than children with MCA. Multidimensional scaling analysis of volumetric data revealed separate clustering of children with MCA, PV, and TD children. PCA extracted anatomical components that comprised the 2 types of brain injury. In the MCA group, reductions of volume were concentrated in sensorimotor structures of the injured hemisphere. Models using PCA predicted hand function with greater accuracy than models based on qualitative brain injury type. Conclusions. Our results highlight unique quantitative differences in children with UCP that also predict differences in hand function. The systematic discrimination between groups found in our study reveals future questions about the potential prognostic utility of this approach.

Response to commentary of Shirani and Okuda regarding "Unilateral arm rehabilitation for persons with multiple sclerosis using serious games in a virtual reality approach: Bilateral treatment effect?"

Response to commentary of Shirani and Okuda regarding "Unilateral arm rehabilitation for persons with multiple sclerosis using serious games in a virtual reality approach: Bilateral treatment effect?"

Frequency of mirror movements and comparison of hand function in spastic cerebral palsy children with and without mirror movements

To assess the frequency of mirror movements in spastic cerebral palsy children and to compare hand function and functional independence of such children with and without mirror movements. . The comparative cross-sectional study was conducted in special education schools of Lahore and Islamabad from August 2017 to January 2018, and comprised children of either gender aged 5-18 years diagnosed with spastic cerebral palsy who were able to make a gross grip. Wood and Teuber criteria for the assessment of mirror movements and Jebsen-Taylor hand function test for hand function assessment were used, while manual ability classification system was used for the assessment of functional independence. Data was analysed using SPSS 21. Of the140 subjects, 113(80.7%) were boys and 27(19.3%) were girls. The overall mean age was 11.17}3.69 years. Of the total, 51(36.4%) subjects had diplegic cerebral palsy, while 50(35.7%) were suffering from mirror movements. There was no difference in the unimanual hand function of children with and without mirror movements (p>0.05). However, children without mirror movements had more functional independence (p<0.001). Mirror movement was found in one third of the sample, and there was no difference in hand function in children with and without mirror movements.

An Analysis of Differences in Hand Function of Visually Impaired Elderly Women Depending on Keyboard Pressing Patterns

An Analysis of Differences in Hand Function of Visually Impaired Elderly Women Depending on Keyboard Pressing Patterns

The Effects of Age, Gender, and Target Force Level on Controlled Force Exertion Tasks

Objective: The purpose of this study is to build basic data to systematically develop a hand function evaluation tool by determining the effects of age, gender and target force level on the difference in hand function according to the target force level.BR Background: Precise and objective evaluation of hand functionality is a very important factor in quantifying treatment progress in patients or elderly people, and in verifying treatment effects. However, most hand function evaluations lack objectivity and accuracy, and therefore it is difficult to properly treat patients according to the given situation.BR Method: Sixteen healthy subjects (eight elderly and eight young people) participated in this study to evaluate the effects of age, gender, and target force level on tracking performance through rRMSE in terms of the tracking force and actual exerted force, by carrying out a task of maintaining six different target force levels for 20 seconds.BR Results: The result of this experiment indicated that elderly people and women had a lower ability to maintain a certain level of force than young people and men by 16% and 10%, respectively. The target force level results showed that the tracking error of the lowest force level (5% MVC) was significantly higher than that of 15% MVC, which in turn showed a higher tracking error than that of the higher target force levels.BR Conclusion: The results of this study can thus be utilized to develop a rehabilitation program for elderly people or other patients.BR Application: The authors expect that the results of the present study will be valuable to develop a rehabilitation program and hand function evaluation tool.

Effects of Task-Oriented Training as an Added Treatment to Electromyogram-Triggered Neuromuscular Stimulation on Upper Extremity Function in Chronic Stroke Patients.

The purpose of the present study was to investigate the effects of electromyogram-triggered neuromuscular stimulation (EMG-stim) combined with task-oriented training (TOT) on upper extremity function in chronic stroke patients. Twenty chronic stroke patients were randomly assigned to either the intervention (n = 10) or control (n = 10) group. The intervention group conducted TOT with EMG-stim on the wrist and finger extensor of the affected arm for 30 minutes per day, 5 days per week, for 4 weeks. The control group was provided EMG-stim for 20 minutes per day for the same duration. The intervention group exhibited significant improvement relative to the control group in muscle activation, motor recovery (Fugl-Meyer assessment) and dexterity (Box and Block Test) (p < 0.05). Significant differences in hand function between the groups were detected in the writing of short sentences and in stacking checkers (p < 0.05). It is concluded that EMG-stim in combination with TOT may be better than EMG-stim alone for the treatment of arm paresis in stroke patients. Further research with a larger sample is recommended to examine neurologic changes or cerebral cortex reorganization. Copyright © 2016 John Wiley & Sons, Ltd.

Endoscopic versus open radial artery harvest and mammario-radial versus aorto-radial grafting in patients undergoing coronary artery bypass surgery: protocol for the 2 × 2 factorial designed randomised NEO trial

BackgroundCoronary artery bypass grafting using the radial artery has, since the 1990s, gone through a revival. Observational studies have indicated better long-term patency when using radial arteries. Therefore, radial artery might be preferred especially in younger patients where long time patency is important. During the last 10 years different endoscopic techniques to harvest the radial artery have evolved. Endoscopic radial artery harvest only requires a small incision near the wrist in contrast to open harvest, which requires an incision from the elbow to the wrist. However, it is unknown whether the endoscopic technique results in fewer complications or a graft patency comparable to open harvest. When the radial artery has been harvested, there are two ways to use the radial artery as a graft. One way is sewing it onto the aorta and another is sewing it onto the mammary artery. It is unknown which technique is the superior revascularisation technique.Methods/DesignThe NEO Trial is a randomised clinical trial with a 2 × 2 factorial design. We plan to randomise 300 participants into four intervention groups: (1) mammario-radial endoscopic group; (2) aorto-radial endoscopic group; (3) mammario-radial open surgery group; and (4) aorto-radial open surgery group.The hand function will be assessed by a questionnaire, a clinical examination, the change in cutaneous sensibility, and the measurement of both sensory and motor nerve conduction velocity at 3 months postoperatively. All the postoperative complications will be registered, and we will evaluate muscular function, scar appearance, vascular supply to the hand, and the graft patency including the patency of the central radial artery anastomosis. A patency evaluation by multi-slice computer tomography will be done at one year postoperatively.We expect the nerve conduction studies and the standardised neurological examinations to be able to discriminate differences in hand function comparing endoscopic to open harvest of the radial artery. The trial also aims to show if there is any patency difference between mammario-radial compared to aorto-radial revascularisation techniques but this objective is exploratory.Trial registrationClinicalTrials.gov identifier: NCT01848886.Danish Ethics committee number: H-3-2012-116.Danish Data Protection Agency: 2007-58-0015/jr.n:30–0838.

P 168. TMS neurophysiology and interventional rTMS in children with perinatal stroke: Safety and tolerability in the PLASTIC CHAMPS trial

Perinatal stroke causes hemiplegic cerebral palsy and lifelong disability. TMS can define neurophysiology and central therapeutic targets while rTMS carries therapeutic potential in adult stroke but have not been applied to the more plastic developing brain. Ipsilateral projections from the unlesioned hemisphere to the affected hand are prominent in this population and the effects of non-lesioned inhibitory rTMS are unknown. PLASTIC CHAMPS is a randomized, blinded, factorial clinical trial of rTMS and constraint therapy (CIMT) to enhance upper extremity function in children (6–18 years) with perinatal stroke hemiparesis. Thirty-five children (mean age 11.25 y, 20 males) attended a 2-week intensive motor learning camp, randomized 1:1 to daily non-lesioned M1 inhibitory (1 Hz, 1200 stimulations) rTMS or sham. TMS neurophysiology mapping lasting 90–120 min (baseline and 1 week post-camp) included RMT, AMT, stimulus response curves, iSP, SICI, ICF, and IHI. Primary safety outcomes were decreased function in: (1) affected hand in children with ipsilateral projections (Assisting Hand Assessment (AHA), Melbourne Assessment (MA)) and (2) unaffected hand in all children (grip strength [GS], pinch strength [PS]). The Pediatric TMS Tolerability Evaluation was administered at 4 timepoints: 2 TMS neurophysiology sessions (pre and post camp) and 2 rTMS treatments (days 1 and 10). This measure characterizes any adverse events and subjectively ranks TMS against 7 common childhood experiences. Differences in hand function and tolerability scores were compared between rTMS and sham and over time (paired t -tests, ANOVA). TMS and rTMS procedures were well tolerated with no serious adverse events and no drop-outs. Affected hand function in children with ispsilateral projections did not decrease between rTMS and sham (AHA no change, MA increased). Unaffected hand function did not decrease with rTMS (GS and PS same). TMS and rTMS tolerability scores were favourable, scoring better than “a long car ride” on average. All side effects were mild, brief (minutes), and self-limiting with none requiring medication. Headache was common (43% during 1st TMS session) but resolved with removal of the swim cap used for mapping. Headache rates decreased (20%) with the same protocol 3 weeks later. Headache was uncommon during rTMS (11%) with tolerance (0% at 2nd session) and comparable rates between rTMS and sham. Other side-effects (neck pain, tingling, nausea, presyncope) were infrequent (<5% on final TMS session). Non-invasive brain stimulation trials are safe and feasible in children with perinatal stroke. Inhibitory rTMS over the non-lesioned M1 does not negatively affect normal hand function or affected hand function in children with ipsilateral projections. Headaches are common but mild and self-limiting.

Functional reorganization associated with outcome in hand function after stroke revealed by regional homogeneity

Previous studies of task-based functional neuroimaging have shown that various patterns of functional reorganization underlie motor recovery following stroke. However, the mechanisms underlying functional reorganization that contribute to outcome differences in hand function after stroke have not been completely characterized. We, for the first time, investigate subgroups of stroke patients with different outcomes in hand function using a resting-state fMRI approach. We selected 24 patients with subcortical stroke and divided them into two subgroups: completely paralyzed hands (CPH, 12 patients) and partially paralyzed hands (PPH, 12 patients). Twenty-four healthy controls (HCs) matched for age and handedness were also recruited. We used regional homogeneity (ReHo) method to map regional spontaneous activity across the whole brain and performed a two-sample t test between each pair of the three diagnostic groups. Compared to HCs, we found increased ReHo in the ipsilesional hemisphere in PPH and, conversely, increased ReHo in the contralesional hemisphere in CPH. Moreover, we detected decreased ReHo in the ipsilesional primary sensorimotor cortex and superior temporal gyrus, in addition to increased ReHo in the contralesional premotor cortex and ipsilesional medial frontal gyrus in CPH compared to PPH. Additionally, the ReHo index of these regions significantly correlated with the Fugl-Meyer assessment scores (hand + wrist) across all stroke patients. Our study offers a new insight into relationships between functional reorganization and outcomes in hand function after subcortical stroke, and the ReHo method can provide an effective tool for evaluating the efficiency of rehabilitative therapies following stroke.

Secondary Degeneration Detected by Combining Voxel-Based Morphometry and Tract-Based Spatial Statistics in Subcortical Strokes with Different Outcomes in Hand Function

Secondary degeneration of the pyramidal tract after focal motor pathway stroke has been observed by diffusion tensor imaging. However, the relationships between outcomes in hand function and secondary degeneration in widespread regions are not well understood. For the first time, we investigated the differences of secondary degeneration across the whole brain between subgroups of patients with stroke. We selected 23 patients who had a subcortical stroke in the left motor pathway and displayed only motor deficits. The patients were divided into 2 subgroups: CPH (11 patients) and PPH (12 patients). Twelve healthy controls matched for age and handedness were also recruited. We used both optimized VBM and TBSS to explore differences of FA across the whole brain between CPH and PPH. Furthermore, ROI analysis was carried out in the identified regions detected by VBM analysis to further quantify the degree of secondary degeneration in the CPH and PPH and compare these with healthy controls. Compared with PPH, FA was significantly decreased in the CPH in widespread regions of the motor system remote from the primary lesion, including the ipsilesional brain stem, medial frontal gyrus, precentral gyrus, superior temporal gyrus, supplementary motor area, and contralesional postcentral gyrus. In addition, FA within these identified regions correlated with Fugl-Meyer Assessment scores (hand+wrist). This study suggests a potential biomarker for outcome differences in hand function after subcortical stroke.