Good Recovery Group Research Articles

Mối tương quan giữa một số chỉ số trên cộng hưởng từ bó tháp trong tiên lượng khả năng phục hồi chức năng vận động ở bệnh nhân nhồi máu não vùng trên lều

Object: Correlation between some indices on pyramidal tract magnetic resonance in predicting motor function recovery in patients with supratentorial cerebral infarction. Method: Cross-sectional description with longitudinal follow-up includes 31 patients with supratentorial cerebral infarction within seven days and had an MRI at Bach Mai Hospital from January 2023 to December 2023. Result: The proportion of male patients with ischemic stroke predominated (61,3%). Hemiplegia was the most common symptom of ischemic stroke which damaged the path of the corticospinal tract. At three months after the stroke, no patient had severe NIHSS score ; the percentage of patients with mild and moderate NIHSS score was 61,3% and 38,7%, respectively. According to mRS, 25 patients (80,6%) recovered well after three months. The patient group, who had the axons did not go through the infarct lesion, had higher at rate of better motor function recovery after three months than the other groups who had the axons go through partly or completely inside the infarction lesion (respective rates were 64,5% and 16,1%); p<0,05. FA index of the axons in the infarct side of the poor recovery group was smaller than the good recovery group, p<0.05. Conclusion: The axonal signal, location versus the infarct lesion, and FA index of the axons in the infarct side are the factors that significantly predictive of motor recovery after three months in ischemic stroke patients.

Analysis of risk factors and construction of nomogram model for arthroscopic single-row rivet repair

BackgroundThe factors influencing the clinical outcome of arthroscopic rotator cuff repair are not fully understood.PurposeTo explore the factors related to the postoperative outcome of arthroscopic single-row rivet rotator cuff repair in patients with rotator cuff injury and to construct the related nomogram risk prediction model.Methods207 patients with rotator cuff injury who underwent arthroscopic single-row rivet rotator cuff repair were reviewed. The differences of preoperative and postoperative Visual Analogue Score (VAS) scores and University of California, Los Angeles (UCLA) scores were analyzed and compared. The postoperative UCLA score of 29 points was taken as the critical point, and the patients were divided into good recovery group and poor recovery group, and binary logstic regression analysis was performed. According to the results of multivariate logistic regression analysis, the correlation nomogram model was constructed, and the calibration chart was used, AUC, C-index. The accuracy, discrimination and clinical value of the prediction model were evaluated by decision curve analysis. Finally, internal validation is performed using self-random sampling.ResultsThe mean follow-up time was 29.92 ± 17.20 months. There were significant differences in VAS score and UCLA score between preoperative and final follow-up (p < 0.05); multivariate regression analysis showed: Combined frozen shoulder (OR = 3.890, 95% CI: 1.544 ∼ 9.800), massive rotator cuff tear (OR = 3.809, 95%CI: 1.218 ∼ 11.908), More rivets number (OR = 2.118, 95%CI: 1.386 ∼ 3.237), lower preoperative UCLA score (OR = 0.831, 95%CI: 0.704–0.981) were adverse factors for the postoperative effect of arthroscopic rotator cuff repair. Use these factors to build a nomogram. The nomogram showed good discriminant and predictive power, with AUC of 0.849 and C-index of 0.900 (95% CI: 0.845 ∼ 0.955), and the corrected C index was as high as 0.836 in internal validation. Decision curve analysis also showed that the nomogram could be used clinically when intervention was performed at a threshold of 2%∼91%.ConclusionCombined frozen shoulders, massive rotator cuff tears, and increased number of rivets during surgery were all factors associated with poor outcome after arthroscopic rotator cuff repair, while higher preoperative UCLA scores were factors associated with good outcome after arthroscopic rotator cuff repair. This study provides clinicians with a new and relatively accurate nomogram model.

Pre-operative spinal cord perfusion quantified by DSC MRI as a predictor of post-operative prognosis in patients with cervical spondylotic myelopathy.

This study aims to investigate the potential of preoperative blood supply condition measured by dynamic susceptibility contract (DSC) MRI in prediction of postoperative outcomes for patients with cervical spondylotic myelopathy (CSM). Thirty-nine patients (Age: 61 ± 7, male: 23, female: 16) with CSM who underwent laminoplasty were enrolled. All patients received DSC MRI before the operation. Five parameters include Enhance, rEnhance, full width at half maxima (FWHM), Slope1 and Slope2 in DSC MRI, were calculated at all the compressed spinal cord segments. Clinical outcomes were evaluated by modified Japanese Orthopaedic Association (mJOA) scores. Patients were divided into two groups based on mJOA recovery rate of 5years: good recovery (> 50%) or poor recovery (≤ 50%). The difference between two groups were compared. The value of DSC MRI to CSM was evaluated by logistic and receiver operating characteristic (ROC) curve analysis. There were 26 patients in good recovery group and 13 patients in poor recovery group. The baseline characteristics, including age, gender, preoperative mJOA score, and smoking status showed no significant difference between the two groups (all p > 0.05). The FWHM was significantly higher in the poor recovery group (9.77 ± 2.78) compared to the good recovery group (6.64 ± 1.65) (p = 0.002). Logistic regression analysis indicated that an increased FWHM was a significant risk factor for poor prognosis recovery (p = 0.013, OR = 0.392, 95%CI: 0.187-0.822). The AUC of FWHM for ROC was 0.843 (95% CI: 0.710-0.975) with a p value of 0.001. In addition, an FWHM greater than 5.87, with a sensitivity of 92.3% and specificity of 69.2%, was found to be an independent risk factor for poor postoperative recovery in patients with CSM. In this study, we successfully quantified the spinal cord blood supply condition by DSC MRI technique. We found that an increase in FWHM was an independent risk factor for poor postoperative recovery in CSM patients. Specifically, patients with FWHM > 5.87 have a poor postoperative recovery.

Quadriceps muscle activity during walking with a knee ankle foot orthosis is associated with improved gait ability in acute hemiplegic stroke patients with severe gait disturbance.

A knee-ankle-foot orthosis (KAFO) prevents knee buckling during walking and enables gait training for acute hemiplegic stroke patients with severe gait disturbances. Although the goal of gait training with a KAFO is to improve gait ability, that is, to acquire walking with an ankle-foot orthosis (AFO), it is not clear how gait training with a KAFO contributes to improving gait ability. Therefore, this study aimed to investigate the relationship between muscle activities during walking with a KAFO and the improvement of gait ability in hemiplegic stroke patients with severe gait disturbance. A prospective cohort study was conducted. Fifty acute hemiplegic stroke patients who could not walk with an AFO participated. Muscle activities of the paretic rectus femoris, biceps femoris, tibialis anterior, and soleus were assessed with surface electromyogram during walking with a KAFO. Electromyograms were assessed at the beginning of gait training and at the time the Ambulation Independence Measure score improved by 3 or higher, or discharge. Even in patients with complete hemiplegia, paretic rectus femoris, biceps femoris, and soleus showed periodic muscle activity during walking with a KAFO. Twenty-three patients improved to an Ambulation Independence Measure score of 3 or higher and were able to walk with an AFO (good recovery group). At the beginning of gait training, paretic rectus femoris muscle activity during the first double-limb support phase was significantly higher in the good recovery group than in the poor recovery group. The rectus femoris muscle activity significantly increased from before to after acute rehabilitation, which consisted mainly of gait training with a KAFO. For acute hemiplegic stroke patients with severe disturbance, the induction and enhancement of paretic quadriceps muscle activity during walking with a KAFO play an important role in acquiring walking with an AFO.

Predictive values of stress hyperglycaemia and glycosylated haemoglobin on admission for long-term recovery of cardiac function in patients with acute myocardial infarction after primary percutaneous coronary intervention.

We aimed to explore the predictive values of stress hyperglycaemia (SHG) and glycosylated haemoglobin (HbA1c) levels on admission for long-term recovery of cardiac function in patients with acute myocardial infarction (AMI) after primary percutaneous coronary intervention (PPCI). A total of 210 AMI patients were randomly selected. The levels of SHG and HbA1c were measured on admission, and all patients were treated with PPCI and followed up for one year. According to the recovery status of cardiac function during follow up, the patients were divided into a good recovery group and a poor recovery group. At one year after treatment, there were statistically significant differences in the levels of SHG (6.75 ± 0.69 vs 7.81 ± 0.92 mmol/l) and HbA1c (5.13 ± 0.25 vs 5.91 ± 0.39%) between the good and poor recovery groups (p < 0.05). The levels of SHG and HbA1c were associated with long-term recovery of cardiac function (p < 0.05). The receiver operating characteristic curves were plotted, and the area under the curves of SHG and HbA1c for predicting the long-term recovery of cardiac function were > 0.70. The levels of SHG and HbA1c were closely associated with longterm recovery of cardiac function after PPCI in AMI patients, displaying high predictive values.

The potential relationship between uric acid and the recovery in sudden sensorineural hearing loss

ObjectiveSerum uric acid is proven to be associated with chronic hearing loss, but its effect on Sudden Sensorineural Hearing Loss (SSNHL) is unclear. This study aims to evaluate the prognostic values of serum uric acid levels in SSNHL patients. MethodsThe clinical records of SSNHL patients were retrospectively reviewed. Patients were divided into different groups based on hearing recovery and audiogram type, and uric acid levels were compared. Based on uric acid levels, patients were categorized into normouricemia and hyperuricemia groups, and clinical features and hearing recovery were evaluated. Univariate and multivariate analyses were performed to identify prognostic factors. ResultsIn total, 520 SSNHL patients were included in this study, including 226 females and 294 males. In female patients, 186 patients were included in the normouricemia group, and 40 patients were enrolled in the hyperuricemia group. Significant differences were observed in uric acid levels, Total Cholesterol (TC), rate of complete recovery, and slight recovery between the two groups. In male patients, 237 subjects were categorized into the normouricemia group, and 57 patients were included in the hyperuricemia group. The rate of complete recovery and slight recovery was lower in the hyperuricemia group compared to the normouricemia group. All patients were further divided into good recovery and poor recovery groups based on hearing outcomes. The uric acid levels, initial hearing threshold, rate of hyperuricemia, and TC were lower in the good recovery group than the poor recovery group both in female and male patients. Binary logistic regression results showed that uric acid levels, initial hearing threshold, and hyperuricemia were associated with hearing recovery. ConclusionHyperuricemia might be an independent risk factor for hearing recovery in SSNHL patients. Serum uric acid and initial hearing threshold possibly affected the hearing outcome in males and females with SSNHL. Level of evidenceLevel 4.

Evaluating the axonal injury and predicting the motor function recovery in supratentorial acute stroke patients

PurposeThis study aims to evaluate axonal injury in supratentorial acute stroke patients and predict motor function recovery. MethodsA cross-sectional descriptive study was performed on 28 patients with supratentorial acute stroke. All patients underwent brain magnetic resonance imaging (MRI) at Bach Mai Hospital from September 2021 to August 2022. Diffuse tensor imaging (DTI) was conducted using a 3-Tesla MRI machine to evaluate the association between the corticospinal tract and infarct area. Therefore, axonal injury and motor function recovery levels could be predicted. ResultsAlmost patients had no change in the signal of the axons, which did not pass through the infarct lesion (28.6%), and the signals strongly decreased in patients whose axons completely stayed inside the infarct lesion (32.1%). The fractional anisotropy (FA) and apparent diffusion coefficient (ADC) indices of the axons on the infarcted side were lower than those of axons on the contralateral side. The patient group, in which the axons did not pass through the infarct lesion or had no change in axonal signals, had a higher rate of better motor function recovery after 3 months than the other groups (39.3% and 25 %, respectively), whereas the axon group, in which the axons stayed completely inside the infarct lesion or had a remarkably decreased signal, had a very poor rate of recovery (32.1% and 39.3 %, respectively). The FA index of the axons on the infarct side in the poor recovery group was lower than that in the good recovery group. The ADC index did not differ between the groups. ConclusionMRI finding with axonal signal, location, and infarct side could significantly predict motor recovery after 3 months in acute stroke patients.

Is Subclassification by Number of Fracture Fragments Necessary for Sanders Type IV Calcaneal Fractures?

The Sanders classification is a widely used method for classifying calcaneal fractures. Type IV fractures (>4 fragments) are known to vary in the number of fracture fragments. However, all relevant cases are classified as type IV irrespective of the number of fragments. We investigated the need for evaluation of postoperative prognoses based on radiologic factors and subtypes of Sanders classification type IV fractures. Fifty-six Sanders type IV calcaneal fractures were enrolled between 2010 and 2018. Patients were divided into two groups according to the number of fragments: four fragments (group 1) and more than four fragments (group 2). Radiologic evaluation was performed using a postoperative recovery percentage calculated from postoperative reduction of the Böhler angle, Gissane angle, and vertical height. Radiologic evaluation was divided into two groups according to postoperative recovery: good and bad recovery groups. American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score and visual analog scale (VAS) score were used for clinical outcome evaluation. There was no significant difference in AOFAS ankle-hindfoot score (P = .909) or VAS score (P = .963) between groups 1 and 2. However, there was a significant (P = .001) difference in AOFAS ankle-hindfoot score or VAS score between good and bad recovery groups. Clinical results of Sanders type IV fractures were not related to the number of bone fragments but to the degree of injury to the Böhler angle, Gissane angle, and vertical height. Therefore, subtype classification of type IV calcaneal fractures is superfluous, and it is important to try to restore these parameters during surgery.

Spontaneous Behavioural Recovery Following Stroke Relates to the Integrity of Parietal and Temporal Regions.

Stroke is a devastating disease that results in neurological deficits and represents a leading cause of death and disability worldwide. Following a stroke, there is a degree of spontaneous recovery of function, the neural basis of which is of great interest among clinicians in their efforts to reduce disability following stroke and enhance rehabilitation. Conventionally, work on spontaneous recovery has tended to focus on the neural reorganization of motor cortical regions, with comparably little attention being paid to changes in non-motor regions and how these relate to recovery. Here we show, using structural neuroimaging in a macaque stroke model (N = 31) and by exploiting individual differences in spontaneous behavioural recovery, that the preservation of regions in the parietal and temporal cortices predict animal recovery. To characterize recovery, we performed a clustering analysis using Non-Human Primate Stroke Scale (NHPSS) scores and identified a good versus poor recovery group. By comparing the preservation of brain volumes in the two groups, we found that brain areas in integrity of brain areas in parietal, temporal and somatosensory cortex were associated with better recovery. In addition, a decoding approach performed across all subjects revealed that the preservation of specific brain regions in the parietal, somatosensory and medial frontal cortex predicted recovery. Together, these findings highlight the importance of parietal and temporal regions in spontaneous behavioural recovery.

Multiplex array analysis of serum cytokines offers minimal predictive value for cognitive function in the subacute phase after stroke.

The effects of inflammation on post-stroke cognitive function are still unclear. This study investigated the correlation between the Th17-related cytokines in peripheral blood and post-stroke cognitive function after ischemic stroke in the subacute phase. A retrospective cohort study. Academic acute inpatient rehabilitation facility. One hundred and fourteen patients with first ischemic stroke were categorized as the poor cognitive recovery group (n = 58) or good cognitive recovery group (n = 56) based on their cognitive MRFS efficiency. All subjects received routine physical, occupational, and speech-language pathology therapy. Serum cytokines/chemokine (IL-1 β, IL-2, IL-4, IL-5, IL-6, IL-9, IL-10, IL-12p70, IL-13, IL-15, IL-17A, IL-17E, IL-17F, IL-21, IL-22, IL-23, IL-27, IL-28A, IL-31, IL-33, GM-CSF, IFN-γ, MIP-3 α, TNF-α, and TNF-β) levels were measured in duplicate using Human Th17 magnetic bead panel and multiplex array analysis (Luminex-200 system). The primary functional outcome was a gain in functional independence measure (FIM) cognitive subscore at discharge. The secondary outcome measures were FIM total score at discharge, length of stay in the hospital, and discharge destination. Cognitive Montebello Rehabilitation Factor Score (MRFS) and cognitive MRFS efficiency were calculated. Demographic and clinical characteristics were obtained from the medical record. The good cognitive recovery group had an interesting trend of higher IL-13 than the poor cognitive recovery group (good cognitive recovery group 257.82 ± 268.76 vs. poor cognitive recovery group 191.67 ± 201.82, p = 0.049, unit: pg/ml). However, Pearson's correlation analysis showed no significant correlation between cytokine levels and gain of cognition, cognitive MRFS, or cognitive MRFS efficiency. Receiver operating characteristic (ROC) analysis of cytokines also suggested a low accuracy of prediction as a predictor for post-stroke cognitive recovery improvement. Our preliminary findings suggested that the level of serum cytokines had minimal predictive value for the recovery of cognitive function during the subacute inpatient rehabilitation after stroke.

Prognostic factors for functional recovery in children with moderate to severe acute disseminated encephalomyelitis

BackgroundAcute disseminated encephalomyelitis (ADEM) is an immune-mediated encephalopathy with heterogeneous disease courses. However, clinical characteristics for a prognostication of functional recovery from acute episodes of ADEM remain limited. The study aims to characterize the clinical presentations and neuroimaging findings of children with poor functional recoveries from acute episodes of moderate to severe ADEM. MethodsThe multicenter retrospective cohort study included children under 18 years of age who presented with moderate to severe ADEM (modified Rankin Scale [mRS] ≥ 3 at nadir) from 2002 to 2019. Children were assigned to a good recovery group (mRS ≤ 2) and a poor recovery group (mRS ≥ 3) after mean 4.3 months of follow-up. The clinical presentations and the distribution of brain lesions on magnetic resonance imaging were compared between the two groups by the t-test for numerical variables and Fisher's exact test for categorical variables. Analyses of logistic regression were conducted and significant variables in the multivariate model were examined by the receiver operating characteristic curve for the prediction of functional recovery. ResultsAmong the 73 children with moderate to severe ADEM, 56 (77%) had good functional recoveries and 17 (23%) showed poor functional recoveries. Children with poor recoveries had a lower rate of prodromal headache (12% vs. 39%, p = 0.04), and presented with higher proportions of dystonia (29% vs. 9%, p = 0.046), myoclonus (24% vs. 2%, p = 0.009), and cerebellar lesions on neuroimages (59% vs. 23%, p = 0.01). The multivariate analyses identified that a lack of prodromal headache (OR 0.1, 95% CI 0.005 - 0.7, p = 0.06) and the presentations of myoclonus (OR 21.6, 95% CI 1.7 – 874, p = 0.04) and cerebellar lesions (OR 4.8, 95% CI 1.3 - 19.9, p = 0.02) were associated with poor functional recoveries. These three factors could prognosticate poor outcomes in children with moderate to severe ADEM (area under the receiver operating characteristic curve 0.80, 95% CI 0.68 – 0.93, p = 0.0002). ConclusionNearly one-fourth of children with moderate to severe ADEM had a poor functional recovery from acute episodes, who were characterized by a lack of prodromal headache, the presentation of myoclonus, and the neuroimaging finding of cerebellar lesions. The clinical variables associated with poor functional recoveries could assist in the planning of immunotherapies during hospitalization for a better outcome in moderate to severe ADEM.

Factors Influencing the Improvement of Activities of Daily Living during Inpatient Rehabilitation in Newly Diagnosed Patients with Glioblastoma Multiforme.

Glioblastoma multiforme (GBM) is the most common and aggressive brain tumor. To identify the factors influencing the improvement of the activities of daily living (ADL) in newly diagnosed patients with GBM, we investigated the characteristics and variable factors and overall survival. A total of 105 patients with GBM were retrospectively analyzed and categorized into the following three groups according to the quartile of change of their Barthel index score from admission to discharge: deterioration (n = 25), no remarkable change (n = 55), and good recovery (n = 25). A statistical difference was observed in the pre-operative, intra-operative, post-operative, and rehabilitation-related factors between the deterioration and good recovery groups. Multiple regression analysis identified the following significant factors that may influence the improvement of ADL after surgery: the improvement of motor paralysis after surgery, mild fatigue during radio and chemotherapy, and length up to early walking training onset. The median overall survival was significantly different between the deterioration (10.6 months) and good recovery groups (18.9 months, p = 0.025). Our findings identified several factors that may be associated with post-operative functional improvement in patients with GBM. The inpatient rehabilitation during radio and chemotherapy may be encouraged without severe adverse events and can promote functional outcomes, which may contribute to the overall survival of newly diagnosed patients with GBM.

Multimodal Imaging Biomarker-Based Model Using Stratification Strategies for Predicting Upper Extremity Motor Recovery in Severe Stroke Patients

Background. Various prognostic biomarkers for upper extremity (UE) motor recovery after stroke have been reported. However, most have relatively low predictive accuracy in severe stroke patients. Objective. This study suggests an imaging biomarker-based model for effectively predicting UE recovery in severe stroke patients. Methods. Of 104 ischemic stroke patients screened, 42 with severe motor impairment were included. All patients underwent structural, diffusion, and functional magnetic resonance imaging at 2 weeks and underwent motor function assessments at 2 weeks and 3 months after stroke onset. According to motor function recovery at 3 months, patients were divided into good and poor subgroups. The value of multimodal imaging biomarkers of lesion load, lesion volume, white matter integrity, and cortical functional connectivity for motor recovery prediction was investigated in each subgroup. Results. Imaging biomarkers varied depending on recovery pattern. The integrity of the cerebellar tract (P = .005, R 2 = .432) was the primary biomarker in the good recovery group. In contrast, the sensory-related corpus callosum tract (P = .026, R 2 = .332) and sensory-related functional connectivity (P = .001, R 2 = .531) were primary biomarkers in the poor recovery group. A prediction model was proposed by applying each biomarker in the subgroup to patients with different motor evoked potential responses (P < .001, R 2 = .853, root mean square error = 5.28). Conclusions. Our results suggest an optimized imaging biomarker model for predicting UE motor recovery after stroke. This model can contribute to individualized management of severe stroke in a clinical setting.

Factors Negatively Influencing Postoperative Improvement After Laminoplasty in Degenerative Cervical Myelopathy.

This was a retrospective study of prospectively collected data. In this study, we aimed to characterize a population of patients with degenerative cervical myelopathy (DCM) and a history of poor postoperative neurological recovery and to identify risk factors associated with poor neurological recovery after laminoplasty. Kyphotic cervical alignment has been considered a relative contraindication to laminoplasty in recent years; hence, laminoplasty has been decreasingly performed for the treatment of DCM in patients with cervical kyphosis. However, the effect of global spinal alignment on postoperative outcomes has not been extensively investigated. We prospectively enrolled patients who were scheduled for laminoplasty for DCM. Outcome (at enrollment and 1 y after surgery) and risk factor analyses were performed by comparing the good recovery and poor recovery groups. The Spearman correlation coefficient was used to evaluate the relationships between the recovery rate and the preoperative radiographic factors. In total, 101 patients completed the 1-year follow-up. Regarding clinical outcomes, the Japanese Orthopedic Association score for the assessment of cervical myelopathy, European Quality of Life-5 Dimensions, and Neck Disability Index scores improved postoperatively. The recovery rate was significantly correlated with the preoperative sagittal vertical axis (SVA). The patients in the poor recovery group were older than those in the good recovery group. Univariate analyses showed that the SVA and T1 pelvic angle were significantly higher in the poor recovery group. Lastly, stepwise logistic regression analysis showed that a higher SVA was an independent predictor of poor recovery after laminoplasty. The SVA and T1 pelvic angle were significantly higher in the poor recovery group. A high preoperative SVA is an independent predictor for poor recovery after laminoplasty. Therefore, indications for laminoplasty in elderly DCM patients with a high preoperative SVA should be carefully considered. Level III.

Predictive Factors Affecting Surgical Outcomes in Patients with Degenerative Lumbar Spondylolisthesis.

Post-hoc analysis of 5-year follow-up data from a prospective randomized multicenter trial. The purpose of this study was to identify preoperative factors that predict poor postoperative outcomes and define clinically important abnormal instabilities in degenerative lumbar spondylolisthesis. Current evidence regarding prognostic factors affecting clinical outcomes after surgery for degenerative lumbar spondylolisthesis is still limited. Moreover, there is no consensus regarding parameters that define clinically important abnormal instability in patients with degenerative lumbar spondylolisthesis. This post-hoc analysis from a prospective randomized trial that compared the effectiveness of decompression, decompression with fusion, and decompression with stabilization for degenerative lumbar spondylolisthesis at the L4/5 level included 70 patients with a 5-year follow-up period. We investigated the correlation between the postoperative recovery rate and preoperative radiographic parameters. We then investigated differences between the good recovery and poor recovery groups. Japanese Orthopaedic Association and visual analogue scale scores improved postoperatively. Of the 70 patients analyzed, 13 were judged to be in the poor recovery group based on their recovery rate. The recovery rate significantly correlated with the intervertebral angle at L4/5. Univariate analysis showed that while the degree of vertebral slippage and the presence of angulation were not associated with poor recovery, the intervertebral angle at L4/5 and the presence of translation were associated with poor recovery. Lastly, multiple stepwise logistic regression analysis revealed the intervertebral angle at L4/5 and the presence of translation as independent predictors of poor recovery after surgery for lumbar degenerative spondylolisthesis. While the degree of vertebral slippage and the presence of angulation were not associated with poor recovery after surgery for lumbar degenerative spondylolisthesis, postoperative outcomes were associated with the intervertebral angle and the presence of translation. Careful preoperative measurement of these factors may help to predict poor postoperative outcomes.Level of Evidence: 3.

Multidimensional assessment of cervical spondylotic myelopathy patients. Usefulness of a comprehensive score system

ObjectiveCervical spondylotic myelopathy (CSM) is caused by cervical spine degeneration and surgery may be beneficial, but selection for surgery might be challenging. We performed a multimodal analysis to assess predicting factors that may be useful to help surgeons in this choice.Patients and methodsWe retrospectively evaluated clinical, motor evoked potentials (MEP), and MRI data of patients who undergone surgery for CSM. Seventy-six consecutive patients (46 males) were enrolled. The median age was 65.5 [IQR: 57–71] years, and the duration of symptoms was 11 [8–13] months. A multivariate analysis in order to assess predictors of outcome and ROC curve analysis were performed.ResultsThirty patients (M:18, 39.5%) gained 6 or more points on mJOA and they were collected in good recovery group, whereas 46 patients (60.5%, M:28) showed a fair recovery. We developed a comprehensive score system (CSS) taking into account clinical, neurophysiological, and neuroradiological data. ROC curve analysis was performed to determine the discriminative power of four models derived from the multivariate logistic regression analysis for predictors of good outcome considering only clinical variables, MRI variables, and MEP variables or considering the comprehensive model, demonstrating a good accuracy of CSS model to predict outcome.ConclusionThis study demonstrates that CSS model taking into consideration functional assessment by mJOA score, neurologic evaluation, cervical MRI, and MEP may be a feasible method to predict outcome in patients candidate to surgery, supporting surgeon’s decisions both for those patients candidate to surgery and for patients in whom a “wait and see” approach could be proposed.

Functional Connectivity Analysis and Prediction of Pain Relief in Association with Spinal Decompression Surgery

Although spinal decompression surgery is an effective treatment for myelopathy-induced upper limb pain, some postoperative patients suffer from residual pain in spite of adequate decompression. However, the neural mechanism underlying the poor outcome of pain relief is still unclear. The goal of this study was to explore the brain mechanisms involved in the poor recovery of upper limb pain after the spinal decompression surgery by using functional connectivity (FC) analysis. In this cross-sectional study, 17 patients who underwent cervical spinal decompression surgery were included. Functional MRI (fMRI) during a tactile stimulus for each hand was performed at 1 day before and 7 days after the surgery. In total, 34 fMRI scans (17 left and right upper limbs, respectively) were obtained before and after the surgery, respectively. The patients were divided into poor-recovery and good-recovery groups, and then we searched for the FC that was related to poor-recovery. The poor-recovery group (n= 15) showed significantly stronger connectivity between the postcentral gyrus (postCG) and dorsolateral prefrontal cortex (DLPFC) than the good-recovery group (n= 12) preoperatively. When the cutoff value of the preoperative FC between the left postCG and right middle frontal gyrus included in DLPFC was >0.17, the sensitivity and specificity for poor recovery were 73% and 75%, respectively. Our study showed that FC between the postCG and DLPFC may be a predictor of pain relief. This result suggested that assessing FC can lead to more informed surgical interventions for cervical spondylotic myelopathy.

Interhemispheric Functional Connectivity in the Primary Motor Cortex Assessed by Resting-State Functional Magnetic Resonance Imaging Aids Long-Term Recovery Prediction among Subacute Stroke Patients with Severe Hand Weakness.

This study aimed to evaluate the usefulness of interhemispheric functional connectivity (FC) as a predictor of motor recovery in severe hand impairment and to determine the cutoff FC level as a clinically useful parameter. Patients with stroke (n = 22; age, 59.9 ± 13.7 years) who presented with unilateral severe upper-limb paresis and were confirmed to elicit no motor-evoked potential responses were selected. FC was measured using resting-state functional magnetic resonance imaging (rsfMRI) scans at 1 month from stroke onset. The good recovery group showed a higher FC value than the poor recovery group (p = 0.034). In contrast, there was no statistical difference in FC value between the good recovery and healthy control groups (p = 0.182). Additionally, the healthy control group showed a higher FC value than that shown by the poor recovery group (p = 0.0002). Good and poor recovery were determined based on Brunnstrom stage of upper-limb function at 6 months as the standard, and receiver operating characteristic curve indicated that a cutoff score of 0.013 had the greatest prognostic ability. In conclusion, interhemispheric FC measurement using rsfMRI scans may provide useful clinical information for predicting hand motor recovery during stroke rehabilitation.

Targeted Metabolomic Profiling Reveals Association Between Altered Amino Acids and Poor Functional Recovery After Stroke.

Amino acids have been shown to be among the most important metabolites to be altered following stroke; however, they are a double-edged sword with regard to regulating hemostasis. In this study, we conducted a targeted metabolomic study to examine the association between serum levels of amino acids and functional recovery after stroke. Three hundred and fifty-one patients with stroke admitted to an acute rehabilitation hospital were screened, and 106 patients were selected based on inclusion and exclusion criteria. Recruited patients were stratified using Montebello Rehabilitation Factor Score (MRFS) efficiency. We selected the top (n = 20, 19%) and bottom (n = 20, 19%) of MRFS efficiency for metabolomic analysis. A total of 21 serum amino acids levels were measured using ultra high performance liquid chromatography and mass spectrometry. The normalized data were analyzed by multivariate approaches, and the selected potential biomarkers were combined in different combinations for prediction of stroke functional recovery. The results demonstrated that there were significant differences in leucine-isoleucine, proline, threonine, glutamic acid, and arginine levels between good and poor recovery groups. In the training (0.952) and test (0.835) sets, metabolite biomarker panels composed of proline, glutamic acid, and arginine had the highest sensitivity and specificity in distinguishing good recovery from poor. In particular, arginine was present in the top 10 combinations of the average area under the receiver operating characteristic curve (AUC) test set. Our findings suggest that amino acids related to energy metabolism and excitotoxicity may play an important role in functional recovery after stroke. Therefore, the level of serum arginine has predictive value for the recovery rate after stroke.

Places visited for activities outside the home after stroke: Relationship with the severity of disability

Introduction Knowledge about the places people visit or do not visit after stroke is lacking. The aim of this study was to describe and compare the places visited for activities outside the home of people with stroke of working age and to explore the influence of the severity of disability, fatigue, driving a car and sociodemographic characteristics on the total number of places visited for activities outside the home. Methods An exploratory cross-sectional study was conducted and 63 people with stroke were interviewed with instruments that covered places outside the home, severity of disability and fatigue. Data were analysed using non-parametric tests, analysis of variance and the general linear model. Results Significant difference in the total number of places visited for activities outside the home were found between all three groups of severity of disability. The good recovery group visited eight places to a significantly higher extent than those with severe/moderate disability. The severity of disability and driving a car were the only aspects that significantly influenced the total number of places visited. Conclusions Places for activities outside the home people with stroke visit and changes therein can add valuable knowledge about participation that can be used in the design of rehabilitation.