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Author Notes:

Corresponding Author: Matthew A. Edwardson, Department of Neurology, Georgetown University, 4000 Reservoir Rd. NW, Building D Room 207, Washington, DC, USA. Phone: (202) 687-2184; Fax: (202) 687-7378; mae97@georgetown.edu

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Research Funding:

The Interdisciplinary Comprehensive Arm Rehabilitation Evaluation (ICARE) trial was funded jointly by the National Institutes of Health, National Institute of Neurological Disorders and Stroke (primary) and the National Center for Medical Rehabilitation Research of the Eunice Kennedy Shriver National Institute of Child Health and Human Development (U01NS056256).

Keywords:

  • Science & Technology
  • Life Sciences & Biomedicine
  • Clinical Neurology
  • Rehabilitation
  • Neurosciences & Neurology
  • corticospinal tract
  • anterior choroidal artery infarction
  • middle cerebral artery occlusion
  • rehabilitation
  • upper extremity paresis
  • magnetic resonance imaging
  • EXPERIMENTAL INTRACEREBRAL HEMORRHAGE
  • CONSTRAINT-INDUCED MOVEMENT
  • CHOROIDAL ARTERY TERRITORY
  • RANDOMIZED CLINICAL-TRIAL
  • COLONY-STIMULATING FACTOR
  • FOCAL CORTICAL INFARCT
  • ACUTE ISCHEMIC-STROKE
  • FORCED ARM USE
  • WHITE-MATTER
  • MOTOR RECOVERY

Stroke Lesions in a Large Upper Limb Rehabilitation Trial Cohort Rarely Match Lesions in Common Preclinical Models

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Journal Title:

Neurorehabilitation and Neural Repair

Volume:

Volume 31, Number 6

Publisher:

, Pages 509-520

Type of Work:

Article | Post-print: After Peer Review

Abstract:

Background. Stroke patients with mild-moderate upper extremity motor impairments and minimal sensory and cognitive deficits provide a useful model to study recovery and improve rehabilitation. Laboratory-based investigators use lesioning techniques for similar goals. Objective. To determine whether stroke lesions in an upper extremity rehabilitation trial cohort match lesions from the preclinical stroke recovery models used to drive translational research. Methods. Clinical neuroimages from 297 participants enrolled in the Interdisciplinary Comprehensive Arm Rehabilitation Evaluation (ICARE) study were reviewed. Images were characterized based on lesion type (ischemic or hemorrhagic), volume, vascular territory, depth (cortical gray matter, cortical white matter, subcortical), old strokes, and leukoaraiosis. Lesions were compared with those of preclinical stroke models commonly used to study upper limb recovery. Results. Among the ischemic stroke participants, median infarct volume was 1.8 mL, with most lesions confined to subcortical structures (61%) including the anterior choroidal artery territory (30%) and the pons (23%). Of ICARE participants, <1% had lesions resembling proximal middle cerebral artery or surface vessel occlusion models. Preclinical models of subcortical white matter injury best resembled the ICARE population (33%). Intracranial hemorrhage participants had small (median 12.5 mL) lesions that best matched the capsular hematoma preclinical model. Conclusions. ICARE subjects are not representative of all stroke patients, but they represent a clinically and scientifically important subgroup. Compared with lesions in general stroke populations and widely studied animal models of recovery, ICARE participants had smaller, more subcortically based strokes. Improved preclinical-clinical translational efforts may require better alignment of lesions between preclinical and human stroke recovery models.

Copyright information:

© American Society of Neurorehabilitation.

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