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Author Notes:

Correspondence: Matthew A. Edwardson mae97@georgetown.edu

Edited by: Thomas Platz, University of Greifswald, Germany

ME and AD conceived the study.

LD, CP, and CL performed statistical analysis.

ME, MN, SW, CW, and AD were involved in data acquisition.

All authors performed data interpretation.

ME wrote the first draft of the manuscript.

All authors contributed to manuscript revision, read and approved the submitted version.

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.


Research Funding:

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

ME received research support from NINDS (1U10NS086513) and from the National Center for Advancing Translational Science (KL2TR001432 and UL1TR001409).


  • Science & Technology
  • Life Sciences & Biomedicine
  • Clinical Neurology
  • Neurosciences
  • Neurosciences & Neurology
  • subcortical infarction
  • stroke rehabilitation
  • occupational therapy
  • upper extremity paresis
  • magnetic resonance imaging
  • internal capsule
  • basal ganglia

Reduced Upper Limb Recovery in Subcortical Stroke Patients With Small Prior Radiographic Stroke


Journal Title:

Frontiers in Neurology


Volume 10


, Pages 454-454

Type of Work:

Article | Final Publisher PDF


Background: Research imaging costs limit lesion-based analyses in already expensive large stroke rehabilitation trials. Despite the belief that lesion characteristics influence recovery and treatment response, prior studies have not sufficiently addressed whether lesion features are an important consideration in motor rehabilitation trial design. Objective: Using clinically-obtained neuroimaging, evaluate how lesion characteristics relate to upper extremity (UE) recovery and response to therapy in a large UE rehabilitation trial. Methods: We reviewed lesions from 297 participants with mild-moderate motor impairment in the Interdisciplinary Comprehensive Arm Rehabilitation Evaluation (ICARE) study and their association with motor recovery, measured by the UE Fugl-Meyer (UE-FM). Significant lesion features identified on correlational and bivariate analysis were further analyzed for associations with recovery and therapy response using longitudinal mixed models. Results: Prior radiographic stroke was associated with less recovery on UE-FM in participants with motor impairment from subsequent subcortical stroke (-5.8 points) and in the overall sample (-3.6 points), but not in participants with cortical or mixed lesions. Lesion volume was also associated with less recovery, particularly after subcortical stroke. Every decade increase in age was associated with 1 less point of recovery on UE-FM. Response to specific treatment regimens varied based on lesion characteristics. Subcortical stroke patients experienced slightly less recovery with higher doses of upper extremity task-oriented training. Participants with cortical or mixed lesions experienced more recovery with higher doses of usual and customary therapy. Other imaging features (leukoaraiosis, ischemic vs. hemorrhagic stroke) were not significant. Conclusions: ICARE clinical imaging revealed information useful for UE motor trial design: stratification of persons with and without prior radiographic stroke may be required in participants with subcortical stroke, the majority of motor rehabilitation trial participants. Most of the prior radiographic strokes were small and cortically-based, suggesting even minor prior brain injury remote to the acute stroke lesion may limit spontaneous and therapy-related recovery. Lesion location may be associated with response to different therapy regimens, but the effects are variable and of unclear significance.

Copyright information:

© 2019 Edwardson, Ding, Park, Lane, Nelsen, Wolf, Winstein and Dromerick.

This is an Open Access work distributed under the terms of the Creative Commons Attribution 4.0 International License (https://creativecommons.org/licenses/by/4.0/).
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