RT Journal Article
SR Electronic
T1 Somatosensory system integrity explains differences in treatment response after stroke
JF Neurology
JO Neurology
FD Lippincott Williams & Wilkins
SP e1098
OP e1108
DO 10.1212/WNL.0000000000007041
VO 92
IS 10
A1 Ingemanson, Morgan L.
A1 Rowe, Justin R.
A1 Chan, Vicky
A1 Wolbrecht, Eric T.
A1 Reinkensmeyer, David J.
A1 Cramer, Steven C.
YR 2019
UL http://n.neurology.org/content/92/10/e1098.abstract
AB Objective To test the hypothesis that, in the context of robotic therapy designed to enhance proprioceptive feedback via a Hebbian model, integrity of both somatosensory and motor systems would be important in understanding interparticipant differences in treatment-related motor gains.Methods In 30 patients with chronic stroke, behavioral performance, neural injury, and neural function were quantified for somatosensory and motor systems. Patients then received a 3-week robot-based therapy targeting finger movements with enhanced proprioceptive feedback.Results Hand function improved after treatment (Box and Blocks score increase of 2.8 blocks, p = 0.001) but with substantial variability: 9 patients showed improvement exceeding the minimal clinically important difference (6 blocks), while 8 patients (all of whom had >2-SD greater proprioception deficit compared to 25 healthy controls) showed no improvement. In terms of baseline behavioral assessments, a somatosensory measure (finger proprioception assessed robotically) best predicted treatment gains, outperforming all measures of motor behavior. When the neural basis underlying variability in treatment response was examined, somatosensory-related variables were again the strongest predictors. A multivariate model combining total sensory system injury and sensorimotor cortical connectivity (between ipsilesional primary motor and secondary somatosensory cortices) explained 56% of variance in treatment-induced hand functional gains (p = 0.002).Conclusions Measures related to the somatosensory network best explained interparticipant differences in treatment-related hand function gains. These results underscore the importance of baseline somatosensory integrity for improving hand function after stroke and provide insights useful for individualizing rehabilitation therapy.ClinicalTrials.gov identifier: NCT02048826.B&B=Box and Blocks; CST=corticospinal tract; FINGER=Finger Individuating Grasp Exercise Robot; MNI=Montreal Neurological Institute; ROI=region of interest; TST=thalamocortical spinal tract