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ABSTRACT: There have been no studies on motor recovery in severe quadriplegic patients with traumatic brain injury (TBI) resulting from combined causes of weakness; this type of patient is often seen in rehabilitation clinics. We report on a quadriplegic patient who showed long-term motor recovery from severe weakness caused by a diffuse axonal injury (DAI) on the brainstem and a traumatic intracerebral hemorrhage (ICH) on left cerebral peduncle, as evaluated by diffuse tensor imaging (DTI) and functional MRI (fMRI). A 17-year-old male patient presented with quadriparesis at the onset of TBI. Over the 28-month period following the onset of the injury, the motor function of the four extremities slowly recovered to a range that was nearly normal. Two longitudinal DTIs (at 11 and 28 months from onset) and fMRI (at 28 months) were performed. Fractional anisotropy and an apparent diffusion coefficient were measured using the region of interest method, and diffusion tensor tractography was conducted using a DTI/fMRI combination. Fractional anisotrophy values in the brainstem, which were markedly decreased on the 11-month DTI, were increased on the 28-month DTI. On the fMRI performed at 28 months, the contralateral primary sensori-motor cortex was activated by the movement of either the right or left hand. Diffusion tensor tractography showed that fiber tracts originating from the motor-sensory cortex passed through the known corticospinal tract pathway to the pons. It seems that the weakness of this patient recovered due to the recovery of the damaged corticospinal tracts.
Neurorehabilitation 01/2009; 25(2):117-22. · 1.63 Impact Factor
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ABSTRACT: We investigated whether the integrity of the corticospinal tract classified by diffusion tensor tractography (DTT) can predict the motor outcome in 25 patients with pontine infarct. DTTs were obtained in the early stage of stroke (5-30 days) and were classified into two groups (type A: the integrity of corticospinal tract was preserved around the infarct; type B: corticospinal tract was interrupted). DTT type A patients showed better motor function than the type B patients at 6 months after onset. DTT obtained at the early stage of pontine infarct appears to have predictive value for motor outcome in patients with pontine infarct.
Annals of Neurology 10/2008; 64(4):460-5. · 11.09 Impact Factor
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ABSTRACT: Constraint-induced movement therapy (CIMT) has been demonstrated to be effective in improving hemiparetic upper extremity function in stroke patients, but few studies have been performed to assess orthosis modification. We investigated the effect of the newly designed small orthosis named modified opposition restriction orthosis (MORO) in chronic hemiparetic patients with stroke.
Twenty-one stroke patients were randomly assigned to the CIMT group or control group. Thirteen patients in the CIMT group wore MORO confining the thumb and index finger for at least 5 hours of each day, 7 days a week for 8 weeks. The affected upper extremity function was evaluated using the manual function test (MFT), Purdue Pegboard (PP) score, and motor activity log (MAL) at pre and post-CIMT.
Four of the 13 patients in the CIMT group dropped out due to motivational problems, and 9 patients remained in the CIMT group at the end of the study. The patients in the CIMT group showed a mean improvement of 195.8% on MAL AOU (Amount of Use), 24.6% on PP score, and 5.5% on MFT.
This new MORO would be effective for use in a CIMT program in chronic hemiparetic patients with stroke.
Neurorehabilitation 02/2008; 23(3):239-44. · 1.63 Impact Factor
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ABSTRACT: Diffusion tensor tractography (DTT) is useful for exploring the state of the corticospinal tract (CST). An accurate estimation of the integrity of the CST in the early stage of a cerebral infarct would enable a determination of motor recovery. DTT was performed to classify CST integrity following a corona radiata infarct to evaluate if the procedure could characterize the motor outcome of the affected hand. Fifty-five patients with completely paralyzed hands due to a corona radiata infarct were recruited for the study, and DTT images were obtained within 7-30 days after a stroke. The DTI findings for the patients were classified into four groups. In type A, the CST was preserved around the infarct; in type B, the CST originated from a cortex other than the primary motor cortex; in type C, the CST was interrupted at the infarct; in type D, the CST failed to reach the infarct due to degeneration. Six months after a stroke, the motor function of the affected hand was evaluated with the motricity index (MI) for the hand, the Medical Research Council score (MRC) for finger extensors and the modified Brunnstrom classification (MBC). These indices were significantly influenced by the DTT type (p<0.05). The highest MI, MRC and MBC were seen in the DTT type A patients; the lowest MI, MRC and MBC were seen in the DTT type D patients (p<0.05). The integrity of the corticospinal tract determined by DTT obtained during the early stage of a corona radiata infarct seems to be helpful in predicting the motor outcome of the affected hand.
Neuroscience Letters 11/2007; 426(2):123-7. · 2.11 Impact Factor
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ABSTRACT: Diffusion tensor image tractography (DTT) could be useful for exploring the state of the corticospinal tract (CST) at the level of the subcortical white matter. The purpose of this study was to demonstrate the speed of degeneration of the CST in patients with cerebral infarct, using DTT.
Two patients with middle cerebral artery territory infarct were recruited for this study. DTT was performed 5 times with an interval of 7 days, starting at 2 days after onset, using a 1.5-T system with a synergy-L Sensitivity Encoding head coil. The termination criteria used were fractional anisotrophy < 0.3, 0.2, 0.1, respectively, and an angle change > 45 degrees .
Detection of CST degeneration began at the 9 day DTT in both patients. The most rapid CST degeneration was noted for 7 days at 16 days from onset. We did not detect any tract in the affected hemisphere of both patients at the 23-day DTT.
We demonstrated that CST degeneration begins before 9 days from onset and progresses rapidly in patients with middle cerebral artery territory infarct. It seems that the CST degeneration began earlier than expected.
Neurorehabilitation 01/2007; 22(4):273-7. · 1.63 Impact Factor
