Revalidatieziekenhuis RevArte

ABSTRACT Background The importance of corticospinal tract (CST) integrity in upper limb recovery poststroke is well established, but its association with standing balance and walking remains unclear. This meta-analysis aimed to establish the relationship between CST and non-CST motor tract integrity, and clinical scores of standing balance and walking poststroke. Methods In July 2024, five databases were searched for studies, focusing on diffusion MRI metrics and clinical scores of standing balance and/or walking independence poststroke. Meta-analyses were conducted to pool correlation coefficients (r) and group differences (d) based on CST integrity. Results Twenty-two studies were included. Cross-sectional analysis showed no correlation (r < .25) between CST metrics and the functional ambulation category (FAC) in the sub-acute phase. Weak prognostic associations were found for CST-FA and CST-FN with FAC. Significant FAC score differences were found between preserved- and disrupted CST groups in the sub-acute (d = .79) and chronic (d = 1.07) phase and for prognostic analysis (d = 1.40). Non-CST metrics showed no cross-sectional associations and mixed prognostic associations. Conclusions CST integrity was not significantly associated with standing balance or walking independence in the sub-acute phase. Early CST integrity showed weak prognostic value for walking at 6 months. Multimodal longitudinal research is needed to improve lower limb recovery prognostics.

Robot-assisted overground walking (RAOW) may facilitate walking aerobic exercise in nonambulatory stroke survivors. The aims of this study were to investigate the physiological responses and perceived exertion during RAOW in persons with stroke and to compare the exercise intensity to aerobic exercise guidelines for stroke survivors. Ten nonambulatory stroke survivors (50% male, median age of 72 years old, and median time poststroke of 40 days) walked 20 minutes overground wearing a lower limb exoskeleton (Ekso GT) with full bilateral assistance. Breath-by-breath gas exchange and heart rate were monitored continuously. The rating of perceived exertion (RPE) on a 6-20 scale was assessed at the end of rest and every 5 min during walking. Net values were obtained by subtracting gross values from resting values. The net heart rate and net RPE significantly increased between minute 5 [median: 8 beats/min; interquartile range (IQR): 10 beats/min; median: 2; IQR: 5] and minute 20 (median: 17 beats/min; IQR: 17 beats/min; median: 6; IQR: 5).

Background. Traumatic brain injury (TBI) has been associated with impairments in inhibiting prepotent motor responses triggered by infrequent external signals (ie, reactive inhibition). It is unclear whether proactive preparation to inhibit upcoming responses is also affected (ie, proactive inhibition). Successful inhibition relies on frontosubcortical interactions; therefore, impairments might be linked with gray matter atrophy in subcortical structures. Objective. We investigated reactive and proactive inhibition in TBI and control groups, and their relationship with subcortical gray matter. Methods. Participants performed a response inhibition task in which the probability of stopping was manipulated. Reactive inhibition was measured as the stop-signal reaction time (SSRT) when the probability of stopping was low. Proactive inhibition was measured as the change in SSRT and in go response time with increasing probability of stopping. Subcortical gray matter structures were automatically segmented with FSL-FIRST. Group differences in subregional volume and associations with reactive and proactive inhibition efficiency were investigated using shape analysis. Results. Reactive inhibition was impaired in TBI, as indicated by longer SSRTs. Moreover, the degree of atrophy in subregions of subcortical structures was predictive for SSRT in TBI. In contrast, proactive inhibition was not affected because both groups showed no response time slowing as a function of stopping probability. Proactive inhibition efficiency could be predicted by local volume in the anterior left putamen, bilateral pallidum, and right thalamus in controls but not in TBI. Conclusions. Our results reveal that proactive inhibition seems unaffected in TBI and that volume of subregions of subcortical nuclei is predictive for response inhibition proficiency and of clinical relevance in TBI.