Clinical Research Directory

Neuroarchitectural Recovery Model of Post-stroke Patients

Sponsor: Chinese University of Hong Kong

Summary

The societal burden of stroke patients with persistent neurological deficit is high. It is therefore imperative that the mechanisms of rehabilitation-induced motor recovery be better understood in the hopes of developing more efficacious rehabilitative therapy. The treatment outcomes of people with stroke after rehabilitation vary, with up to 60% of people having residual impairment of the upper limb function. The high variability in rehabilitation-induced recovery prompted researchers and clinicians to develop more efficacious rehabilitative interventions for functional regain in post-stroke patients. However, the mechanisms underlying post-stroke functional regain have not been well articulated. The majority of studies in this area placed a limited scope on associating improvement in functions with changes in the activation of the motor cortices, ranging from normalization to the overactivity of the motor regions. A wider scope, however, needs to include structural changes in the motor cortices, as well as functional and structural changes in other neural substrates, as other non-motor cortices underpin stroke recovery. The results of our pilot study on acute post-stroke patients indicate that both functional and structural brain connections are significantly associated with motor recovery after conventional post-stroke rehabilitation. In addition to sensorimotor cortices, the investigators also found other non-motor areas, such as the superior frontal gyrus and the precuneus, that play important roles in post-stroke rehabilitation-induced recovery. Given the gap in elusive neural processes and in the mechanisms underlying rehabilitation-induced recovery, this proposed study is aimed at providing a better understanding of the functional regain of post-stroke patients by constructing a brain recovery model. As a first attempt, the investigators propose building a basic recovery model based on patients who will undergo constraint-induced movement therapy, a popular evidence-based post-stroke intervention, for capturing training-induced neuroplastic changes. Two groups of chronic stroke patients will be recruited, respectively, for the treatment and control groups. Magnetic resonance imaging (used to map functional and structural brain connections), the clinical assessments of motor impairments, and activities of daily living will be conducted at four time points-namely at the baseline, one week, four weeks, and three months after the treatment commences. The two objectives set for the proposed study are: (1) to characterize the longitudinal changes in functional and structural brain networks, which would differentiate the rate of changes in these networks; and (2) to define the functional and the structural brain network coupling, as well as their contributions to the daily function regain.

Key Details

Conditions

Interventions

Locations (1)