Hammerbeck, U 
ORCID: https://orcid.org/0000-0003-2657-4347, Tyson, SF ORCID: https://orcid.org/0000-0001-6301-8791, Samraj, P, Hollands, K ORCID: https://orcid.org/0000-0002-3691-9532, Krakauer, JW and Rothwell, J
2021,
'The strength of the corticospinal tract not the reticulospinal tract determines upper-limb impairment level and capacity for skill-acquisition in the sub-acute post-stroke period'
, Neurorehabilitation and Neural Repair, 35 (9)
, pp. 812-822.
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Abstract
Background. Upper-limb impairment in patients with chronic stroke appears to be partly attributable to an upregulated reticulospinal tract (RST). Here, we assessed whether the impact of corticospinal (CST) and RST connectivity on motor impairment and skill-acquisition differs in sub-acute stroke, using transcranial magnetic stimulation (TMS)–based proxy measures. Methods. Thirty-eight stroke survivors were randomized to either reach training 3-6 weeks post-stroke (plus usual care) or usual care only. At 3, 6 and 12 weeks post-stroke, we measured ipsilesional and contralesional cortical connectivity (surrogates for CST and RST connectivity, respectively) to weak pre-activated triceps and deltoid muscles with single pulse TMS, accuracy of planar reaching movements, muscle strength (Motricity Index) and synergies (Fugl-Meyer upper-limb score). Results. Strength and presence of synergies were associated with ipsilesional (CST) connectivity to the paretic upper-limb at 3 and 12 weeks. Training led to planar reaching skill beyond that expected from spontaneous recovery and occurred for both weak and strong ipsilesional tract integrity. Reaching ability, presence of synergies, skill-acquisition and strength were not affected by either the presence or absence of contralesional (RST) connectivity. Conclusion. The degree of ipsilesional CST connectivity is the main determinant of proximal dexterity, upper-limb strength and synergy expression in sub-acute stroke. In contrast, there is no evidence for enhanced contralesional RST connectivity contributing to any of these components of impairment. In the sub-acute post-stroke period, the balance of activity between CST and RST may matter more for the paretic phenotype than RST upregulation per se.
| Item Type: | Article |
|---|---|
| Additional Information: | ** From Crossref journal articles via Jisc Publications Router **Journal IDs: pissn 1545-9683; eissn 1552-6844 **History: issued 04-07-2021; published_online 04-07-2021 |
| Schools: | Schools > School of Health and Society |
| Journal or Publication Title: | Neurorehabilitation and Neural Repair |
| Publisher: | SAGE Publications |
| ISSN: | 1545-9683 |
| Related URLs: | |
| Funders: | The Stroke Association, Post-doctoral Fellowship |
| SWORD Depositor: | Publications Router |
| Depositing User: | Publications Router |
| Date Deposited: | 14 Jul 2021 14:40 |
| Last Modified: | 15 Feb 2022 17:36 |
| URI: | https://usir.salford.ac.uk/id/eprint/61201 |
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