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Mean diffusivity as a potential diffusion tensor biomarker of motor rehabilitation after electrical stimulation incorporating task specific exercise in stroke: a pilot study

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Abstract

Changes in diffusion tensor imaging (DTI) values co-occur with neurological and functional changes after stroke. However, quantitative DTI metrics have not been examined in response to participation in targeted rehabilitative interventions in chronic stroke. The primary purpose of this pilot study was to examine whether changes in DTI metrics co-occur with paretic arm movement changes among chronic stroke patients participating in a regimen of electrical stimulation targeting the paretic arm. Three subjects exhibiting stable arm hemiparesis were administered 30-minute (n = 1) or 120-minute (n = 2) therapy sessions emphasizing paretic arm use during valued, functional tasks and incorporating an electrical stimulation device. These sessions occurred every weekday for 8 weeks. A fourth subject served as a treatment control, participating in a 30-minute home exercise regimen without electrical stimulation every weekday for 8 weeks. DTI and behavioral outcome measures were acquired at baseline and after intervention. DTI data were analyzed using a region of interest (ROI) approach, with ROIs chosen based on tract involvement in sensorimotor function or as control regions. Behavioral outcome measures were the Fugl-Meyer Scale (FM) and the Action Research Arm Test (ARAT). The treatment control subject exhibited gains in pinch and grasp, as shown by a 5-point increase on the ARAT. The subject who participated in 30-minute therapy sessions exhibited no behavioral gains. Subjects participating in 120-minute therapy sessions displayed consistent impairment reductions and distal movement changes. DTI changes were largest in subjects two and three, with mean diffusivity (MD) decreases in the middle cerebellar peduncle and posterior limb of the internal capsule following treatment. No changes in fractional anisotropy (FA) were observed for sensorimotor tracts. Our preliminary results suggest that active rehabilitative therapies augmented by electrical stimulation may induce positive behavioral changes which are underscored by DTI changes indicative of increased white matter tract integrity in regions specific to sensory-motor function.

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Acknowledgements

This study was supported by a grant from the American Heart Association, and a University of Cincinnati Research Council Grant.

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Authors and Affiliations

  1. Psychiatry and Behavioral Neurosciences & Center for Imaging Research & Neuroscience Graduate Program, University of Cincinnati College of Medicine, 231 Albert Sabin Way, Suite E685, Cincinnati, OH, 45267-0583, USA

    Erin L. Boespflug

  2. University of Cincinnati, Center for Imaging Research, 231 Albert Sabin Way, Suite E685, Cincinnati, OH, 45267-0583, USA

    Judd M. Storrs & James C. Eliassen

  3. Department of Neurology, University of Cincinnati Academic Health Center, 260 Stetson St., Suite 2300, PO Box 670525, Cincinnati, OH, 45267-0525, USA

    Jane B. Allendorfer

  4. Center for Imaging Research & Physician Scientist Training Program, University of Cincinnati College of Medicine, 231 Albert Sabin Way, Cincinnati, OH, 45267-0583, USA

    Martine Lamy

  5. Occupational Therapy, The Ohio State University, 453 West 10th Street, Columbus, OH, 43210, USA

    Stephen Page

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  1. Erin L. Boespflug
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Correspondence to Stephen Page.

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Boespflug, E.L., Storrs, J.M., Allendorfer, J.B. et al. Mean diffusivity as a potential diffusion tensor biomarker of motor rehabilitation after electrical stimulation incorporating task specific exercise in stroke: a pilot study. Brain Imaging and Behavior 8, 359–369 (2014). https://doi.org/10.1007/s11682-011-9144-1

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