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London, United Kingdom 2013 12 Rehabilitation and reorganisation after stroke B 14:50 - 15:00 Contribution of corticospinal tract damage and functional connectivity abnormalities in hand motor impairment after stroke C. ROSSO1, R. Valabrègue2, Y. Attal3, F. Baronnet4, P. Vargas5, V. Perlbarg6, A. Leger7, S. Le-héricy8, Cerebrovasc Dis 2013; 35 (suppl 3)1-854 145 Y. Samson9 AP-HP, Urgences Cérébro-Vasculaires, Pitié-Salpêtrière Hospital, Paris, FRANCE1,Centre de NeuroImagerie de Recherche (CENIR), Institut du Cerveau et de la moelle épinière, UPMC Paris 6, Paris, France, Paris, FRANCE2, Centre de Recherche de l’Institut du Cerveau et de la Moelle épinière, UPMC Paris 6, Inserm, U975, CNRS, UMR 7225, COGIMAGE, Paris, FRANCE3, AP-HP, Urgences Cérébro-Vasculaires, Pitié-Salpêtrière Hospital, Paris, FRANCE4, Centre de Recherche de l’Institut du Cerveau et de la Moelle épinière, UPMC Paris 6, Inserm, U975, CNRS, UMR 7225, COGIMAGE, Paris, FRANCE5, Laboratoire d’Imagerie Fonction-nelle, INSERM 678, UPMC Paris 6, Paris, FRANCE6, AP-HP, Urgences Cérébro-Vasculaires, Pitié-Salpêtrière Hospital, Paris, FRANCE7, AP-HP, Department of Neuroradiology, Pitié- Salpêtrière Hospital, Paris, FRANCE8, AP-HP, Urgences Cérébro-Vasculaires, Pitié-Salpêtrière Hospital, Paris, FRANCE9 Background: Stroke motor outcome is associated with reorganisation of cortical areas and corti-cospinal tract (CST) integrity. However, the relationships between those are hard to disentangle. The objective was to study the effect of CST damage on the relationship between functional motor network connectivity and hand motor function in two groups of stroke patients: the se-verely (n=8) and the mildly impaired (n=14). Methods: Patients were studied with MRI at 3 weeks, 3 and 6 months. Healthy subjects (n=28) were scanned once. The CST injury was assessed by fractional anisotropy (FA) values and functional connectivity was calculated from a fist closure task fMRI in a cortical and cerebellar motor network.The relationship between hand motor strength, ipsilesional CST damage and functional connectivity from the primary motor cortex (M1) was investigated using global and partial correlations. Results: In mildly impaired, the FA values in the ipsilesional CST were significantly higher than those in the severely impaired (p<0.0001), and there was a trend toward lower FA values vs. healthy subjects (p:0.08). The cortico-cortical connectivity returned to a normal pattern after 3 months but cortico-cerebellar connectivity was still decreased at 6 months. In severely im-paired patients, the cortico-cortical connectivity tended to return to a normal pattern except for the reduced ipsilesional M1-supplementary motor area correlation, but the cortico-cerebellar connectivity was totally abolished during follow-up. In the entire group of patients, the hand motor function was correlated to the ipsilesional functional connectivity from M1. Partial cor-relations revealed that these associations were not significant anymore when the impact of CST damage was removed, except for the ipsilesional M1-contralateral cerebellum connectivity. Conclusion: Upper limb function is mainly explained by the CST damage and by the ipsilesion-al cortico-cerebellar connectivity. 11 Rehabilitation and reorganisation after stroke B 14:40 - 14:50 Which stroke patients benefit from robotic therapy for the upper extremities? T. Takebayashi1, K. Takahashi2, S. Amano3, K. Domen4, K. Hachisuka5, T. Kimura6 T. Takebayashi Department of rehabilitation, The Hospital of Hyogo college of medicine, Nishinomiya, JAPAN1,School of Allied Health Sciences, Kitasati University,, Kanagawa, JAPAN2, Depart-ment of rehabilitation, The Hospital of Hyogo College of Medicine, Nishinomiya, JAPAN3, Department of Rehabilitation medicine, Hyogo College of Medicine, Nishinomiya, JAPAN4, Department of Rehabilitation Medicine, University of Occupational and environmental Health, Kitakyushu, JAPAN5, Nihon Rehabilitation academy, Toyoshima, JAPAN6  Background: Although robotic therapy (RT) has been shown to improve Upper extremity (UE) function in stroke patients, it remains unclear which stroke patients benefit most from RT. In our previous study, ReoGo therapy (Motorika Medical Ltd., Israel), which is one of RTs, was found to be more effective in low UE function with hemiparesis (Fugl-Meyer Assessment FMA < 30 at baseline). The purpose of this study was to examine the more details of the im-provements observed under RT. Methods: A pilot prospective, randomized, open, blinded-end-point trial was conducted at six facilities in Japan. The inclusion criteria were first stroke with hemiplegic UE (Brunnstrom Stage 3 to 4) from 4 to 8 weeks after onset. The patients were randomly assigned to either the RT group (40 minutes ReoGo therapy 7 days a week) or the control group (CT, 40 minutes self-training 7 days a week). Both groups underwent standard occupational therapy (OT) for 40 minutes before each training session. The ReoGo had a stick with a platform to stabilize the subject’s forearm that helped to move the UE in various direc-tions at five levels of assistance (from total-assistance to total-active modes). The UE function was measured using the FMA at baseline and post-intervention. In addition, each patients was classified into severe (0 to 5), moderate (6 to 9), or mild (10 to 12) subgroups based on the FMA-Flexion Synergy (FS) score at baseline in order to determine which subgroups exhibited the greatest benefit in the UE impairment. Results: Sixty Patients were recruited from Novem-ber 2008 to May 2010 (41 males and 19 females; mean age, 64.8 +/- 10.8 years). The RT group showed significantly greater changes in the FMA Shoulder/Elbow/Forearm scores (4.8 +/- 5.0 vs 1.9 +/- 5.5; p<0.05) than the CT group. The Moderate-RT subgroup shown significantly greater changes in the FMA-FS score than the Moderate-CT subgroup (2.3+/-1.3 vs −0.1+/-2.8, p<0.05). Conclusions: ReoGo therapy with standard OT was shown to increase recovery of UE function in post-stroke patients. We believe that patients with moderate impairment (6 to 9 on FMA-FS score at baseline) benefit most from the RT.


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