Does stroke location predict walk speed response to gait rehabilitation?

This is fucking pathetic that we are still asking questions like these. It means that every stroke survivor is an unregistered clinical trial of one for walking rehabilitation.  Because we have never had an objective stroke damage diagnosis.
https://ueaeprints.uea.ac.uk/55626/1/Does_Stroke_Location_Predict_Walk_Speed_Response_to_Gait_Rehabilitation.pdf
P. Simon Jones 1
, Valerie M. Pomeroy 2
, Jasmine Wang 3
, Gottfried Schlaug 3
, S. Tulasi Marrapu 1
, Sharon Geva 1
, Philip J. Rowe 4
, Elizabeth Chandler 2
,  Andrew  Kerr 4
,  Jean+Claude  Baron 1,5
,  for  the  SWIFT+Cast
investigators.
Affiliations:
1.Stroke Research Group, Dept of Clinical Neuroscienc
es, University of
Cambridge, UK
2.Acquired Brain Injury Rehabilitation Alliance, Scho
ol of Health Sciences,
University of East Anglia, Norwich, UK
3.Department of Neurology, Beth Israel Deaconess Medi
cal Center, Harvard
Medical School Boston, USA.
4.Bioengineering Unit, University of Strathclyde, Gla
sgow, UK.
5.Inserm U894, Sorbonne Paris Cité, Centre Hospitalie
r Sainte+Anne, Paris,
France
Running head: Stroke location and walking rehabilit
ation
Correspondence: 
Jean+Claude Baron
INSERM U894
2 ter rue d'Alésia
75014 Paris, France
tel: (33) (0)1 40788626 
fax: (33) (0)1 45807293 
email: jean+claude.baron@inserm.fr

Abstract
Objectives:  Recovery  of  independent  ambulation  after  stroke  is  a  major  goal.
However, which rehabilitation regimen best benefits each individual is unknown and
decisions are currently made on a subjective basis.  Predictors of response to specific
therapies would guide the type of therapy most appropriate for each patient. Although
lesion topography is a strong predictor of upper limb response, walking involves more
distributed functions.  Earlier studies that assessed the cortico+spinal tract (CST) were
negative, suggesting other structures may be important.
Experimental design: The relationship between lesion topography and response of
walking speed to standard rehabilitation was assessed in 50 adult+onset patients using
both  volumetric measurement  of  CST  lesion  load  and voxel+based  lesion+symptom
mapping (VLSM) to assess non+CST structures. Two functional mobility scales, the
Functional Ambulation Category (FAC) and the Modified Rivermead Mobility Index
(MRMI) were also administered. Performance measures were obtained both at entry
into the study (3+42 days post+stroke) and at the end of a six+week therapy. Baseline
score,  age,  time  since  stroke  onset  and  white  matter  hyperintensities  score  were
included as nuisance covariates in regression models.
Principal  observations:
CST  damage  independently  predicted  response  to therapy for FAC and MRMI, but not for Walk speed. However, using VLSM the latter  was  predicted  by  damage  to  the  putamen, insula,  external  capsule  and neighbouring white matter.
Conclusions:
Walk  speed  response  to  rehabilitation  was  affected by  damage involving the putamen and neighbouring structures but not the CST, while the latter  has  modest  but  significant  impact  on  everyday  functions  of  general mobility and gait.