The Effects of Stroke Type, Locus, and Extent on Long-Term Outcome of Gait Rehabilitation

No clue if this tells us anything useful.
http://nnr.sagepub.com/content/early/2015/10/22/1545968315613851.abstract?&location1=all&location2=all&row_operator2=and&term1a=neuroplasticity&term1b=neurogenesis&term_operator1=or&term_operator2=and&ct

1. Stephen E. Nadeau, MD1,2⇑
2. Bruce Dobkin, MD3
3. Samuel S. Wu, PhD4
4. Qinglin Pei, PhD4
5. Pamela W. Duncan, PhD5
6. for the LEAPS Investigative Team

1. ¹Malcom Randall VA Medical Center, Gainesville, FL, USA
2. ²University of Florida College of Medicine, Gainesville, FL, USA
3. ³Geffen/UCLA School of Medicine, Los Angeles, CA, USA
4. ⁴University of Florida Colleges of Medicine and Public Health and Health Professions, Gainesville, FL, USA
5. ⁵Wake Forest School of Medicine, Winston-Salem, NC, USA

1. Stephen E. Nadeau, MD, Research Service (151), Malcom Randall VA Medical Center, 1601 SW Archer Road, Gainesville, FL 32608-1197, USA. Email: snadeau@ufl.edu

Abstract

Background. Paresis in stroke is largely a result of damage to descending corticospinal and corticobulbar pathways. Recovery of paresis predominantly reflects the impact on the neural consequences of this white matter lesion by reactive neuroplasticity (mechanisms involved in spontaneous recovery) and experience-dependent neuroplasticity, driven by therapy and daily experience. However, both theoretical considerations and empirical data suggest that type of stroke (large vessel distribution/lacunar infarction, hemorrhage), locus and extent of infarction (basal ganglia, right-hemisphere cerebral cortex), and the presence of leukoaraiosis or prior stroke might influence long-term recovery of walking ability. In this secondary analysis based on the 408 participants in the Locomotor Experience Applied Post-Stroke (LEAPS) study database, we seek to address these possibilities. 

Methods. Lesion type, locus, and extent were characterized by the 2 neurologists in the LEAPS trial on the basis of clinical computed tomography and magnetic resonance imaging scans. A series of regression models was used to test our hypotheses regarding the effects of lesion type, locus, extent, and laterality on 2- to 12-month change in gait speed, controlling for baseline gait speed, age, and Berg Balance Scale score.  

Results. Gait speed change at 1 year was significantly reduced in participants with basal ganglia involvement and prior stroke. There was a trend toward reduction of gait speed change in participants with lacunar infarctions. The presence of right-hemisphere cortical involvement had no significant impact on outcome.  

Conclusions. Type, locus, and extent of lesion, and the loss of substrate for neuroplastic effect as a result of prior stroke may affect long-term outcome of rehabilitation of hemiparetic gait.