The Journal of Korean Physical Therapy

  • 제34권6호
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  • Pages.326-331
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  • 2022
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  • 1229-0475(pISSN)
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  • 2287-156X(eISSN)
대한물리치료학회 (The Korean Society of Physical Therapy)
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Gait Recovery Characteristic According to the Injury Aspect of Descending Motor Pathway in a Chronic Stroke Patient: a Case Study

  • Sang Seok, Yeo (Department of Physical Therapy, College of Health and Welfare Sciences, Dankook University)
  • 투고 : 2022.11.30
  • 심사 : 2022.12.27
  • 발행 : 2022.12.31
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초록

Purpose: The stroke patients have gait dysfunction due to impaired neural tracts; corticospinal tract (CST), corticoreticular pathway (CRP), and vestibulospinal tract (VST). In this study, we investigated characteristics of gait pattern according to the injury aspect of the neural track in a stroke patient. Methods: One patient and six control subjects of similar age participated. A 19-year-old male patient with spontaneous intracerebral hemorrhage on right basal ganglia, thalamus, corona radiata and cerebral cortex due to arteriovenous malformation rupture. Diffusion tensor imaging (DTI) data was acquired 21 months after the stroke. Kinematic and spatio-temporal parameters of gait were collected using a three-dimensional gait analysis system. Results: On 21 months DTI, the CST and CRP in affected hemisphere showed severe injury, in contrast, the VST in affected hemisphere showed intact integrity. Result of gait analysis, walking distance and speed were significantly decreased in a patient. The stance rate of unaffected lower limb, the swing rate of affected lower limb and the duration of double stance significantly increased compared with normal control. The knee and hip joint angle were significantly decreased in a patient. Conclusion: We found recovered independent gait ability may be associated with unimpaired VST in a patient with severe injury in CST and CRP.

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참고문헌

  1. Bohannon RW. Gait performance of hemiparetic stroke patients: selected variables. Arch Phys Med Rehabil. 1987;68(11):777-81. 
  2. Jorgensen HS, Nakayama H, Pedersen PM et al. Epidemiology of stroke-related disability. Clin Geriatr Med. 1999;15(4):785-99.  https://doi.org/10.1016/s0749-0690(18)30031-4
  3. Beyaert C, Vasa R, Frykberg GE. Gait post-stroke: Pathophysiology and rehabilitation strategies. Neurophysiologie clinique. Neurophysiol Clin. 2015;45(4-5):335-55.  https://doi.org/10.1016/j.neucli.2015.09.005
  4. Jorgensen HS, Nakayama H, Raaschou HO et al. Recovery of walking function in stroke patients: the copenhagen stroke study. Arch Phys Med Rehabil. 1995;76(1):27-32.  https://doi.org/10.1016/S0003-9993(95)80038-7
  5. Perry J, Garrett M, Gronley JK et al. Classification of walking handicap in the stroke population. Stroke. 1995;26(6):982-9.  https://doi.org/10.1161/01.str.26.6.982
  6. Wonsetler EC, Bowden MG. A systematic review of mechanisms of gait speed change post-stroke. Part 1: spatiotemporal parameters and asymmetry ratios. Top Stroke Rehabil. 2017;24(6):435-46.  https://doi.org/10.1080/10749357.2017.1285746
  7. Wonsetler EC, Bowden MG. A systematic review of mechanisms of gait speed change post-stroke. Part 2: exercise capacity, muscle activation, kinetics, and kinematics. Top Stroke Rehabil. 2017;24(5):394-403.  https://doi.org/10.1080/10749357.2017.1282413
  8. Takakusaki K. Neurophysiology of gait: from the spinal cord to the frontal lobe. Mov Disord. 2013;28(11):1483-91.  https://doi.org/10.1002/mds.25669
  9. Jang SH, Chang CH, Lee J et al. Functional role of the corticoreticular pathway in chronic stroke patients. Stroke. 2013;44(4):1099-104.  https://doi.org/10.1161/STROKEAHA.111.000269
  10. Jang SH, Kwon HG. Recovery of an injured corticospinal tract during the early stage of rehabilitation following pontine infarction. Neural Regen Res. 2016;11(3):519-20.  https://doi.org/10.4103/1673-5374.179080
  11. Takakusaki K. Functional Neuroanatomy for Posture and Gait Control. J Mov Disord. 2017;10(1):1-17.  https://doi.org/10.14802/jmd.16062
  12. Thomke F, Marx JJ, Iannetti GD et al. A topodiagnostic investigation on body lateropulsion in medullary infarcts. Neurology. 2005;64(4):716-8.  https://doi.org/10.1212/01.WNL.0000152040.27264.1A
  13. Ahn YH, Ahn SH, Kim H et al. Can stroke patients walk after complete lateral corticospinal tract injury of the affected hemisphere? Neuroreport. 2006;17(10):987-90.  https://doi.org/10.1097/01.wnr.0000220128.01597.e0
  14. Jang SH, Cho SH, Kim YH et al. Diffusion anisotrophy in the early stages of stroke can predict motor outcome. Restor Neurol Neurosci. 2005;23(1):11-7. 
  15. Luft AR, Smith GV, Forrester L et al. Comparing brain activation associated with isolated upper and lower limb movement across corresponding joints. Hum Brain Mapp. 2002;17(2):131-40.  https://doi.org/10.1002/hbm.10058
  16. Matsuyama K, Mori F, Nakajima K et al. Locomotor role of the corticoreticular-reticulospinal-spinal interneuronal system. Prog Brain Res. 2004;143:239-49.  https://doi.org/10.1016/S0079-6123(03)43024-0
  17. Yeo SS, Chang MC, Kwon YH et al. Corticoreticular pathway in the human brain: diffusion tensor tractography study. Neurosci Lett. 2012;508(1):9-12.  https://doi.org/10.1016/j.neulet.2011.11.030
  18. Yeo SS, Kim SH, Jang SH. Proximal weakness due to injury of the corticoreticular pathway in a patient with traumatic brain injury. NeuroRehabilitation. 2013;32(3):665-9.  https://doi.org/10.3233/nre-130889
  19. Brandt T, Dieterich M, Danek A. Vestibular cortex lesions affect the perception of verticality. Ann Neurol. 1994;35(4):403-12.  https://doi.org/10.1002/ana.410350406
  20. Fukushima K. Corticovestibular interactions: anatomy, electrophysiology, and functional considerations. Exp Brain Res. 1997;117(1):1-16.  https://doi.org/10.1007/PL00005786
  21. Jang SH. The recovery of walking in stroke patients: a review. International journal of rehabilitation research. Int J Rehabil Res. 2010;33(4):285-9.  https://doi.org/10.1097/MRR.0b013e32833f0500
  22. Jang SH, Kwon HG. Delayed regaining of gait ability in a patient with brain injury: a case report. Medicine. 2016;95(38):e4898.  https://doi.org/10.1097/md.0000000000004898
  23. Kwon H, Jang SH. Delayed recovery of gait function in a patient with intracerebral haemorrhage. J Rehabil Med. 2012;44(4):378-80.  https://doi.org/10.2340/16501977-0962
  24. Seo JP, Do KH, Jung GS et al. The difference of gait pattern according to the state of the corticospinal tract in chronic hemiparetic stroke patients. NeuroRehabilitation. 2014;34(2):259-66.  https://doi.org/10.3233/nre-131046
  25. Seo JP, Lee MY, Kwon YH et al. Delayed gait recovery in a stroke patient. Neural Regen Res. 2013;8(16):1514-8. 
  26. Demeurisse G, Demol O, Robaye E. Motor evaluation in vascular hemiplegia. Eur Neurol. 1980;19(6):382-9.  https://doi.org/10.1159/000115178
  27. Cunha IT, Lim PA, Henson H et al. Performance-based gait tests for acute stroke patients. Am J Phys Med Rehabil. 2002;81(11):848-56.  https://doi.org/10.1097/00002060-200211000-00008
  28. Li F, Wu Y, Li X. Test-retest reliability and inter-rater reliability of the Modified Tardieu Scale and the Modified Ashworth Scale in hemiplegic patients with stroke. Eur J Phys Rehabil Med. 2014;50(1):9-15. 
  29. Park HY, Jeon SS, Lee JY et al. Korean Version of the mini-mental state examination using smartphone: a validation study. Telemed J E Health. 2017;23(10):815-21.  https://doi.org/10.1089/tmj.2016.0281
  30. Jang SH. Somatotopic arrangement and location of the corticospinal tract in the brainstem of the human brain. Yonsei Med J. 2011;52(4):553-7.  https://doi.org/10.3349/ymj.2011.52.4.553
  31. Jang SH, Kwon JW, Yeo SS. Three dimensional identification of medial and lateral vestibulospinal tract in the human brain: A diffusion tensor imaging study. Front Hum Neurosci. 2018;12:229.  https://doi.org/10.3389/fnhum.2018.00229
  32. Yeo SS, Jang S, Kwon J. Central vestibular disorder due to ischemic injury on the parieto-insular vestibular cortex in patients with middle cerebral artery territory infarction: Observational study. Medicine. 2017;96(51):e9349.  https://doi.org/10.1097/MD.0000000000009349
  33. Yeo SS, Jang SH, Kwon JW. Lateral medullary syndrome following injury of the vestibular pathway to the core vestibular cortex: Diffusion tensor imaging study. Neurosci Lett. 2017;665:147-51.  https://doi.org/10.1016/j.neulet.2017.12.010
  34. Gill SV, Walsh MK, Pratt JA et al. Changes in spatiotemporal gait patterns during flat ground walking and obstacle crossing 1 year after bariatric surgery. Surg Obes Relat Dis. 2016;12(5):1080-5.  https://doi.org/10.1016/j.soard.2016.03.029
  35. Najafi B, Helbostad JL, Moe-Nilssen R et al. Does walking strategy in older people change as a function of walking distance? Gait Posture. 2009;29(2):261-6.  https://doi.org/10.1016/j.gaitpost.2008.09.002
  36. Zukowski LA, Martin JM, Scronce G et al. The influence of cognitive load on metabolic cost of transport during overground walking in healthy, young adults. Eur J Appl Physiol. 2017;117(4):679-86.  https://doi.org/10.1007/s00421-017-3536-x
  37. Green AM, Angelaki DE. Internal models and neural computation in the vestibular system. Exp Brain Res. 2010;200(3-4):197-222.  https://doi.org/10.1007/s00221-009-2054-4
  38. Highstein SM, Holstein GR. The anatomical and physiological framework for vestibular prostheses. Anat Rec. 2012;295(11):2000-9.  https://doi.org/10.1002/ar.22582
  39. Lambert FM, Bras H, Cardoit L et al. Early postnatal maturation in vestibulospinal pathways involved in neck and forelimb motor control. Dev Neurobiol. 2016;76(10):1061-77.  https://doi.org/10.1002/dneu.22375
  40. Markham CH. Vestibular control of muscular tone and posture. The Canadian journal of neurological sciences. Can J Neurol Sci. 1987;14(3 Suppl):493-6.  https://doi.org/10.1017/S0317167100037975
  41. Yamada K, Sakai K, Akazawa K et al. MR tractography: a review of its clinical applications. Magn Reson Med Sci. 2009;8(4):165-74.  https://doi.org/10.2463/mrms.8.165
  42. Jang SH, Chang CH, Lee J et al. Functional role of the corticoreticular pathway in chronic stroke patients. Stroke. 2013;44(4):1099-104.  https://doi.org/10.1161/STROKEAHA.111.000269
  43. Yeo SS, Jang SH, Park GY et al. Effects of injuries to descending motor pathways on restoration of gait in patients with pontine hemorrhage. J Stroke Cerebrovasc Dis. 2020;29(7):104857. https://doi.org/10.1016/j.jstrokecerebrovasdis.2020.104857