Approximately 33% of patients die and 33% have persistent disability after stroke, placing a burden on society. The mechanisms involved in recovery of function are not well understood. Both structural and functional brain reorganization contribute to recovery and are enhanced by rehabilitation, a complex programme of interacting therapies that promote recovery and independence. Conclusive data to define the optimal intensity of training strategies are lacking. MRI techniques have revolutionized our understanding of connectivity: diffusion tensor imaging (DTI) reveals the macro- and micro-structure of the brain, and functional MRI (fMRI) shows specific cognitive and behavioral networks. Pre-existing functional/structural connections and the impact of lesion onto them are the most important determinants of outcome.
The primary objective of this project is to determine the value of MRI markers of brain connectivity (MRI-BBC) in predicting stroke patients’ functional outcomes after rehabilitation. Secondary objectives are (S1) to determine whether combining MRI-BBC and clinical scores can predict functional outcomes better than either approach alone and (S2) whether MRI-BBC can identify patients who will respond better to higher rehabilitation intensities.
Around 100 patients will receive standard rehabilitation treatment (i.e, physiotherapy, occupational therapy, and speech therapy sessions aimed at treating specific deficits). As a pilot study, 40 patients (BARCELONA-PSMAR-cohort ) will receive intense rehabilitation( (≥3hours/day) in an inpatient rehabilitation facilities scenario