Longitudinal Motor Function Recovery in Stroke Patients with Focal Pons Infarction: Report of 4 cases

국소 교뇌 경색으로 인한 뇌졸중 환자에서 장기적인 운동기능 회복에 관한 사례보고

  • Park, Ji-Won (Department of Physical Therapy, College of Health Science, University of Daegu Catholic)
  • 박지원 (대구가톨릭대학교 보건과학대학 물리치료학과)
  • Received : 2009.10.29
  • Accepted : 2009.12.15
  • Published : 2009.12.25

Abstract

Purpose: The aim of this study was to present fundamental information regarding clinical prognosis and clinical criteria for therapeutic intervention in stroke patients with focal pons infarction. Methods: Four stroke patients (male: 2, female: 2) who were diagnosed with pons infarction were recruited. All subjects had motor functions evaluated using methods such as the Motricity Index (MI), the Modified Brunnstrom Classification (MBC), Functional Ambulatory Category (FAC), and the Bathel Index (BI). Evaluations were done at least 4 times over a period that was approximately 8~11 months from stroke onset. We compared the final evaluation with the first evaluation. Results: All patients with focal pons infarction showed improvement with time in motor function. The physical strength of all patients was improved to normal or good grades from zero or trace grades in the Motricity Index test. Also, other motor functions such as ambulatory capacity and activities of daily living (ADL) improved with time. Conclusion: Aspects of functional recovery and clinical prognosis are clearly predictable for specific patients with focal pons infarction. In addition, adequate therapeutic interventions can be provided clinical criterion to patients, according to aspect of functional recovery. Accordingly, patients with pons infarction change for the better over time.

References

  1. Duncan PW, Goldstein LB, Matchar D et al. Measurement of motor recovery after stroke. Outcome assessment and sample size requirements. Stroke. 1992;23(8):1084-9. https://doi.org/10.1161/01.STR.23.8.1084
  2. Kautz SA, Patten C. Interlimb influences on paretic leg function in poststroke hemiparesis. J Neurophysiol. 2005;93 (5):2460-73. https://doi.org/10.1152/jn.00963.2004
  3. Kwon MJ. Daily physical functioning and quality of life for stroke. J Kor Soc Phys Ther. 2007;19(5):87-96.
  4. Weller P, Wittsack HJ, Siebler M et al. Motor recovery as assessed with isometric finger movements and perfusion magnetic resonance imaging after acute ischemic stroke. Neurorehabil Neural Repair. 2006;20(3):390-7. https://doi.org/10.1177/1545968305285037
  5. Kwakkel G, Kollen B, Twisk J. Impact of time on improvement of outcome after stroke. Stroke. 2006;37(9): 2348-53. https://doi.org/10.1161/01.STR.0000238594.91938.1e
  6. Chen CL, Tang FT, Chen HC et al. Brain lesion size and location: Effects on motor recovery and functional outcome in stroke patients. Arch Phys Med Rehabil. 2000;81(4): 447-52. https://doi.org/10.1053/mr.2000.3837
  7. Jang SH. A review of the ipsilateral motor pathway as a recovery mechanism in patients with stroke. NeuroRehabilitation. 2009;24(4):315-20.
  8. Jang SH. A review of motor recovery mechanisms in patients with stroke. NeuroRehabilitation. 2007;22(4):253-9.
  9. Jang SH, Cho SH, Kim YH et al. Motor recovery mechanism of diffuse axonal injury: A combined study of transcranial magnetic stimulation and functional mri. Restor NeurolNeurosci. 2005;23(1):51-6.
  10. Nannetti L, Paci M, Pasquini J et al. Motor and functional recovery in patients with post-stroke depression. DisabilRehabil. 2005;27(4):170-175.
  11. Brown JA. Recovery of motor function after stroke. Prog Brain Res. 2006;157:223-8. https://doi.org/10.1016/S0079-6123(06)57015-3
  12. Jang SH. The role of the corticospinal tract in motor recovery in patients with a stroke: A review. NeuroRehabilitation. 2009;24(3):285-90.
  13. Bassetti C, Bogousslavsky J, Barth A et al. Isolated infarcts of the pons. Neurology. 1996;46(1):165-75. https://doi.org/10.1212/WNL.46.1.165
  14. Nighoghossian N, Ryvlin P, Trouillas P et al. Pontine versus capsular pure motor hemiparesis. Neurology. 1993;43(11): 2197-201. https://doi.org/10.1212/WNL.43.11.2197
  15. Kumral E, Bayulkem G, Evyapan D. Clinical spectrum of pontine infarction. Clinical-mri correlations. J Neurol. 2002; 249(12):1659-70. https://doi.org/10.1007/s00415-002-0879-x
  16. Kim JS, Lee JH, Im JH et al. Syndromes of pontine base infarction. A clinical-radiological correlation study. Stroke. 1995;26(6):950-5. https://doi.org/10.1161/01.STR.26.6.950
  17. Kataoka S, Hori A, Shirakawa T et al. Paramedian pontine infarction. Neurological/topographical correlation. Stroke. 1997;28(4):809-15. https://doi.org/10.1161/01.STR.28.4.809
  18. Erro ME, Gallego J, Herrera M et al. Isolated pontine infarcts: Etiopathogenic mechanisms. Eur J Neurol. 2005;12(12): 984-8. https://doi.org/10.1111/j.1468-1331.2005.01119.x
  19. Ahn YH, You SH, Randolph M et al. Peri-infarct reorganization of motor function in patients with pontine infarct. NeuroRehabilitation. 2006;21(3):233-7.
  20. Park JW, Kim SH, Kim YW et al. Motor control via spared peri-infarct corticospinal tract in patients with pontine infarct. J Comput Assist Tomogr. 2008;32(1):159-62. https://doi.org/10.1097/RCT.0b013e31814cf231
  21. Liang Z, Zeng J, Zhang C et al. Progression of pathological changes in the middle cerebellar peduncle by diffusion tensor imaging correlates with lesser motor gains after pontine infarction. Neurorehabil Neural Repair. 2009;23(7):692-8. https://doi.org/10.1177/1545968308331142
  22. Bellelli G, Morghen S, Tirelli V et al. Motor recovery after rehabilitation and long-term clinical outcomes. J Am Geriatr Soc. 2009;57(7):1300-1. https://doi.org/10.1111/j.1532-5415.2009.02310.x
  23. Hamzat TK, Peters GO. Motor function recovery and quality of life among stroke survivors in ibadan, nigeria. A 6-month follow-up study. Eur J Phys Rehabil Med. 2009;45(2):179-83.
  24. Jang SH, Kwon YH. Motor recovery in stroke patients. Yeungnam Univ J of Med. 2005;22(2):119-30.
  25. Schmahmann JD, Ko R, MacMore J. The human basis pontis: Motor syndromes and topographic organization. Brain. 2004; 127(6):1269-91. https://doi.org/10.1093/brain/awh138