INS NYC 2024 Program

Poster	Poster Session 03 Program Schedule 02/15/2024 09:30 am - 10:40 am Room: Majestic Complex (Posters 61-120) Poster Session 03: Neurotrauma \| Neurovascular Final Abstract #84 Preliminary Findings from a Randomized Control Trial of Backwards Walking Training in Stroke: Functional Connectivity and Recovery Abigail Waters, Brain Rehabilitation Research Center, Gainesville, United States Kelly Hawkins, University of Florida, Gainesville, United States Ronald Cohen, Brain Rehabilitation Research Center, Gainesville, United States John Williamson, Brain Rehabilitation Research Center, Gainesville, United States Dorian Rose, Brain Rehabilitation Research Center, Gainesville, United States Category: Stroke/Cerebrovascular Injury and Disease (Adult) Keyword 1: neuroimaging: functional connectivity Keyword 2: stroke Objective: Backwards Walking Training (BWT) is a novel rehabilitation intervention to improve gait and balance deficits post-stroke, important in fall prevention and associated injury as well as in reducing cerebrovascular risk through increased physical activity. As a less automatic intervention with lack of visual flow, BWT may foster greater engagement of prefrontal networks. The purpose of this study is to present preliminary findings on the association between resting-state functional MRI (rs-fMRI) at baseline and improved physical functioning during an ongoing prospective, single-blind, randomized control trial of BWT dosage post-stroke. Participants and Methods: Individuals between 2- and 4-months post-stroke (N = 6) with unilateral gait and balance deficits (Berg Balance Scale < 42, 10-Meter gait speed < 0.8 m/s) were randomized into two BWT dose groups (18- and 27-sessions; N_group= 3). Mean age for the sample was 53.0 (SD = 14.8), with majority right-sided lesion in each group. Measures of gait and balance were collected at baseline and post-treatment: 10-Meter Walk Test, Functional Gait Assessment (FGA), and the Berg Balance Scale (BBS). Structural MRI (1mm³ T1-Weighted; 1.12mm³ FLAIR) and rs-fMRI (2.5mm³, TR = 1.5) were collected at an average of 125.7 days post-stroke (SD = 42.8), prior to BWT. Lesion masks were generated with ITK-SNAP, images were pre-processed and co-registered with FMRIPREP, and ROI-to-ROI functional connectivity (FC) analyses were performed in CONN with Threshold Free Cluster Enhancement (p_FDR < 0.05). Results: There were no differences in FC between groups at baseline. Stronger FC between the superior sensorimotor network and right prefrontal cortex [F(1,2) = 1455.58, p_FDR < 0.001] was associated with greater improvement on the FGA in the 18-session group (MΔ = 28%) but not the 27-session group (MΔ = 167%). In contrast, stronger FC between the right putamen and right supplementary motor area [F(1,2) = 2709.54, p_FDR < 0.001] was associated with greater improvement on the BBS in the 27-session group (MΔ = 27%) but not the 18-session group (MΔ = 16%). For the 10-Meter Walk Test, improvement in gait speed was associated with stronger FC between the left posterior parietal cortex and left prefrontal cortex in the 18-session group (MΔ = 16%), but not the 27-session group (MΔ = 9%), but this relationship did not survive correction for multiple comparisons [F(1,2) = 477.57, p_unc = 0.002]. Conclusions: Consistent with prior studies, preliminary data suggests that BWT is an effective intervention for gait and balance deficits post-stroke. This work provides new data that increased dosage of BWT may offset the impact of frontal control region FC, at baseline, on recovery of gait. Future research is needed to explore the relationship between FC and rehabilitation response, to help tailor rehabilitation interventions and improve prognosis.

Poster

02/15/2024
09:30 am - 10:40 am
Room: Majestic Complex (Posters 61-120)

Poster Session 03: Neurotrauma | Neurovascular

Final Abstract #84

Preliminary Findings from a Randomized Control Trial of Backwards Walking Training in Stroke: Functional Connectivity and Recovery

Abigail Waters, Brain Rehabilitation Research Center, Gainesville, United States
Kelly Hawkins, University of Florida, Gainesville, United States
Ronald Cohen, Brain Rehabilitation Research Center, Gainesville, United States
John Williamson, Brain Rehabilitation Research Center, Gainesville, United States
Dorian Rose, Brain Rehabilitation Research Center, Gainesville, United States

Category: Stroke/Cerebrovascular Injury and Disease (Adult)

Keyword 1: neuroimaging: functional connectivity
Keyword 2: stroke

Objective:

Backwards Walking Training (BWT) is a novel rehabilitation intervention to improve gait and balance deficits post-stroke, important in fall prevention and associated injury as well as in reducing cerebrovascular risk through increased physical activity. As a less automatic intervention with lack of visual flow, BWT may foster greater engagement of prefrontal networks. The purpose of this study is to present preliminary findings on the association between resting-state functional MRI (rs-fMRI) at baseline and improved physical functioning during an ongoing prospective, single-blind, randomized control trial of BWT dosage post-stroke.

Participants and Methods:

Individuals between 2- and 4-months post-stroke (N = 6) with unilateral gait and balance deficits (Berg Balance Scale < 42, 10-Meter gait speed < 0.8 m/s) were randomized into two BWT dose groups (18- and 27-sessions; N_group= 3). Mean age for the sample was 53.0 (SD = 14.8), with majority right-sided lesion in each group. Measures of gait and balance were collected at baseline and post-treatment: 10-Meter Walk Test, Functional Gait Assessment (FGA), and the Berg Balance Scale (BBS). Structural MRI (1mm³ T1-Weighted; 1.12mm³ FLAIR) and rs-fMRI (2.5mm³, TR = 1.5) were collected at an average of 125.7 days post-stroke (SD = 42.8), prior to BWT. Lesion masks were generated with ITK-SNAP, images were pre-processed and co-registered with FMRIPREP, and ROI-to-ROI functional connectivity (FC) analyses were performed in CONN with Threshold Free Cluster Enhancement (p_FDR < 0.05).

Results:

There were no differences in FC between groups at baseline. Stronger FC between the superior sensorimotor network and right prefrontal cortex [F(1,2) = 1455.58, p_FDR < 0.001] was associated with greater improvement on the FGA in the 18-session group (MΔ = 28%) but not the 27-session group (MΔ = 167%). In contrast, stronger FC between the right putamen and right supplementary motor area [F(1,2) = 2709.54, p_FDR < 0.001] was associated with greater improvement on the BBS in the 27-session group (MΔ = 27%) but not the 18-session group (MΔ = 16%). For the 10-Meter Walk Test, improvement in gait speed was associated with stronger FC between the left posterior parietal cortex and left prefrontal cortex in the 18-session group (MΔ = 16%), but not the 27-session group (MΔ = 9%), but this relationship did not survive correction for multiple comparisons [F(1,2) = 477.57, p_unc = 0.002].

Conclusions:

Consistent with prior studies, preliminary data suggests that BWT is an effective intervention for gait and balance deficits post-stroke. This work provides new data that increased dosage of BWT may offset the impact of frontal control region FC, at baseline, on recovery of gait. Future research is needed to explore the relationship between FC and rehabilitation response, to help tailor rehabilitation interventions and improve prognosis.