Stroke+

IDENTIFYING CHANGES IN BRAIN STRUCTURE AND FUNCTION BENEFICIAL FOR POST-STROKE MOTOR RECOVERY


Relevant for Research Area

C - Applications


Summary

Reliably predicting the individual course of recovery after stroke is essential for a successful implementation of tailored rehabilitative treatments Identifying the anatomical preconditions and physiological mechanisms in the lesioned brain that are beneficial for rehabilitation is hence a major challenge in human stroke research.

Given the heterogeneity of stroke-associated deficit patterns, a large database of longitudinal datasets is key. The STROKE+ project therefore utilized a multidimensional longitudinal approach combining comprehensive clinical and behavioral data with multi-modal MR-imaging acquired at the acute, subacute, and chronic stage. 

 

In plain numbers, the STROKE+ database covers assessments from more than 500 acute stroke patients. Building on this, >15 peer-reviewed journal publications have been generated. Several strands of analyses were pursued towards understanding the determinants post-stroke outcome. Voxel-based lesion-behavior mapping analyses were used to evaluate associations between lesion locations and different types of stroke-associated motor, language, spatial and memory, attention, executive deficits in the acute phase. Task-based and resting-state functional MRI[Office1]  enabled to (i) identify regions with potentially compensatory activity in acute and chronic patients and (ii) to find stroke-induced changes in network activity in the acute phase that are predictive of the course of recovery. Analyses of white matter integrity disclosed the role of disrupted association fibers for post-stroke deficits. Finally, novel methodical approaches were explored to extend hitherto unimodal modality-specific analyses towards multi-variate multi-modal analyses integrating structural and functional indices of stroke-induced alterations in brain integrity.

Taken together, the STROKE+ project has revealed substantial new insights into the stroke-induced structural and functional changes underlying impairment and recovery. The large-scale and comprehensive STROKE+ database will constitute an outlasting foundation for future research and progress towards a better understanding of the network effects of stroke-induced brain lesions and their impact on individual post-stroke outcome.



Publications and Achievements

Peer reviewed publications

Akin B, Lee HL, Hennig J, LeVan P. (2017). Enhanced subject-specific resting-state network detection and extraction by using fast fMRI. Human Brain Mapping 38(2): 817-830.

Beume LA, Hieber M, Kaller CP, Nitschke K, Bardutzky J, Urbach H, Weiller C, Rijntjes M (2018). Large vessel occlusion in acute stroke: Cortical symptoms are more sensitive prehospital indicators than motor deficits. Stroke 49: 2323-2329.

Beume LA, Martin M, Kaller CP, Kloppel S, Schmidt CS, Urbach H, Egger K, Rijntjes M, Weiller C, Umarova RM. (2016). Visual neglect after left-hemispheric lesions: a voxel-based lesion-symptom mapping study in 121 acute stroke patients. Experimental Brain Research 235(1): 83-95.

Beume LA, Kaller CP, Hoeren M, Kloppel S, Kuemmerer D, Glauche V, Kostering L, Mader I, Rijntjes M, Weiller C, Umarova R (2015). Processing of bilateral versus unilateral conditions: evidence for the functional contribution of the ventral attention network. Cortex 66: 91-102.

Dressing A, Nitschke K, Kummerer D, Bormann T, Beume L, Schmidt CSM, Ludwig VM, Mader I, Willmes K, Rijntjes M, Kaller CP, Weiller C, Martin M (2017). Distinct contributions of dorsal and ventral streams to imitation of tool-use and communicative gestures. Cereb Cortex 28(2): 474-492.

Dressing A, Kaller CP, Nitschke K, Beume LA, Kummerer D, Schmidt CSM, Bormann T, Umarova RM, Egger K, Rijntjes M, Weiller C, Martin M. Neural correlates of acute apraxia: evidence from lesion data and functional MRI in stroke patients.  Cortex. 2019 May 18;120:1-21.

 Hamzei F, Vry MS, Saur D, Glauche V, Hoeren M, Mader I, Weiller C, Rijntjes M (2016) The Dual-Loop Model and the Human MIrror Neuron System: an exploratory combined fMRI and DTI Study of the inferior frontal gyrus. Cerebral Cortex 26: 2215- 24

Hoeren M, Kummerer D, Bormann T, Beume L, Ludwig VM, Vry MS, Mader I, Rijntjes M, Kaller CP, Weiller C. (2014). Neural bases of imitation and pantomime in acute stroke patients: distinct streams for praxis. Brain 137(Pt 10): 2796-810.

LeVan P, Akin B, Hennig J (2018). Fast imaging for mapping dynamic networks. Neuroimage 180: 547-558.

Loosli SV, Bormann T, Mader I, Martin M, Schumacher LV, Katzev M, Weiller C, Kaller CP. Dissociation among preserved resistance to proactive interference and impaired behavioral inhibition in a patient with bilateral lesions in the inferior frontal gyrus: A single-case study. Cortex. 2019 Apr 12;119:111-127

Malherbe C, Umarova RM, Zavaglia M, Kaller CP, Beume L, Thomalla G, Weiller C, Hilgetag CC (2018). Neural correlates of visuospatial bias in patients with left hemisphere stroke: a causal functional contribution analysis based on game theory. Neuropsychologia 115: 142-153.

Martin M, Beume L, Kummerer D, Schmidt CS, Bormann T, Dressing A, Ludwig VM, Umarova RM, Mader I, Rijntjes M, Kaller CP, Weiller C. (2016). Differential Roles of Ventral and Dorsal Streams for Conceptual and Production-Related Components of Tool Use in Acute Stroke Patients. Cereb Cortex 26(9): 3754-71.

Martin M, Dressing A, Bormann T, Schmidt CS, Kummerer D, Beume L, Saur D, Mader I, Rijntjes M, Kaller CP, Weiller C. (2018). Componential Network for the Recognition of Tool-Associated Actions: Evidence from Voxel-based Lesion-Symptom Mapping in Acute Stroke Patients. Cereb Cortex 27(8): 4139-4152.

Martin M, Nitschke K, Beume L, Dressing A, Buhler LE, Ludwig VM, Mader I, Rijntjes M, Kaller CP, Weiller C. (2016). Brain activity underlying tool-related and imitative skills after major left hemisphere stroke. Brain 139(Pt 5): 1497-516.

Schmidt CSM, Schumacher LV, Romer P, Leonhart R, Beume L, Martin M, Dressing A, Weiller C, Kaller CP (2017). Are semantic and phonological fluency based on the same or distinct sets of cognitive processes? Insights from factor analyses in healthy adults and stroke patients. Neuropsychologia 99: 148-155.

Schmidt CSM, Nitschke K, Bormann T, Romer P, Kummerer D, Martin M, Umarova RM, Leonhart R, Egger K, Dressing A, Musso MC, Willmes K, Weiller C, Kaller CP. Dissociating frontal and temporal correlates of phonological and semantic fluency in a large sample of left hemisphere stroke patients. Neuroimage Clin. 2019 Apr 25;23:101840.

Umarova RM, Nitschke K, Kaller CP, Kloppel S, Beume L, Mader I, Martin M, Hennig J, Weiller C. (2016). Predictors and signatures of recovery from neglect in acute stroke. Annals of Neurology 79(4): 673-86.

Umarova RM, Reisert M, Beier TU, Kiselev VG, Kloppel S, Kaller CP, Glauche V, Mader I, Beume L, Hennig J, Weiller C (2014). Attention-network specific alterations of structural connectivity in the undamaged white matter in acute neglect. Human Brain Mapping 35(9): 4678-92.

Umarova RM, Beume L, Reisert M, Kaller CP, Kloppel S, Mader I, Glauche V, Kiselev VG, Catani M, Weiller C (2017). Distinct white matter alterations following sever stroke: longitudinal DTI study in neglect. Neurology 88(16): 1546-1555.

 Wiesmeier IK, Dalin D, Wehler A, Granacher U, Muehlbauer T, Dietterle J, Weiller C,  Gollhofer A, Maurer C (2017) Balance training enhances vestibular function and reduces overactive proprioreceptive feedback in elderly. Fron Aging Neurosci 11: 273

List of conference abstracts (posters and talks)

Beume LA, Hoeren M, Kaller CP, Klöppel S, Schmidt C, Urbach H, Rijntjes M, Weiller C, Umarova RM (2015). Lesion imprint for visual neglect and extinction to the right – a voxel-based study in 128 left hemisphere stroke patients. Poster presented at the 24th European Stroke Conference, 05/2015; Wien.

Beume LA, Hoeren M, Kaller CP, Urbach H, Rijntjes M, Umarova RM, Weiller C (2017). Das visuell-räumliche Aufmerksamkeitssystem im Zweischleifenmodell. Talk presented at the Annual meeting of the German Society for Clinical Neurophysiology (DGKN), 03/2013, Leipzig.

Conterno M, Kümmerer D, Kaller CP, Weiller C (2017). Apraxia of speech and oral apraxia: a voxel-based lesion-symptom mapping study on acute stroke patients. Talk presented at the Annual meeting of the German Society for Neurology (DGN, 09/2017), Leipzig.

Dressing A, Beume L, Kümmerer D, Schmidt CSM, Bormann T, Mader I, Rijntjes M, Kaller CP, Weiller C, Martin M (2015). The dual loop system in imitation of transitive and intransitive gestures - a VLSM approach. Poster presented at the Meeting of Organization for Human Brain Mapping (OHBM), 06/2015, Honolulu.

Dressing A, Beume L, Schmidt CSM, Kümmerer D, Bormann T, Rijntjes M, Kaller CP, Weiller C, Martin M (2016). Brain activity after acute left hemispheric stroke in imitation and tool-associated actions. Poster presented at the Annual meeting of the German Society for Clinical Neurophysiology and Neuroimaging (DGKN), 03/2016, Düsseldorf.

Dressing A, Kaller CP, Nitschke K, Beume LA, Kümmerer D, Schmidt CSM, Bormann T, Umarova RM, Egger K, Rijntjes M, Weiller C, Martin M (2017). Early brain reorganization during recovery from apraxia after left-hemispheric stroke. Talk presented at the Annual meeting of the German Society for Neurology (DGN), 09/2017, Leipzig.

Dressing A, Kaller CP, Nitschke K, Beume LA, Kümmerer D, Schmidt CSM, Bormann T, Umarova RM, Egger K, Rijntjes M, Weiller C, Martin M (2017). Brain activity related to tool-associated actions: a fMRI study in acute stroke patients. Talk presented at the Annual meeting of the European academy of Neurology (EAN), 06/2017, Amsterdam.

Dressing A, Martin M, Kaller CP, Nitschke K, Beume LA, Kümmerer D, Musso C, Bormann T, Egger K, Rijntjes M, Weiller C (2018). Anatomische Prädiktoren für Erholung bei Apraxien: eine longitudinale Läsionsstudie in Schlaganfall-Patienten. Talk presented at the Annual meeting of the German Society for Neurology (DGN), 11/2018, Berlin.

Dressing A, Nitschke K, Kümmerer D, Bormann T, Beume L, Schmidt CSM, Ludwig VM, Mader I, Willmes K, Rijntjes M, Kaller CP, Weiller C, Martin M (2015). Distinct contributions of dorsal and ventral streams to imitation of transitive and intransitive gestures: Evidence from acute stroke patients. Talk presented at the Annual meeting of the German Society for Clinical Neurophysiology (DGKN), 03/2015, Düsseldorf.

Hören M, Kümmerer D, Bormann T, Beume L, Ludwig VM, Vry MS, Kaller CP, Weiller C (2014). Apraxia in acute stroke patients: Pantomime and imitation rely on partly separated brain networks. Poster presented at the Annual meeting of the German Society for Clinical Neurophysiology (DGKN), 03/2014, Berlin.

Huang D, Hieber M, Kaller C, Beume L, Dressing A, Martin M, Musso C, Schmidt C, Kümmerer D, Hennig J, Weiller C, LeVan P (2017). Resting-state fMRI connectivity biomarkers of functional impairments and recovery in a large cohort of stroke patients. Talk presented at the Annual Meeting of the Organization for Human Brain Mapping (OHBM), 06/2017, Vancouver.

Kümmerer D (2015). Funktionsverlust und Restitution im Sprachsystem nach (akutem) Schlaganfall - Untersuchungen mit struktureller und funktionaler Bildgebung. Talk presented at the Jahreskongress des Deutschen Bundesverbandes für Logopädie, 06/2015, Düsseldorf.

Kümmerer D (2016). Netzwerkorganisation von Sprache bei Gesunden und bei Patienten mit Aphasie. Talk presented at the 5. Forschungssymposium des Deutschen Bundesverbandes für Logopädie und des Deutschen Bundesverbandes der akademischen Sprachtherapeuten, 03/2016, Brühl.

Kümmerer D (2017). Phonemic and semantic paraphasias in acute aphasic patients. Poster presented at the Science of Aphasia meeting, 09/2017, Genf.

Kümmerer D (2017). Schädigungen im Zweischleifenmodell bei Patienten mit Aphasie. Talk presented at the Annual meeting of the German Society for Neurology (DGN, 09/2017), Leipzig.

Kümmerer D, Bormann T, Glauche V, Mader I, Rijntjes M, Saur D, Schelter B, Weiller C (2013). Schädigungen der Assoziationsfasersysteme bei Patienten mit akuter Aphasie. Poster presented at the Annual meeting of the German Society for Clinical Neurophysiology (DGKN), 03/2013, Leipzig.

Kümmerer D, Stockert A, Wrede K, Hartwigsen G, Mader I, Weiller C, Saur D (2013). Dynamics of language reorganization after stroke in patients with left frontal lesions. Talk presented at the Annual Meeting der Academy of Aphasia, 10/2013, Luzern.

Kümmerer D, Weiller C (2016). Classification of language impairments in acute aphasic patients. Poster presented at the Annual Meeting of the Society for the Neurobiology of Language, 08/2016, London.

Kümmerer, D (2015). Aphasia symptoms and syndromes in the context of the dual-loop model. Talk presented at the Brain.Lesion.Anatomy Symposium, 11/2015, Freiburg.

Martin M (2016). Recognition and production of tool use in acute stroke patients. Talk presented at the Annual meeting of the German Society for Clinical Neurophysiology (DGKN), 03/2016, Düsseldorf.

Martin M (2017). Die Rolle des ventralen Wegs für die Apraxie. Talk presented at the Annual meeting of the German Society for Clinical Neurophysiology (DGKN), 03/2013, Leipzig.

Martin M (2017). Korrelate erhaltener kognitiv-motorischer Funktionen nach linkshemispheralem Schlaganfall und Erholung von Apraxie. Talk presented at the Annual meeting of the German Society for Clinical Neurophysiology (DGKN), 03/2013, Leipzig.

Musso M, Gutierrez D.L., Sautter R., Rombach F, Weiller. C. Anatomical correlates for speech and music perception: Evidence from patients with focal left or right cerebral lesions. Talk presented at the Annual meeting of the German Society for Neurology (DGN, 09/2017 München)

Nitschke K, Schmidt CSM, Martin M, Egger K, Weiller C, Kaller CP (2016). Testing dissociations in lesion-symptom mapping: A tool for non-parametric interaction efects (NIX). Poster presented at the 22nd Annual Meeting of the Organization for Human Brain Mapping (OHMB), 06/ 2016, Geneva.

Schmidt CSM, Kaller CP (2017). Semantische und phonologische Wortflüssigkeit: Neue Daten zu alten Hypothesen. Talk presented at the Annual Meeting of the German Society of Neuropsychology (GNP), 09/2017, Konstanz.

Schmidt CSM, Köstering L, Nitschke K, Schumacher FK, Weiller C, Kaller CP (2014). Effects of item difficulty on the test-retest reliability of the verbal fluency task. Poster presented at the Annual Meeting of the German Society of Neurology (DGN), 09/2014, Munich.

Schmidt CSM, Köstering L, Nitschke K, Schumacher FK, Weiller C, Kaller CP (2014). The retest-reliability of the verbal fluency task and the impact of item difficulty. Poster presented at the 2014 Psychologie und Gehirn Meeting, 06/2014, Luebeck.

Schwaderlapp N, Akin B, Beume L, Schmidt C, Hören M, Kaller C, Korvink J, Egger K, Urbach H, Weiller C, Hennig J, LeVan P (2015). Dynamic resting-state fMRI connectivity reflects behavioral measures in stroke patients. Talk presented at the Annual Meeting of the Organization for Human Brain Mapping (OHBM), 06/2015, Honolulu.