White Matter Integrity as a Biomarker of Gait Recovery in Patients Post-Stroke

Patients with stroke often experience persistent motor impairments despite intensive rehabilitation. While previous research focused on the corticospinal tract (CST) as a biomarker for recovery post-stroke, this study investigated additional neural pathways involved in gait recovery using diffusion tensor imaging (DTI) in 16 patient's post-stroke. In an ongoing clinical trial, this project explored the relationship between DTI metrics and functional gait outcomes. Patients underwent functional assessments and a magnetic resonance image (MRI) before and after a 10-weeks of gait training intervention. Results showed significant improvement in all functional measures pre- to post-intervention. Baseline fractional anisotropy (FA) correlated with baseline functional measures and post-intervention improvements. Higher baseline FA of the lesioned CST was associated with better gait function at baseline (within 40 days of stroke). Higher FA in other pathways such as the lesioned hemisphere inferior fronto-occipital fasciculus (IFOF) and inferior longitudinal fasciculus (ILF) were associated with greater improvements in gait, including increased self-selected speed.Clinical Relevance- The findings highlight the importance of examining multiple pathways beyond the CST as a biomarker for gait recovery. These findings could inform rehabilitation strategies, focusing on interventions to improve white matter integrity in gait-recovery related pathways.