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. PURPOSE: The primary objective 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. POPULATION: A prospective observational cohort of 140 consecutive patients with moderate-to-severe acute stroke in 4 centers in Spain(2), the United States(1), and New Zealand(2). METHODS: MRI examinations will be done using 1.5T or 3T scanners; anatomical sequences, DTI, and resting state-fMRI will be acquired. Several clinical scales will provide comprehensive information about biological, psychological, and social factors through the evaluation of motor function, emotional state, cognitive status, and ability to perform activities of daily living at admission and 6-months follow-up. In the GIRONA, HARVARD and AUCKLAND cohorts, patients (n=60+20+20) 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.

1/1/2018 - 31/12/2020

http://www.ccma.cat/tv3/marato/projectes-financats/2016/1070/