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Research paper
Brain regions important for recovery after severe post-stroke upper limb paresis
  1. Jane M Rondina1,
  2. Chang-hyun Park2,
  3. Nick S Ward1,3,4
  1. 1 Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology, University College London, London, UK
  2. 2 Department of Neurology, Ewha Medical Research Institute, Ewha Womans University School of Medicine, Seoul, Republic of Korea
  3. 3 Rehabilitation, The National Hospital for Neurology and Neurosurgery, London, UK
  4. 4 UCL Partners Centre for Neurorehabilitation, London, UK
  1. Correspondence to Dr Jane M Rondina, Sobell Department of Motor Neuroscience, University College London, Institute of Neurology 33 Queen Square, London WC1N 3BG, UK; j.rondina{at}, jmrondina{at}


Background The ability to predict outcome after stroke is clinically important for planning treatment and for stratification in restorative clinical trials. In relation to the upper limbs, the main predictor of outcome is initial severity, with patients who present with mild to moderate impairment regaining about 70% of their initial impairment by 3 months post-stroke. However, in those with severe presentations, this proportional recovery applies in only about half, with the other half experiencing poor recovery. The reasons for this failure to recover are not established although the extent of corticospinal tract damage is suggested to be a contributory factor. In this study, we investigated 30 patients with chronic stroke who had presented with severe upper limb impairment and asked whether it was possible to differentiate those with a subsequent good or poor recovery of the upper limb based solely on a T1-weighted structural brain scan.

Methods A support vector machine approach using voxel-wise lesion likelihood values was used to show that it was possible to classify patients as good or poor recoverers with variable accuracy depending on which brain regions were used to perform the classification.

Results While considering damage within a corticospinal tract mask resulted in 73% classification accuracy, using other (non-corticospinal tract) motor areas provided 87% accuracy, and combining both resulted in 90% accuracy.

Conclusion This proof of concept approach highlights the relative importance of different anatomical structures in supporting post-stroke upper limb motor recovery and points towards methodologies that might be used to stratify patients in future restorative clinical trials.

  • motor recovery
  • stroke
  • proportional recovery
  • corticospinal tract
  • lesion likelihood
  • support vector machine.

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  • Contributors JMR contributed to the study planning, conducted the analyses, elaborated the tables and figures and wrote the first draft of the manuscript. NSW collected the data, planned the study, interpreted the results and contributed to the manuscript writing. ChP preprocessed the images and contributed to the manuscript writing. All authors reviewed the manuscript.

  • Funding This research was funded by The Wellcome Trust (No. 088414) and supported by the National Institute for Health Research University College London Hospitals Biomedical Research Centre.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Ethics approval Joint Ethics Committee of the Institute of Neurology, UCL and National Hospital for Neurology and Neurosurgery, UCL Hospitals NHS Foundation Trust, London.

  • Provenance and peer review Not commissioned; externally peer reviewed.