Functional Magnetic Resonance Imaging in Predicting Post-Stroke Rehabilitation Outcomes: a Pilot Clinical Study

INTRODUCTION. Determining the rehabilitation potential (RP) after ischemic stroke (IS) is a key aspect for predicting the restoration of impaired functions and selecting appropriate rehabilitation strategies. Currently, there is no universal and reliable method for assessing RP. Existing protocols are primarily designed to predict outcomes in the acute phase of IS and lack sufficient specificity and sensitivity. Functional magnetic resonance imaging (fMRI) may be considered a potential method for RP assessment. AIM. To evaluate the feasibility of using fMRI as a predictor of functional recovery following IS. MATERIALS AND METHODS. The study included 34 patients (age 62.0 [58.0; 65.0] years) in the early recovery period after IS, presenting with hemi- or monoparesis scored between 2 and 4 on the MRC scale, who underwent medical rehabilitation (MR) at the S.I. Spasokukotsky Moscow Centre for Research and Practice in Medical Rehabilitation, Restorative and Sports Medicine for 12 days. All patients received kinesiotherapy and physiotherapy. To assess baseline status and track changes in functional impairments, the following scales were used: MRCS, MAS, FMA, NHPT, FAT, ARAT, BBT, TUG, Tinetti, BBS, RMI, BI. All participants underwent fMRI with a simple motor task for each limb to evaluate the degree of activation in the cerebral cortex. RESULTS AND DISCUSSION. Upon completion of the MR course, statistically significant improvements were observed in the Tinetti, NHPT, BBT, BBS, FMA-UE, RMI, BI, TUG, ARAT, FAT, MRCS scales (p 0.01). Patients with higher cortical activation showed better outcomes in FMA-UE scores, although no statistically significant differences were found compared to those with lower cortical activation. Distinct activation patterns in specific brain areas were observed during the performance of elementary motor tasks. Increased activity in the affected hemisphere during paretic limb movements was associated with a trend toward better recovery, though this did not reach statistical significance (p = 0.056). In patients with low activation of the affected hemisphere, ipsilateral cerebellar hemisphere activation was additionally observed during movement of the paretic hand. CONCLUSION. The study results do not provide sufficient evidence to confirm the reliability of fMRI in predicting functional recovery. Further research is required to evaluate the effectiveness of this method in clinical practice.