Research Article| Volume 32, ISSUE 3, 106937, March 2023

Investigation of inpatient convalescent rehabilitation outcomes in branch atheromatous disease


      • We explored the convalescent rehabilitation outcomes after LSA-BAD and PPA-BAD with both neurological severity and ADLs.
      • Convalescent rehabilitation outcomes of BAD should be assessed in terms of improvements in pure-motor hemiparesis and ADLs.
      • The disturbance patterns in the corticospinal tract by ischemic lesions may be different between LSA-BAD and PPA-BAD.



      We investigated inpatient convalescent rehabilitation outcomes of Branch atheromatous disease (BAD).

      Subjects and methods

      The subjects were 116 patients with lenticulostriate artery territory - BAD (LSA-BAD) and 29 with paramedian pontine artery territory - BAD (PPA-BAD). For all patients, the National Institutes of Health Stroke Scale (NIHSS), Functional Independence Measure (FIM) scores, and Brunnstrom recovery stages (BRS) of the upper limb, fingers, and lower limb were measured on admission and at discharge.


      There were no significant differences in clinical characteristics on admission between the LSA-BAD and PPA-BAD groups. The neurological severity of PPA-BAD, as measured by the NIHSS, was significantly milder compared with that of LSA-BAD upon admission (p = 0.015) and at discharge (p = 0.001). Patients with LSA-BAD had significantly less improvement in the BRS of the upper limb (p = 0.001), fingers (p < 0.001), and lower limb (p = 0.007) at discharge. Furthermore, they had significantly smaller changes in BRS between admission and discharge for the upper limb (p = 0.033) and fingers (p = 0.014) compared with patients with PPA-BAD. The improvement in BRS for patients with LSA-BAD tended to be limited to two stages; however, both patients with LSA-BAD and PPA-BAD saw sufficient gains in FIM at discharge.


      Rehabilitation outcomes following BAD in the convalescent period should be assessed in terms of improvements in pure-motor hemiparesis and activities of daily living. Furthermore, the disturbance patterns in the corticospinal tract by ischemic stroke lesions may be different between LSA-BAD and PPA-BAD.


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        • Caplan LR.
        Intracranial branch atheromatous disease: a neglected, understudied, and underused concept.
        Neurology. 1989; 39: 1246-1250
        • Yamamoto Y
        • Ohara T
        • Hamanaka M
        • et al.
        Characteristics of intracranial branch atheromatous disease and its association with progressive motor deficits.
        J Neurol Sci. 2011; 304: 78-82
        • Nakase T
        • Yamamoto Y
        • Takagi M
        • et al.
        The impact of diagnosing branch atheromatous disease for predicting prognosis.
        J Stroke Cerebrovasc Dis. 2015; 24: 2423-2428
        • Kwan MW
        • Mak W
        • Cheung RT
        • et al.
        Ischemic stroke related to intracranial branch atheromatous disease and comparison with large and small artery diseases.
        J Neurol Sci. 2011; 303: 80-84
        • Nannoni S
        • Del Bene A
        • Palumbo V
        • et al.
        Predictors of progression in patients presenting with minor subcortical stroke.
        Acta Neurol Scand. 2015; 132: 304-309
        • Klein IF
        • Lavallée PC
        • Schouman-Claeys E
        • et al.
        Highresolution MRI identifies basilar artery plaques in paramedian pontine infarct.
        Neurology. 2005; 64: 551-552
        • Cho ZH
        • Kang CK
        • Han JY
        • et al.
        Observation of the lenticulostriate arteries in the human brain in vivo using 7.0T MR angiography.
        Stroke. 2008; 39: 1604-1606
        • Ryoo S
        • Lee MJ
        • Cha J
        • et al.
        Differential vascular pathophysiologic types of intracranial atherosclerotic stroke: a high-resolution wall magnetic resonance imaging study.
        Stroke. 2015; 46: 2815-2821
        • Niimi M
        • Abo M
        • Miyano S
        • et al.
        Comparison of functional outcome between lacunar infarction and branch atheromatous disease in lenticulostriate artery territory.
        J Stroke Cerebrovasc Dis. 2016; 25: 2271-2275
        • Kim SK
        • Song P
        • Hong JM
        • et al.
        Prediction of progressive motor deficits in patients with deep subcortical infarction.
        Cerebrovasc Dis. 2008; 25: 297-303
        • Yamada M
        • Yoshimura S
        • Kaku Y
        • et al.
        Prediction of neurologic deterioration in patients with lacunar infarction in the territory of the lenticulostriate artery using perfusion CT.
        Am J Neuroradiol. 2004; 25: 402-408
        • Serena J
        • Leira R
        • Castillo J
        • Pumar JM
        • et al.
        Neurological deterioration in acute lacunar infarctions: the role of excitatory and inhibitory neurotransmitters.
        Stroke. 2001; 32: 1154-1161
        • Castellanos M
        • Castillo J
        • García MM
        • et al.
        Inflammation-mediated damage in progressing lacunar infarctions.
        Stroke. 2002; 33: 982-987
        • Audebert HJ
        • Pellkofer TS
        • Wimmer ML
        • et al.
        Progression in lacunar stroke is related to elevated acute phase parameters.
        Eur Neurol. 2004; 5: 125-131
        • Kim YS
        • Lee KY
        • Koh SH
        • et al.
        The role of matrix metalloproteinase 9 in early neurological worsening of acute lacunar infarction.
        Eur Neurol. 2006; 55: 11-15
        • Yamamoto Y
        • Ohara T
        • Hamanaka M
        • et al.
        Predictive factors for progressive motor deficits in penetrating artery infarctions in two different arterial territories.
        J Neurol Sci. 2010; 288: 170-174
        • Ohara T
        • Yamamoto Y
        • Tamura A
        • et al.
        The infarct location predicts progressive motor deficits in patients with acute lacunar infarction in the lenticulostriate artery territory.
        J Neurol Sci. 2010; 293: 87-91
        • van Swieten JC
        • Koudstaal PJ
        • Visser MC
        • et al.
        Interobserver agreement for the assessment of handicap in stroke patients.
        Stroke. 1988; 19: 604-607
        • Mahoney FI
        • Barthel DW.
        Functional evaluation: the Barthel Index.
        Md State Med J. 1965; 14: 61-65
        • Goldstein LB
        • Samsa GP.
        Reliability of the national institutes of health stroke scale. Extension to nonneurologists in the context of a clinical trial.
        Stroke. 1997; 28: 307-310
        • Granger CV
        • Cotter AC
        • Hamilton BB
        • et al.
        Functional assessment scales: a study of persons after stroke.
        Arch Phys Med Rehabil. 1993; 74: 133-138
        • Brunnstrom S
        Movement Therapy in Hemiplegia. A Neurophysiological Approach.
        Harper & Row, New York1970
        • Liberati A
        • Altman DG
        • Tetzlaff J
        • et al.
        The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration.
        BMJ. 2009; 339: b2700
        • Nakase T
        • Yoshioka S
        • Sasaki M
        • et al.
        Clinical evaluation of lacunar infarction and branch atheromatous disease.
        J Stroke Cerebrovasc Dis. 2013; 22: 406-412
        • Nakase T
        • Yamamoto Y
        • Takagi M
        Japan branch atheromatous disease registry collaborators. The impact of diagnosing branch atheromatous disease for predicting prognosis.
        J Stroke Cerebrovasc Dis. 2015; 24: 2423-2438
        • The Joint Committee on Guidelines for the Management of Stroke
        Japanese Guidelines for the Management of Stroke 2009.
        (In: Shinohara Y, Ogawa A, Suzuki N, et al, eds.) Kyowakikaku, Tokyo, Japan2009
        • Mutai H
        • Furukawa T
        • Araki K
        • Misawa K
        • Hanihara T.
        Factors associated with functional recovery and home discharge in stroke patients admitted to a convalescent rehabilitation ward.
        Geriatr Gerontol Int. 2012; 12: 215-222
        • Safaz I
        • Yilmaz B
        • Ya?ar E
        • Alaca R
        Brunnstrom recovery stage and motricity index for the evaluation of upper extremity in stroke: analysis for correlation and responsiveness.
        Int J Rehabil Res. 2009; 32: 228-231
        • Huang CY
        • Lin GH
        • Huang YJ
        • Song CY
        • Lee YC
        • How MJ
        • Chen YM
        • Hsueh IP
        • Chen MH
        • Hsieh CL.
        Improving the utility of the Brunnstrom recovery stages in patients with stroke: Validation and quantification.
        Medicine (Baltimore). 2016; 95: e4508
        • Dromerick AW
        • Edwards DF
        • Diringer MN.
        Sensitivity to changes in disability after stroke: a comparison of four scales useful in clinical trials.
        J Rehabil Res Dev. 2003; 40: 1-8
        • Takahashi Y
        • Yamashita T
        • Morihara R
        • et al.
        Different characteristics of anterior and posterior branch atheromatous diseases with or without early neurologic deterioration.
        J Stroke Cerebrovasc Dis. 2017; 26: 1314-1320
        • Hashimoto K
        • Higuchi K
        • Nakayama Y
        • et al.
        Ability for basic movement as an early predictor of functioning related to activities of daily living in stroke patients.
        Neurorehabil Neural Repair. 2007; 21: 353-357
        • Shimodozono M
        • Noma T
        • Nomoto Y
        • et al.
        Benefits of a repetitive facilitative exercise program for the upper paretic extremity after subacute stroke: a randomized controlled trial.
        Neurorehabil Neural Repair. 2013; 27: 296-305
      1. Parent A: Carpenter's Human Neuroanatomy.
        9th ed. Media: Williams & Wilkins, 1996: 383-389
        • Kim JS
        • Lee JH
        • Im JH
        • et al.
        Syndromes of pontine base infarction. A clinical-radiological correlation study.
        Stroke. 1995; 26: 950-955
        • Kumral E
        • Bayülkem G
        • Evyapan D
        Clinical spectrum of pontine infarction. Clinical-MRI correlations.
        J Neurol. 2002; 249: 1659-1670
        • Konishi J
        • Yamada K
        • Kizu O
        • et al.
        MR tractography for the evaluation of functional recovery from lenticulostriate infarcts.
        Neurology. 2005; 64: 108-113
        • Beck E
        The origin, course and termination of the prefronto-pontine tract in the human brain.
        Brain. 1950; 73: 368-391
        • Dum RP
        • Strick PL
        Motor areas in the frontal lobe of the primate.
        Physiol Behav. 2002; 77: 677-682
        • Grässel D
        • Ringer TM
        • Fitzek C
        • et al.
        Wallerian degeneration of pyramidal tract after paramedian pons infarct.
        Cerebrovasc Dis. 2010; 30: 380-388
        • Koyama T
        • Marumoto K
        • Miyake H
        • et al.
        Relationship between diffusion tensor fractional anisotropy and motor outcome in patients with hemiparesis after corona radiata infarct.
        J Stroke Cerebrovasc Dis. 2013; 22: 1355-1360
        • Puig J
        • Blasco G
        • Schlaug G
        • et al.
        Diffusion tensor imaging as a prognostic biomarker for motor recovery and rehabilitation after stroke.
        Neuroradiology. 2017; 59: 343-351
        • Saeki S
        • Ogata H
        • Hachisuka K
        • et al.
        Association between location of the lesion and discharge status of ADL in first stroke patients.
        Arch Phys Med Rehabil. 1994; 75: 858-860
        • Beloosesky Y
        • Streifler JY
        • Burstin A
        • et al.
        The importance of brain infarct size and location in predicting outcome after stroke.
        Age Ageing. 1995; 24: 515-518
        • Pappalardo A
        • Ciancio MR
        • Patti F
        Is the basic trunk control recovery different between stroke patients with right and left hemiparesis?.
        NeuroRehabilitation. 2014; 35: 215-220
        • Ween JE
        • Alexander MP
        • D'Esposito M
        • et al.
        Factors predictive of stroke outcome in a rehabilitation setting.
        Neurology. 1996; 47: 388-392
        • Deguchi I
        • Hayashi T
        • Kato Y
        • et al.
        Treatment outcomes of tissue plasminogen activator infusion for branch atheromatous disease.
        J Stroke Cerebrovasc Dis. 2013; 22: e168-e172