Research supports move toward better tailoring stroke rehabilitation

WASHINGTON – A new Georgetown University Medical Center study in collaboration with MedStar Health and the National Institutes of Health exploring a new brain imaging technique is bringing stroke experts a step closer to better tailoring rehabilitation.

Neurologists often use MRI images of the brain’s white matter to glean information about a person’s ability to recover, but a new imaging technique added to MRI allows clinicians to better see the condition of white matter tracts leading to the limbs, an observation usually only seen after death during an autopsy.

“A white matter tract called the corticospinal tract provides the main wiring that goes from your brain down to your spinal cord to help power your arms and legs,” explains study leader, Matthew A. Edwardson, MD, an associate professor of neurology at Georgetown University School of Medicine and a vascular neurologist and a member of the stroke team at MedStar Georgetown University Hospital. “If those cables are severed or atrophied, the person is not going to be able to regain meaningful use of their arms and legs – they wouldn’t have much motor strength.”

The imaging technique used by Edwardson and his colleagues is called diffusion tensor-based morphometry (DTBM). It combines directional information about the structures in the brain with the shape and size of the structures being imaged.  Previously it was difficult to separate the white matter cables from the gray matter using morphometry approaches because they did not include the directional information. This two-part technique allows researchers to map and quantify changes over time in the white matter tracts.

“To our knowledge, this is the first study to allow us to measure atrophy of these tracts in stroke survivors,” says Edwardson, a member of the Center for Brain Plasticity and Recovery, a joint collaboration between Georgetown University and MedStar National Rehabilitation Network.

He and colleagues from the National Institutes of Health (NIH) describe their findings in March 3, 2025 in the journal Neurology (“Association between changes in white matter volume detected with diffusion tensor-based morphometry and motor recovery after stroke”).

“Now, we can see if the cables have shrunk in size which would indicate that a stroke has caused enough damage to the brain to lead to the wiring becoming atrophied,” says Edwardson. “That observation is strongly correlated with how well somebody will recover. If there's a lot of atrophy in the brain in those cables, they're not going to have much ability to recover their arm function after a stroke.”

Edwardson says further studies would be needed before the observations could be used to tailor stroke rehabilitation.

“It would be helpful for the therapist to know at the time of admission to inpatient rehabilitation whether there's some likelihood of their patient regaining function,” he says. “If it is determined that the patient isn’t likely to recover meaningful motor use, then the therapist could change their strategy to perhaps focus on the unimpaired side with strategies to compensate for the disability.”

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Along with Edwardson co-authors of the publication are Amritha Nayak, ME, M. Okan Irfanoglu, PhD; and Carlo Pierpaoli, MD, PhD; of NIH’s National Institute of Biomedical Imaging and Bioengineering; and . Marie Luby, PhD; and Lawrence L. Latour, PhD; of NIH’s National Institute of Neurological Disorders and Stroke.

The authors report having no personal financial interests related to the study.

Funding  was received from the National Center for Advancing Translational Sciences (UL1TR000101), and Georgetown’s Clinical and Translational Science Award.