Washington University in St. Louis Washington University Open Scholarship Arts & Sciences Electronic Theses and Dissertations Arts & Sciences Summer 8-15-2016 Behavioral and Neurophysiological Mechanisms of Recovery Post-Stroke Lenny Eveline Ramsey Washington University in St. Louis Follow this and additional works at: https://openscholarship.wustl.edu/art_sci_etds Recommended Citation Ramsey, Lenny Eveline, "Behavioral and Neurophysiological Mechanisms of Recovery Post-Stroke" (2016). Arts & Sciences Electronic Theses and Dissertations. 886. https://openscholarship.wustl.edu/art_sci_etds/886 This Dissertation is brought to you for free and open access by the Arts & Sciences at Washington University Open Scholarship. It has been accepted for inclusion in Arts & Sciences Electronic Theses and Dissertations by an authorized administrator of Washington University Open Scholarship. For more information, please contact [email protected]. WASHINGTON UNIVERSITY IN ST. LOUIS Division of Biology and Biomedical Sciences Neurosciences Dissertation Examination Committee: Maurizio Corbetta, Chair Bradley Schlaggar Joshua Shimony Jin-Moo Lee Catherine Lang Behavioral and Neurophysiological Mechanisms of Recovery Post-Stroke by Lenny Eveline Ramsey A dissertation presented to the Graduate School of Arts & Sciences of Washington University in partial fulfillment of the requirements for the degree of Doctor of Philosophy August 2016 St. Louis, Missouri © 2016, Lenny Eveline Ramsey Table of Contents List of Figures ................................................................................................................................. v List of Tables ................................................................................................................................. vi Acknowledgments ......................................................................................................................... vii Abstract of Dissertation ................................................................................................................. ix Chapter 1: Introduction ................................................................................................................... 1 1.1 Why study stroke? ................................................................................................................. 1 Box 1: Basic information on lesions caused by stroke ......................................................................... 2 1.2 What behavioral deficits does a stroke cause? ...................................................................... 4 1.2.1 Motor ............................................................................................................................................ 5 1.2.2 Language ...................................................................................................................................... 6 1.2.3 Memory ........................................................................................................................................ 7 1.2.4 Attention ..................................................................................................................................... 10 1.3 Specific deficits or syndromes? ........................................................................................... 12 1.4 Recovery of behavioral deficits ........................................................................................... 14 1.4.1 How do stroke deficits recover? ................................................................................................. 14 Box 2. Types of behavioral recovery .................................................................................................. 16 1.4.2 Interhemispheric balance and behavioral recovery .................................................................... 17 1.4.3 A systems view on recovery ...................................................................................................... 19 Box 3: What is resting state fMRI? ..................................................................................................... 20 1.5 Neurophysiology of stroke recovery ................................................................................... 21 1.5.1 Why use resting state fMRI? ...................................................................................................... 21 1.5.2 What do we know about functional connectivity after stroke? .................................................. 23 1.6 Current objectives ............................................................................................................... 25 Chapter 2: Patterns of behavioral recovery across language, memory, motor and attention deficits after stroke .................................................................................................................................... 27 2.1 Abstract ............................................................................................................................... 28 2.2 Introduction ......................................................................................................................... 29 2.3 Methods ............................................................................................................................... 32 2.3.1 Subjects ...................................................................................................................................... 32 ii 2.3.2 Behavioral assessment ............................................................................................................... 34 2.3.3 Lesions ....................................................................................................................................... 36 2.3.4 Behavioral data reduction .......................................................................................................... 36 2.3.5 Recovery analyses ...................................................................................................................... 37 2.3.6 Prediction of chronic behavior ................................................................................................... 38 2.3.7 Effects of multiple deficits ......................................................................................................... 39 2.4 Results ................................................................................................................................. 40 2.4.1 Demographics and Lesion variables .......................................................................................... 42 2.4.2 Recovery of behavioral deficits within each domain ................................................................. 45 2.4.3 Prediction of chronic behavior ................................................................................................... 49 2.4.4 Effects of multiple deficits ......................................................................................................... 52 2.5 Discussion ........................................................................................................................... 53 2.5.1 Recovery patterns ....................................................................................................................... 54 2.5.2 Recovery of motor deficits ......................................................................................................... 55 2.5.3 Aphasia recovery ........................................................................................................................ 56 2.5.4 Recovery of memory deficits and neglect .................................................................................. 57 Chapter 3: Normalization of network connectivity in hemi-spatial neglect recovery .................. 59 3.1 Abstract ............................................................................................................................ 60 3.2 Introduction ...................................................................................................................... 61 3.3 Methods ............................................................................................................................ 63 3.3.1 Participants ................................................................................................................................. 63 3.3.2 Behavioral testing ...................................................................................................................... 65 3.3.3 Measures of spatial attention ...................................................................................................... 66 3.3.4 Functional magnetic resonance imaging (fMRI) scanning and data preprocessing .................. 67 3.3.5 Lesions ....................................................................................................................................... 68 3.3.6 Resting state functional connectivity networks and mapping .................................................... 68 3.3.7 Functional connectivity - behavior correlations ......................................................................... 68 3.3.8 Effects of Lag ............................................................................................................................. 70 3.4 Results .............................................................................................................................. 71 3.4.1 Lesion topography .....................................................................................................................