Introduction: White matter hyperintensities (WMH) are commonly associated with balance and gait disturbances. Little is known whether WMH may affect post-stroke balance and gait recovery. We aim to investigate the association of post-stroke balance and gait recovery with imaging marker of WMH on magnetic resonance imaging (MRI). Methods: This prospective cohort study will enroll consecutive patients with first-ever ischemic hemisphere stroke, between September 2023 and December 2024. Clinical data will be collected on day 30 ± 3 and at 3 months after stroke onset. WMH on FLAIR are graded according to the modified Fazekas scale. Resting-state functional MRI (rs-fMRI) and diffusion tensor imaging (DTI) will be acquired to evaluate functional and structural connectivity. The primary endpoint is balance recovery, defined as a Postural Assessment Scale for Stroke score of 32 or higher at 3 months. The secondary endpoint is gait recovery, assessed using the modified Fugl-Meyer Gait Assessment at 3 months. We will investigate the association of post-stroke balance and gait recovery with WMH severity as well as WMH-related functional and structural connectivity. Conclusion: The study may contribute to clarify the effect of WMH on post-stroke balance and gait disorder recovery.

Bower K, Thilarajah S, Pua Y-H, Williams G, Tan D, Mentiplay B, et al. Dynamic balance and instrumented gait variables are independent predictors of falls following stroke. J NeuroEng Rehabil. 2019;16(1):3.
Marsden JF, Playford DE, Day BL. The vestibular control of balance after stroke. J Neurol Neurosurg Psychiatry. 2005;76(5):670–8.
Yang J, Wong A, Wang Z, Liu W, Au L, Xiong Y, et al. Risk factors for incident dementia after stroke and transient ischemic attack. Alzheimers Dement. 2015;11(1):16–23.
Ryu W-S, Woo S-H, Schellingerhout D, Jang MU, Park K-J, Hong K-S, et al. Stroke outcomes are worse with larger leukoaraiosis volumes. Brain. 2017;140(1):158–70.
Lau KK, Li L, Schulz U, Simoni M, Chan KH, Ho SL, et al. Total small vessel disease score and risk of recurrent stroke: validation in 2 large cohorts. Neurology. 2017;88(24):2260–7.
Ntaios G, Lip GYH, Lambrou D, Papavasileiou V, Manios E, Milionis H, et al. Leukoaraiosis and stroke recurrence risk in patients with and without atrial fibrillation. Neurology. 2015;84(12):1213–9.
Sharma B, Wang M, McCreary CR, Camicioli R, Smith EE. Gait and falls in cerebral small vessel disease: a systematic review and meta-analysis. Age Ageing. 2023;52(3):afad011.
Dai S, Piscicelli C, Lemaire C, Christiaens A, Schotten MT, Hommel M, et al. Recovery of balance and gait after stroke is deteriorated by confluent white matter hyperintensities: cohort study. Ann Phys Rehabil Med. 2022;65(1):101488.
Cao X, Wang Z, Chen X, Liu Y, Abdoulaye IA, Ju S, et al. Changes in resting-state neural activity and nerve fibres in ischaemic stroke patients with hemiplegia. Brain Topogr. 2023;36(2):255–68.
van den Heuvel MP, Hulshoff Pol HE. Exploring the brain network: a review on resting-state fMRI functional connectivity. Eur Neuropsychopharmacol. 2010;20(8):519–34.
Cai M, Jacob MA, Norris DG, Duering M, de Leeuw F-E, Tuladhar AM. Cognition mediates the relation between structural network efficiency and gait in small vessel disease. Neuroimage Clin. 2021;30:102667.
Crockett RA, Hsu CL, Dao E, Tam R, Alkeridy W, Eng JJ, et al. Mind the gaps: functional networks disrupted by white matter hyperintensities are associated with greater falls risk. Neurobiol Aging. 2022;109:166–75.
Folstein MF, Folstein SE, McHugh PR. “Mini-mental state.” A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975;12(3):189–98.
Di Monaco M, Trucco M, Di Monaco R, Tappero R, Cavanna A. The relationship between initial trunk control or postural balance and inpatient rehabilitation outcome after stroke: a prospective comparative study. Clin Rehabil. 2010;24(6):543–54.
Lindmark B, Hamrin E. Evaluation of functional capacity after stroke as a basis for active intervention. Presentation of a modified chart for motor capacity assessment and its reliability. Scand J Rehabil Med. 1988;20(3):103–9.
Soulard J, Huber C, Baillieul S, Thuriot A, Renard F, Aubert Broche B, et al. Motor tract integrity predicts walking recovery: a diffusion MRI study in subacute stroke. Neurology. 2020;94(6):e583–93.
Wang Y, Tang R, Wang H, Yu X, Li Y, Wang C, et al. The validity and reliability of a new intelligent three-dimensional gait analysis system in healthy subjects and patients with post-stroke. Sensors. 2022;22(23):9425.
Allali G, Launay CP, Blumen HM, Callisaya ML, De Cock A-M, Kressig RW, et al. Falls, cognitive impairment, and gait performance: results from the GOOD initiative. J Am Med Dir Assoc. 2017;18(4):335–40.
Fazekas F, Chawluk JB, Alavi A, Hurtig HI, Zimmerman RA. MR signal abnormalities at 1.5 T in Alzheimer’s dementia and normal aging. AJR Am J Roentgenol. 1987;149(2):351–6.
Ashburner J, Friston KJ. Voxel-based morphometry--the methods. Neuroimage. 2000;11(6 Pt 1):805–21.
Zang Y, Jiang T, Lu Y, He Y, Tian L. Regional homogeneity approach to fMRI data analysis. Neuroimage. 2004;22(1):394–400.
Zou Q-H, Zhu C-Z, Yang Y, Zuo X-N, Long X-Y, Cao Q-J, et al. An improved approach to detection of amplitude of low-frequency fluctuation (ALFF) for resting-state fMRI: fractional ALFF. J Neurosci Methods. 2008;172(1):137–41.
Smith SM, Jenkinson M, Johansen-Berg H, Rueckert D, Nichols TE, Mackay CE, et al. Tract-based spatial statistics: voxelwise analysis of multi-subject diffusion data. Neuroimage. 2006;31(4):1487–505.
Zecevic AA, Salmoni AW, Speechley M, Vandervoort AA. Defining a fall and reasons for falling: comparisons among the views of seniors, health care providers, and the research literature. Gerontologist. 2006;46(3):367–76.
Hayes AF. Beyond baron and kenny: statistical mediation analysis in the new mill ennium. Commun Monogr. 2009/12//;76(4):408–20.
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