{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T18:26:43Z","timestamp":1787250403340,"version":"build-2736575974"},"reference-count":38,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"4","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Stroke"],"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND:<\/jats:title>\n                    <jats:p>Persistent compromised hand function is one of the most common long-term deficits after stroke. It is related to dysfunction of the primary motor cortex (M1) and corticospinal tract (CST) as assessed by magnetic resonance imaging-derived estimates of CST lesion load or by transcranial magnetic stimulation-derived measures, such as motor evoked potential (MEP) status. However, substantial interindividual variability remains with these measures. We tested whether a novel measure, mean motor disconnectivity (MMD), explains additional variation in the hand function of subacute stroke patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS:<\/jats:title>\n                    <jats:p>Thirty-two participants (15 M\/17 F; age, 58.6\u00b19.65 years) after unilateral ischemic stroke involving the CST and related upper extremity weakness were studied within 4 weeks of stroke in a cross-sectional study design at Emory University between 2015 and 2021. The primary outcome measure was skilled hand function assessed using the Jebsen-Taylor test. Gross hand function and proximal UE function were secondary outcome measures. Transcranial magnetic stimulation was used to measure MEP status. Lesion masks were hand-drawn on each participant\u2019s structural magnetic resonance imaging image and were used to calculate lesion volume, CST lesion load, and MMD across a 20-region bilateral motor network consisting of the precentral gyrus, postcentral gyrus, thalamus, caudate, putamen, and brainstem regions. MMD is the mean of the disconnection values across the 20\u00d720 nodes of this network of the adult human connectome; disconnection values quantify how severely a participant\u2019s lesion disrupts structural connectivity between region pairs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS:<\/jats:title>\n                    <jats:p>Univariable analysis indicated MEP status (MEP+\/\u2212), CST lesion load, and MMD were significantly correlated with preserved hand function; lesion volume was not. Adding MMD to a model containing MEP status significantly improved the fit of a multivariable model.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS:<\/jats:title>\n                    <jats:p>MMD explains additional variability in skilled hand function after accounting for MEP status, suggesting that disconnectivity measures capture stroke impact on motor areas beyond M1.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>REGISTRATION:<\/jats:title>\n                    <jats:p>\n                      URL:\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/www.clinicaltrials.gov\">https:\/\/www.clinicaltrials.gov<\/jats:ext-link>\n                      ; Unique identifier: NCT02544503.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/strokeaha.125.052559","type":"journal-article","created":{"date-parts":[[2026,1,7]],"date-time":"2026-01-07T10:00:14Z","timestamp":1767780014000},"page":"1057-1063","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Mean Motor Disconnectivity Predicts Hand Function Impairment After Stroke: Beyond Motor Cortex Output"],"prefix":"10.1161","volume":"57","clinical-trial-number":[{"clinical-trial-number":"nct02544503","registry":"10.18810\/clinical-trials-gov"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9497-7987","authenticated-orcid":true,"given":"Kate Pirog","family":"Revill","sequence":"first","affiliation":[{"name":"Department of Psychology, Emory University, Atlanta, GA (K.P.R.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5833-4471","authenticated-orcid":true,"given":"Elizabeth","family":"Rizor","sequence":"additional","affiliation":[{"name":"Department of Psychological &amp; Brain Sciences, University of California, Santa Barbara (E.R., S.T.G.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0235-362X","authenticated-orcid":true,"given":"Marc W.","family":"Haut","sequence":"additional","affiliation":[{"name":"Departments of Behavioral Medicine and Psychiatry, Neurology, and Radiology, Rockefeller Neuroscience Institute, West Virginia University, Morgantown (M.W.H.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4015-3151","authenticated-orcid":true,"given":"Scott T.","family":"Grafton","sequence":"additional","affiliation":[{"name":"Department of Psychological &amp; Brain Sciences, University of California, Santa Barbara (E.R., S.T.G.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6473-7800","authenticated-orcid":true,"given":"Cathrin M.","family":"Buetefisch","sequence":"additional","affiliation":[{"name":"Departments of Neurology, Rehabilitation Medicine, and Radiology, Emory University, Atlanta, GA (C.M.B.)."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1682\/jrrd.2005.04.0075"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.1523\/JNEUROSCI.5173-13.2014"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1523\/jneurosci.1161-23.2024"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/0165-0173(85)90005-0"},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.1152\/jn.1996.75.5.1826"},{"key":"e_1_3_3_7_2","doi-asserted-by":"crossref","first-page":"389","DOI":"10.1177\/107385849700300612","article-title":"Mechanisms of cortical control of hand function.","volume":"3","author":"Lemon R","year":"1997","unstructured":"Lemon R. Mechanisms of cortical control of hand function. Neuroscientist. 1997;3:389\u2013398","journal-title":"Neuroscientist"},{"key":"e_1_3_3_8_2","doi-asserted-by":"publisher","DOI":"10.1152\/jn.00130.2003"},{"key":"e_1_3_3_9_2","doi-asserted-by":"publisher","DOI":"10.1002\/cne.21940"},{"key":"e_1_3_3_10_2","doi-asserted-by":"publisher","DOI":"10.1177\/15459683231152816"},{"key":"e_1_3_3_11_2","doi-asserted-by":"publisher","DOI":"10.1177\/1545968319899911"},{"key":"e_1_3_3_12_2","doi-asserted-by":"publisher","DOI":"10.1152\/jn.00715.2017"},{"key":"e_1_3_3_13_2","doi-asserted-by":"publisher","DOI":"10.1177\/1747493017714176"},{"key":"e_1_3_3_14_2","doi-asserted-by":"publisher","DOI":"10.1002\/ana.24309"},{"key":"e_1_3_3_15_2","doi-asserted-by":"publisher","DOI":"10.1093\/brain\/awl333"},{"key":"e_1_3_3_16_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.110.599340"},{"key":"e_1_3_3_17_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.nicl.2019.101903"},{"key":"e_1_3_3_18_2","doi-asserted-by":"publisher","DOI":"10.1076\/jcen.20.3.310.823"},{"key":"e_1_3_3_19_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.2044-8260.1967.tb00530.x"},{"key":"e_1_3_3_20_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.neuroimage.2025.121347"},{"key":"e_1_3_3_21_2","first-page":"311","article-title":"An objective and standardized test of hand function.","volume":"50","author":"Jebsen RH","year":"1969","unstructured":"Jebsen RH, Taylor N, Trieschmann RB, Trotter MJ, Howard LA. An objective and standardized test of hand function. Arch Phys Med Rehabil. 1969;50:311\u2013319","journal-title":"Arch Phys Med Rehabil"},{"key":"e_1_3_3_22_2","doi-asserted-by":"publisher","DOI":"10.5014\/ajot.46.7.647"},{"key":"e_1_3_3_23_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.str.32.7.1635"},{"key":"e_1_3_3_24_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.str.31.12.2984"},{"key":"e_1_3_3_25_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.neuroimage.2018.09.060"},{"key":"e_1_3_3_26_2","doi-asserted-by":"publisher","DOI":"10.1162\/jocn.2007.19.7.1081"},{"key":"e_1_3_3_27_2","doi-asserted-by":"publisher","DOI":"10.1093\/cercor\/bhx066"},{"key":"e_1_3_3_28_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.neuroimage.2013.04.127"},{"key":"e_1_3_3_29_2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0048121"},{"key":"e_1_3_3_30_2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pbio.0060159"},{"key":"e_1_3_3_31_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.neuroimage.2017.12.039"},{"key":"e_1_3_3_32_2","doi-asserted-by":"publisher","DOI":"10.1093\/brain\/aws115"},{"key":"e_1_3_3_33_2","doi-asserted-by":"publisher","DOI":"10.1523\/JNEUROSCI.0196-21.2021"},{"key":"e_1_3_3_34_2","doi-asserted-by":"publisher","DOI":"10.1113\/JP281681"},{"key":"e_1_3_3_35_2","doi-asserted-by":"publisher","DOI":"10.3389\/fneur.2022.836716"},{"key":"e_1_3_3_36_2","doi-asserted-by":"publisher","DOI":"10.1016\/0304-3940(87)90083-8"},{"key":"e_1_3_3_37_2","doi-asserted-by":"publisher","DOI":"10.1113\/expphysiol.1991.sp003485"},{"key":"e_1_3_3_38_2","doi-asserted-by":"publisher","DOI":"10.1177\/17474930231203982"},{"key":"e_1_3_3_39_2","doi-asserted-by":"publisher","DOI":"10.1016\/bs.pbr.2014.12.010"}],"container-title":["Stroke"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ahajournals.org\/doi\/full\/10.1161\/STROKEAHA.125.052559","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T18:01:48Z","timestamp":1787248908000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ahajournals.org\/doi\/10.1161\/STROKEAHA.125.052559"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4]]},"references-count":38,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2026,4]]}},"alternative-id":["10.1161\/STROKEAHA.125.052559"],"URL":"https:\/\/doi.org\/10.1161\/strokeaha.125.052559","relation":{},"ISSN":["0039-2499","1524-4628"],"issn-type":[{"value":"0039-2499","type":"print"},{"value":"1524-4628","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4]]},"assertion":[{"value":"2025-06-17","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-12-09","order":1,"name":"revised","label":"Revised","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-12-18","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-01-07","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}