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Updated: Jul 17, 2026
Motor Imagery Brain-Computer Interface in Rehabilitation of Upper Limb Motor Dysfunction After Stroke
Published on: September 1, 2023
Initial motor impairment influences activation pattern of motor recovery
Masahito Kobayashi1, Hideichi Takayama, Ban Mihara
1Department of Neurosurgery, Keio University School of Medicine, Tokyo, Japan. mkobayas@sc.itc.keio.ac.jp
Objectives:
We investigated the functional magnetic resonance imaging (fMRI) activation pattern of a motor task in patients with acute subcortical lesions to examine the relationship between activation pattern and recovery of motor impairment.
Methods:
Five patients (one with subcortical infarction and four with thalamic hemorrhage) were examined using fMRI 1 month after the insult. Impairment was assessed by the Medical Research Council motor strength classification (MRC). One patient with severe motor deficits was also studied at 4 months when her motor deficits improved up to MRC grade 4.
Results:
Three patients with relatively mild deficits (MRC grade 3 or 4) at their onsets, improved fully up to grade 5 within 1 month. FMRI performed at 1 month showed activation in the contralateral primary motor cortex and supplementary motor area (SMA), but no significant activation was seen on the ipsilateral unaffected side. Two patients with severe motor impairment (MRC grade 1) improved up to 3 and 4 of MRC at 1 month or later. They showed activation of the ipsilateral premotor area as well as contralateral primary motor cortex and SMA. One of them, whose severe motor deficit improved at 4 month, also showed activation of the ipsilateral postcentral gyrus and the activated area expanded longitudinally corresponding with her functional recovery.
Discussion:
Our study demonstrates that the fMRI pattern varies according to functional recovery, suggesting the importance of the ipsilateral premotor area and postcentral gyrus especially for those patients with severe motor impairment initially.
Insights
Functional magnetic resonance imaging (fMRI) reveals brain activation patterns linked to motor recovery after subcortical lesions. Ipsilateral premotor area and postcentral gyrus activation are crucial for severe motor impairment recovery.
Area of Science:
- Neuroscience
- Neurology
- Radiology
Background:
- Subcortical lesions, such as infarction and hemorrhage, can cause significant motor impairment.
- Understanding brain plasticity and functional reorganization is key to predicting motor recovery.
Purpose of the Study:
- To investigate functional magnetic resonance imaging (fMRI) activation patterns during a motor task in patients with acute subcortical lesions.
- To examine the relationship between fMRI activation patterns and the recovery of motor impairment.
Main Methods:
- Five patients (subcortical infarction/thalamic hemorrhage) underwent fMRI 1 month post-insult.
- Motor impairment was assessed using the Medical Research Council (MRC) motor strength scale.
- One patient with severe deficits was studied longitudinally at 4 months.
Main Results:
- Mildly impaired patients (MRC 3-4) showed contralateral motor cortex/SMA activation and full recovery.
- Severely impaired patients (MRC 1) exhibited ipsilateral premotor cortex and contralateral motor cortex/SMA activation.
- Improved motor function correlated with expanded ipsilateral postcentral gyrus activation in one severe case.
Conclusions:
- fMRI activation patterns correlate with motor functional recovery after subcortical lesions.
- The ipsilateral premotor area and postcentral gyrus are vital for motor recovery, particularly in severe cases.
