Dorsal premotor activity and connectivity relate to action selection performance after stroke

Compensatory activation in dorsal premotor cortex (PMd) during movement execution has often been reported after stroke. However, the role of PMd in the planning of skilled movement after stroke has not been well studied. The current study investigated the behavioral and neural response to the addition of action selection (AS) demands, a motor planning process that engages PMd in controls, to movement after stroke. Ten individuals with chronic, left hemisphere stroke and 16 age-matched controls made a joystick movement with the right hand under two conditions. In the AS condition, participants moved right or left based on an abstract, visual rule; in the execution only condition, participants moved in the same direction on every trial. Despite a similar behavioral response to the AS condition (increase in reaction time), brain activation differed between the two groups: the control group showed increased activation in left inferior parietal lobule (IPL) while the stroke group showed increased activation in several right/contralesional regions including right IPL. Variability in behavioral performance between participants was significantly related to variability in brain activation. Individuals post-stroke with relatively poorer AS task performance showed greater magnitude of activation in left PMd and dorsolateral prefrontal cortex (DLPFC), increased left primary motor cortex-PMd connectivity, and decreased left PMd-DLPFC connectivity. Changes in the premotor-prefrontal component of the motor network during complex movement conditions may negatively impact the performance and learning of skilled movement and may be a prime target for rehabilitation protocols aimed at improving the function of residual brain circuits after stroke. Hum Brain Mapp 37:1816-1830, 2016. © 2016 Wiley Periodicals, Inc.