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Predictors and brain connectivity changes associated with arm motor function improvement from intensive practice in
George F Wittenberg1, Lorie G Richards2, Lauren M Jones-Lush3
1Department of Veterans Affairs (VA) Maryland Health Care System, Geriatrics Research, Education and Clinical Center, and Maryland Exercise & Robotics Center of Excellence, Baltimore, MD, 21201, USA; Departments of Neurology, Physical Therapy and Rehabilitation Science, Internal Medicine, Older Americans Independence Center, University of Maryland, Baltimore, MD, 21201, USA.
F1000Research
|April 4, 2017
Summary
Brain imaging and nerve stimulation can predict stroke recovery. Increased connectivity in motor networks after therapy suggests potential for improved motor function and rehabilitation strategies.
Area of Science:
- Neuroscience
- Rehabilitation Medicine
- Clinical Neurophysiology
Background:
- Brain changes driving motor function improvement after stroke are not well understood.
- Measuring motor system physiology in clinical trials is feasible and useful.
Purpose of the Study:
- To assess the feasibility and utility of measuring motor system physiology during upper extremity rehabilitation in chronic stroke patients.
- To investigate the relationship between neurophysiological measures and functional recovery.
Main Methods:
- Substudy of two multi-center trials involving robotic and conventional arm therapy for chronic stroke.
- Transcranial magnetic stimulation (TMS) measured motor cortical output.
- Magnetic resonance imaging (MRI) assessed cortical anatomy, fractional anisotropy, and resting-state blood oxygenation (BOLD) for connectivity analysis.
- Functional status evaluated using Fugl-Meyer and Wolf Motor Function Test.
Main Results:
- Motor evoked potential (MEP) presence correlated with better outcomes, though not significantly when controlling for baseline impairment.
- Internal capsule fractional anisotropy on the affected side predicted baseline function.
- Increased correlation between affected primary motor cortex (M1) and frontal motor regions observed post-therapy.
- Resting-state connectivity between affected M1 and dorsal premotor area (PMAd) predicted recovery.
Conclusions:
- Motor evoked potentials and M1-PMAd functional connectivity may predict stroke recovery.
- Intensive arm therapy (robotic or conventional) shows a trend towards increased motor network functional connectivity.