Activation changes in sensorimotor cortex during improvement due to CIMT in chronic stroke

作者：Rijntjes Michel^*; Hamzei Farsin; Glauche Volkmar; Saur Dorothee; Weiller Cornelius

来源：Restorative Neurology and Neuroscience, 2011, 29(5): 299-310.

DOI：10.3233/RNN-2011-0600

• Motor stroke
• recovery
• fMRI
• CIMT

Purpose: The integrity of the pyramidal tract (PT) does not seem to influence clinical improvement after two weeks of Constraint-Induced Movement Therapy (CIMT). However, when PT is intact, improvement is associated with a decrease of fMRI-activation in primary sensorimotor cortex (SMC) and when affected, with an increase of activation in SMC. The aim was to observe the long-term effect of CIMT, depending on the integrity of the PT, and to correlate improvement with changes in fMRI-activation.
Subjects and methods: Twelve new chronic stroke patients were treated with CIMT and integrity of PT was measured with transcranial magnetic stimulation. Before therapy, after therapy, and after 6 months, changes in motor function were correlated with differential and percent fMRI signal changes.
Results: All patients improved after two weeks of therapy, but only those with intact PT maintained improvement after 6 months. When PT was intact, improvement correlated with first a decrease of activation in SMC and after 6 months with an increase. When PT was affected, improvement consistently correlated with an increase in a lateral extension of SMC. Percent changes of activation were surrounded by differential changes.
Conclusions: An intact PT might be advantageous for lasting improvement after CIMT and subregions in SMC seem to behave differently during recovery.

• 出版日期2011