Functional versus Nonfunctional Rehabilitation in Chronic Ischemic Stroke: Evidences from a Randomized Functional MRI Study

Abstract

Motor rehabilitation of stroke survivors may include functional and/or nonfunctional strategy. The present study aimed to compare the effect of these two rehabilitation strategies by means of clinical scales and functional Magnetic Resonance Imaging (fMRI). Twelve hemiparetic chronic stroke patients were selected. Patients were randomly assigned a nonfunctional (NFS) or functional (FS) rehabilitation scheme. Clinical scales (Fugl-Meyer, ARA test, and modified Barthel) and fMRI were applied at four moments: before rehabilitation (P1) and immediately after (P2), 1 month after (P3), and three months after (P4) the end of rehabilitation. The NFS group improved significantly and exclusively their Fugl-Meyer scores at P2, P3, and P4, when compared to P1. On the other hand, the FS group increased significantly in Fugl-Meyer at P2, when compared to P1, and also in their ARA and Barthel scores. fMRI inspection at the individual level revealed that both rehabilitation schemes most often led to decreased activation sparseness, decreased activity of contralesional M1, increased asymmetry of M1 activity to the ipsilesional side, decreased perilesional activity, and decreased SMA activity. Increased M1 asymmetry with rehabilitation was also confirmed by Lateralization Indexes. Our clinical analysis revealed subtle differences between FS and NFS.

Neurofunctional changes after a single mirror therapy intervention in chronic ischemic stroke

“…39 Also, rehabilitation programs with functional and/or nonfunctional exercises observed decreased sparseness in fMRI activity maps, reflecting a decreased activity of the unaffected M1, decreased perilesional M1 activity. 6 These sub-acute MT modifications are consistent with previous fMRI studies that found changes in the motor cortex after many MT session. 10,14 For example, previous studies in stroke survivors suggests that the improved motor performance after 30-40 MT sessions is accompanied by increased activity of the affected M1.…”

“…[34][35][36][37] In line with these findings, an increasing number of studies have suggested that increased fMRI activity of the unaffected M1, with respect to the affected M1, is associated with poorer motor recovery. 6,10,[38][39][40][41][42] On the contrary, we found significant increased focal fMRI activity in the affected M1, and decreased activity in the unaffected M1, after a single MT intervention, with a more restricted M1 activity. [43][44][45] Furthermore, increasing evidence points to a widespread recruitment of brain regions early after the stroke insult, followed by a progressive reduction in this task-related recruitment over the course of rehabilitation sessions.…”

“…[43][44][45] Furthermore, increasing evidence points to a widespread recruitment of brain regions early after the stroke insult, followed by a progressive reduction in this task-related recruitment over the course of rehabilitation sessions. 6,39,46 For instance, an fMRI study in stroke observed a linear decrease in the size of unaffected M1 activity, along the course of a 2 weeks rehabilitation program with constraint-induced movement therapy, which correlated with the observed motor improvement. 39 Also, rehabilitation programs with functional and/or nonfunctional exercises observed decreased sparseness in fMRI activity maps, reflecting a decreased activity of the unaffected M1, decreased perilesional M1 activity.…”

“…Ischemic stroke is frequently accompanied by motor functions deficits, which evolves with limited spontaneous recovery particularly at the chronic stage of stroke (6 months after the insult). 1,2 During this stage, patients usually undergo motor rehabilitation programs [3][4][5][6] A promising rehabilitation approach is the use of mirror therapy (MT), which was originally designed and used to help alleviating phantom limb pain. 7 More recently, it has been tested as an adjuvant therapy in stroke motor rehabilitation.…”

Enhanced Functional Connectivity between the Bilateral Primary Motor Cortices after Acupuncture at Yanglingquan (GB34) in Right-Hemispheric Subcortical Stroke Patients: A Resting-State fMRI Study

“…The primary motor cortex (M1) is a brain region related with voluntary movement, which involves in motor function recovery. Abundant cross-sectional and longitudinal neuroimaging studies in subcortical stroke patients had confirmed that functional reorganization in the ipsilesional M1 existed (Pelicioni et al, 2016), and the resting-state functional connectivity (rsFC) between the bilateral M1s initially decreased and then it gradually increased during motor function recovery (Wang et al, 2010; Rehme et al, 2011; Zhang J. et al, 2014). …”