Impairment–oriented training and adaptive motor cortex reorganisation after stroke: a fTMS study

Abstract

In a sample of 28 subacute anterior circulation ischemic stroke patients with severe arm paresis, reduced motor cortex excitability (increased motor thresholds, reduced MEP amplitudes, reduced number of active points) and a reduced conduction velocity in the corticospinal system were found in the affected hemisphere. At the same time motor cortex topology for the abductor pollicis brevis (APB) representation was comparable for the affected and non-affected hemisphere. Considerable arm motor recovery (Fugl-Meyer test) was observed when assessed four weeks later after a period of rehabilitation intervention. Motor cortex excitability and conduction velocity in the corticospinal system improved in the affected hemisphere. In addition, APB representation showed a medial shift in patients with such a representation at pre test (n=14). Multiple stepwise regression indicated that of all transcranial magnetic stimulation (TMS) parameters only the medial shift of the motor cortex map predicted motor recovery. Assessing the effect of training time (non-intensified vs. intensified therapy) and type of arm training (Bobath approach vs. Arm BASIS training) with a randomised controlled design revealed that the impairment-oriented Arm BASIS training improved motor control more than the control conditions. In addition, patients of the group receiving the Arm BASIS training with an APB representation at pre test showed a medial shift of the motor cortex map and improved conduction times. In conclusion, changes in motor cortex topology were likely to be relevant for motor recovery and might have been induced by the impairment-oriented training.

The Effectiveness of the Bobath Concept in Stroke Rehabilitation

“…Thus, based on this selection, 21 studies were excluded and 18 studies proceeded for further analysis (Figure). This number was reduced to 16 because Langhammer and Stanghelle 39,40 and Platz et al 41,42 refer to the same data; therefore, these 4 papers have been considered as 2 studies.…”

“…38,39,41,43,44,45,49,50,[51][52][53] Seven studies used blinding of all subjects. 38,39,43,44,48,51,52 Eleven studies used independent assessors for outcomes 38,39,41,43-46,48 -51 In 11 studies, 85% of the subjects were measured for at least one key outcome, 38,39,[41][42][43][44][45]48,49,53,54 whereas in 10 studies, an intentionto-treat analysis was performed. 38,39,41,[43][44][45][46]48,49,53 The results of between-group statistical comparison were reported in all studies.…”

Movement-dependent stroke recovery: A systematic review and meta-analysis of TMS and fMRI evidence

“…Our literature search identified 28 relevant training studies that quantified neural plasticity changes for further analysis to determine if inclusion in this meta-analysis was appropriate (Brouwer & Ambury, 1994;Carey et al, 2002;Cramer, 2004;Cramer et al, 1999;Cramer et al, 1997;Foltys et al, 2003;Jang et al, 2003;Jang et al, 2005;Könönen et al, 2005;Koski et al, 2004;Levy et al, 2001;Liepert, Bauder et al, 2000;Liepert, Graef et al, 2000;Liepert et al, 2001;Lindberg et al, 2004;Luft et al, 2004;Muellbacher et al, 2002;Nelles, 2004;Nelles et al, 2001;Newton et al, 2002;Park et al, 2004;Platz et al, 2005;Schaechter et al, 2002;Seitz et al, 2004;Sonde et al, 2001;Stinear & Byblow, 2004;Wittenberg et al, 2003). For meta-analysis inclusion, each article was originally examined for changes in neural representation measured in four areas of interest: (1) primary motor cortex (M1), (2) supplementary motor area, (3) dorsal premotor area, and (4) cingulate area.…”

“…The 13 remaining studies (Carey et al, 2002;Jang et al, 2003;Jang et al, 2005;Könönen et al, 2005;Koski et al, 2004;Liepert, Bauder et al, 2000;Liepert et al, 2001;Luft et al, 2004;Muellbacher et al, 2002;Nelles et al, 2001;Platz et al, 2005;Schaechter et al, 2002;Stinear & Byblow, 2004) used upper extremity training as a rehabilitation treatment while testing stroke subjects in both the sub-acute and chronic stages of recovery. The necessary data from the 13 treatment studies were extracted by two authors and separately confirmed by the other three authors of this meta-analysis.…”

Application of Multiple Sensor Data Fusion for the Analysis of Human Dynamic Behavior in Space: Assessment and Evaluation of Mobility-Related Functional Impairments

“…The proprioceptive and exteroceptive sensory information data are transduced by sensory structures that in turn transfer a subset of their information to the central nervous system which, following yet another transformation, issues a set of motor commands [4] [6] [8]. The mechanical coupling between musculoskeletal elements and the muscles controlling them is yet another transformation of information in the system [14] [15] [16] [17]. The control problem revolves around the specific transfer functions that describe each transformation [6] [14] [15].…”