Motor cortex plasticity during constraint-induced movement therapy in stroke patients

Liepert, Joachim; Miltner, Wolfgang H. R.; Bauder, H.; Sommer, Monika; Dettmers, Christian; Taub, Edward; Weiller, Cornelius

doi:10.1016/s0304-3940(98)00386-3

Cited by 625 publications

(405 citation statements)

References 17 publications

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“…This behavior demonstrates the recovery or regeneration of cortical connections in the motor network. Liepert et al., demonstrated that also in the chronic stage of stroke, reorganization of the motor cortical neurons still may continue as shown by increased MEPs and shift of cortical presentation [14].…”

Section: Introductionmentioning

confidence: 99%

Longitudinal study on modulated corticospinal excitability throughout recovery in supratentorial stroke

Julkunen

Könönen

Määttä

et al. 2016

Neuroscience Letters

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Longitudinal study on modulated corticospinal excitability throughout recovery in supratentorial stroke, Neuroscience Letters http://dx.doi.org/10. 1016/j.neulet.2016.02.014 This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. AbstractCorticospinal excitability (CSE) is modulated by stroke-induced lesions affecting the brain. This modulation is known to be dependent on the timing of the evaluation, and strongest abnormalities are often found in the acute stage. Our study aimed to characterize changes in CSE asymmetry between the affected and the unaffected hemisphere (AH and UH) during the first month after stroke onset and at 6 month follow-up. Neuronavigated transcranial magnetic stimulation (nTMS) was used to assess the CSE of the abductor pollicis brevis (APB) muscle of the hand and tibialis anterior (TA) muscle of the leg in 16 patients over 5 time-points. AH excitability recovered significantly during 6 months, whereas interhemispheric asymmetry remained significant up to 1 month post-stroke in the APB muscle. Greater initial CSE was associated with good motor function at 6 months. The motor cortical excitatory recovery initiated within week of the stroke and was most prominent within 1 month after stroke onset. Lesion size correlated with CSE of the UH at 10 days, while overall severity of the symptoms correlated inversely with CSE of the AH. This study demonstrates the quick improvement in the CSE via estimation of interhemispheric asymmetry; however, the recovery in the asymmetry continues to normalize even after reaching the threshold for normal values in CSE.

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Section: Introductionmentioning

confidence: 99%

Longitudinal study on modulated corticospinal excitability throughout recovery in supratentorial stroke

Julkunen

Könönen

Määttä

et al. 2016

Neuroscience Letters

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“…Transcranial magnetic stimulation (TMS) has gained considerable acceptance as a method to non-invasively study adaptive changes in motor cortex as a consequence of repeated practice or learning in able-bodied individuals (e.g., Tinazzi and Zanette 1998) and as a consequence of injury in individuals who have suffered strokes, limb amputation and spinal cord injury (e.g., Turton et al 1996;Liepert et al 1998;Capaday et al 2000;Park et al 2004). For example, effects of some rehabilitation techniques following brain injury have been evaluated by estimating the motor cortical area that is responsive to suprathreshold stimulation of a muscle of interest (e.g., Liepert et al 1998).…”

Section: Introductionmentioning

confidence: 99%

“…For example, effects of some rehabilitation techniques following brain injury have been evaluated by estimating the motor cortical area that is responsive to suprathreshold stimulation of a muscle of interest (e.g., Liepert et al 1998). However, motor evoked potentials (MEPs) recorded by EMG in response to the same stimulation intensity at a particular motor cortex site can be highly variable because of independent fluctuations in excitability of motor cortex neurons and of spinal interneurons and motor neurons at the time of stimulation (Kiers et al 1993;Thickbroom et al 1999).…”

Section: Introductionmentioning

confidence: 99%

Variability of motor potentials evoked by transcranial magnetic stimulation depends on muscle activation

2006

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The purpose of this research was to determine whether motor cortex excitability assessed using transcranial magnetic stimulation (TMS) is less variable when subjects maintain a visually controlled low-level contraction of the muscle of interest. We also examined the dependence of single motor evoked potential (MEP) amplitude on stimulation intensity and pre-stimulus muscle activation level using linear and non-linear multiple regression analysis. Eight healthy adult subjects received single pulse TMS over the left motor cortex at a point where minimal stimulation intensity was required to produce MEPs in extensor digitorum communis (EDC). Voluntary activation of the muscle was controlled by visual display of a target force (indicated by a stable line on an oscilloscope) and the isometric force produced as the subject attempted to extend the fingers (indicated by a line on the oscilloscope representing the finger extension force) while subjects were instructed to: exert zero extension force (0%) and produce forces equal to 5 and 10% of maximum voluntary finger extension under separate conditions. Relative variability (coefficient of variation) of single MEPs at a constant stimulus intensity and of pre-stimulus muscle EMG was lower during maintained 5 and 10% contractions than at 0% contraction levels. Therefore, maintaining a stable low intensity contraction helps stabilize cortical and spinal excitability. Multiple regression analyses showed that a linear dependence of single MEPs on stimulation intensity and pre-stimulus muscle activation level produced similar fits to those for a non-linear dependence on stimulus intensity and a linear dependence on pre-stimulus EMG. Thus, a simple linear method can be used to assess dependence of single MEP amplitudes on both stimulus intensity (to characterize slope of the recruitment curve) and low intensity background muscle activation level.

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“…An intense physiotherapeutic/behavioristic treatment (constraint-induced movement therapy) over a fortnight in chronic stroke patients reduces disability and use of the affected hand, which sustains after the treatment has stopped at least for the next 6 months. This functional improvement is accompanied by an increased excitability of primary motor cortex, due to a focal disinhibition (97)(98)(99) by transcranial magnetic stimulation. Musso et al (100) investigated correlations between the training-induced improvement of comprehension in stroke patients with chronic aphasia and changes in the activation pattern.…”

Section: Clinical Applications Of Fmrimentioning

confidence: 99%

Functional magnetic resonance imaging: A review of methodological aspects and clinical applications

Hennig¹,

Speck²,

Koch

et al. 2003

Magnetic Resonance Imaging

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This paper gives an overview of the recent literature on methodological developments of functional magnetic resonance imaging (fMRI) and recent trends in clinical applications. With the recent introduction of high-field systems and methodological developments leading to more robust signal behavior, fMRI is in a transition state from a research modality for use by experts to a standard procedure with useful applications in patient management. Compared to the use in neuroscientific research, which is often based on BOLD techniques alone, the application in patients is distinguished by a multiparametric characterization of the brain using a combination of several techniques. Neuronal fiber tracking based on diffusion anisotropy measurements, in particular, has already turned out to provide relevant supplementary information to the BOLD-based cortical activation maps.

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Motor cortex plasticity during constraint-induced movement therapy in stroke patients

Cited by 625 publications

References 17 publications

Longitudinal study on modulated corticospinal excitability throughout recovery in supratentorial stroke

Longitudinal study on modulated corticospinal excitability throughout recovery in supratentorial stroke

Variability of motor potentials evoked by transcranial magnetic stimulation depends on muscle activation

Functional magnetic resonance imaging: A review of methodological aspects and clinical applications

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