Motor cortex plasticity during forced-use therapy in stroke patients: a preliminary study

Abstract

Treatment-induced plastic changes were investigated in the brains of stroke patients in the subacute stage of illness. Nine patients participated in 1 week of conventional physiotherapy. In the subsequent week conventional physiotherapy was combined with forced-use therapy. Focal transcranial magnetic stimulation was used to determine the motor output areas of the abductor pollicis brevis muscles prior to the treatment and after the first and after the second week. Motor performance was evaluated using the Nine Hole Peg Test, the Frenchay Arm Test and vigorometry to measure the grip strength. Before treatment the cortical representation area of the paretic hand muscle was significantly smaller than the contralateral side. This difference persisted after the first week of physiotherapy. In contrast, the motor output map in the affected hemisphere was significantly enlarged after forced-use therapy. This increase in motor cortex excitability was accompanied by a significant improvement in dexterity. Across the two treatment weeks the centres of the motor output maps shifted significantly stronger in the affected hemisphere than in unaffected hemisphere, suggesting the recruitment of adjacent brain areas. We conclude that the combination of forced-use therapy and conventional physiotherapy enhances motor cortex excitability and improves motor performance compared to a preceding conventional physiotherapy alone. Due to the small number of patients and the lack of a control group, these results are preliminary observations and require replication in a larger sample.

Effects of a Rostral Motor Cortex Lesion on Primary Motor Cortex Hand Representation Topography in Primates

“…Motor cortical representations of the muscles of the affected arm increased in size after 2 weeks of CI therapy treatment. 50,55 The present study complements the results of CI therapy treatments. In both sets of experiments, adaptive cortical changes were maximally achieved by intensive training of the impaired hand after the cortical injury.…”

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.…”

Nogo Receptor Antagonism Promotes Stroke Recovery by Enhancing Axonal Plasticity

“…It is likely that both anatomical changes in the pattern of existing connectivity and altered electrical patterns in stable connections account for these shifts in activation patterns during specific tasks. There is some evidence that plasticity and recovery after stroke can be enhanced in the subacute phase by focused training regimens (van der Lee et al, 1999;Bland et al, 2001;Liepert et al, 2001;Wolf et al, 2002) or by increased monoaminergic activation with D-amphetamine (Hurwitz et al, 1991;Walker-Batson et al, 1995;Stroemer et al, 1998;Knecht et al, 2001;Sonde et al, 2001;Walker-Batson et al, 2001). Inosine and FGF treatments have also been reported to increase axonal plasticity and functional recovery from stroke in rodents (Kawamata et al, 1997;Chen et al, 2002); however, there is currently no clinically useful pharmacological method to enhance stroke recovery.…”