Rhythmic Bilateral Movement Training Modulates Corticomotor Excitability and Enhances Upper Limb Motricity Poststroke: A Pilot Study

Abstract

The recovery of coordinated motor function after stroke onset has been associated with the practice of upper limb movements that required the activation of homologous muscles. This pilot study investigated whether repetitive bimanual coordinated movements enhanced upper limb corticomotor (CM) excitability and motor function poststroke. Patients practiced driving their paretic wrist through passive rhythmical flexion-extension by active flexion-extension of their unaffected wrist using purpose-built manipulanda over a 4-week period. Both preintervention and postintervention motricity was assessed using the upper limb Fugl-Meyer rating scale, and cortical maps of wrist flexor and extensor representations were derived from potentials evoked by transcranial magnetic stimulation. Five of nine subjects improved upper limb motricity in response to this novel active-passive bimanual movement therapy (APBT). Unaffected cortical map volume decreased, especially for a subgroup of five patients who had a postintervention increase in motricity. No change in unaffected map volume was revealed for the four patients who did not improve their postintervention motricity. No consistent shifts in cortical map center of gravity were revealed. These findings suggest that APBT can initiate an improvement in motricity that is accompanied by a balancing of between-hemisphere CM excitability. The findings justify the assessment of the rehabilitative effects of APBT in a homogeneous sample of patients poststroke.

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.…”

Non-Invasive Brain Stimulation Improves Paretic Limb Force Production: A Systematic Review and Meta-Analysis

“…The affected side of the upper and lower extremities interferes with both unilateral and bilateral movements [1,2]. Typically, an inability to generate and modulate force production in paretic limbs causes movement control impairments such as compromised motor coordination, excessive movement variability, and motor dysfunctions evaluated by clinical assessments [3][4][5].…”

Bilateral Transcutaneous Electrical Nerve Stimulation Improves Lower‐Limb Motor Function in Subjects With Chronic Stroke: A Randomized Controlled Trial

“…The mechanisms that mediate the effects of bilateral intervention in subjects with stroke include rebalancing interhemispheric inhibition,20, 21, 22 activating the homologous neural networks in both hemispheres,23, 24 and recruiting the neural networks of the contralesional hemisphere 17, 23, 25. The use of transcranial magnetic stimulation in subjects with stroke, in which the maximum voluntary contraction of the nonparetic hand was combined with less‐forceful contraction of the paretic hand, increased the cortical excitability of the ipsilesional motor representation area of the hand when compared with contraction of the paretic hand alone 24.…”

“…Current evidence shows that bilateral intervention recruits spare neural substrates to enhance motor recovery17, 20, 21, 22, 23, 24, 25; we thus hypothesized that the application of TENS over both paretic and nonparetic legs (Bi‐TENS) might induce greater and earlier improvement in lower‐limb motor function than the use of Uni‐TENS in subjects with stroke. A literature search revealed that no study has compared the efficacy of Bi‐TENS+TOT and Uni‐TENS+TOT on motor recovery after stroke.…”