Neuroplastic changes in resting-state functional connectivity after stroke rehabilitation

You'll have to read this yourself.  I am most interested in this statement;

All participants received 5 min of tone(spasticity) normalization for the arm at the beginning of therapy. (Your doctor will need to get that protocol.)

Neuroplastic changes in resting-state functional connectivity after stroke rehabilitation

ORIGINAL RESEARCH
published: 06 October 2015doi: 10.3389/fnhum.2015.00546
Neuroplastic changes in resting-state functional connectivity after stroke rehabilitation
Yang-teng Fan
1†
 , Ching-yi Wu
 2,3†
 , Ho-ling Liu
4,5
 , Keh-chung Lin
1,6
*, Yau-yau Wai
7,8
 and Yao-liang Chen
8
1
School of Occupational Therapy, College of Medicine, National Taiwan University and Division of Occupational Therapy,Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan,
 2
Department of Occupational Therapy and Graduate Institute of Behavioral Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan,
 3
Healthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan,
 4
Department of Imaging Physics, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX, USA,
5
Department of Medical Imaging and Radiological Sciences, Chang Gung University, Taoyuan, Taiwan,
 6
Department of Physical Medicine and Rehabilitation, Division of Occupational Therapy, National Taiwan University Hospital, Taipei, Taiwan,
7
Department of Diagnostic Radiology, Chang Gung Memorial Hospital, Keelung, Taiwan,
 8
MRI Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
 Most neuroimaging research in stroke rehabilitation mainly focuses on the neural mechanisms underlying the natural history of post-stroke recovery.However,connectivity mapping from resting-state fMRI is well suited for different neurological conditions and provides a promising method to explore plastic changes for treatment-induced recovery from stroke. We examined the changes in resting-state functional connectivity (RS-FC) of the ipsilesional primary motor cortex (M1) in 10 post-acute stroke patients before and immediately after 4 weeks of robot-assisted bilateral arm therapy (RBAT). Motor performance, functional use of the affected arm, and daily function improvedin all participants. Reduced interhemispheric RS-FC between the ipsilesional andcontralesional M1 (M1-M1) and the contralesional lateralized connections were noted before treatment. In contrast, greater M1-M1 functional connectivity and disturbed resting-state networks were observed after RBAT relative to pretreatment. Increased changes in M1-M1 RS-FC after RBAT were coupled with better motor and functional improvements. Mediation analysis showed the pre-to-post difference in M1-M1 RS-FC was a significant mediator for the relationship between motor and functional recovery. These results show neuroplastic changes and functional recoveries induced by RBAT in post-acute stroke survivors and suggest that interhemispheric functional connectivity in the motor cortex may be a neurobiological marker for recovery after stroke rehabilitation.
Much more at link until you get to these results.
 

 Results
Clinical Measures
The results of the FMA-UL, WMFT-FAS, and FIM are presented in
 Table 1
. All participants had substantial deficits in motor performance, functional use of the ULs, and daily function before treatment.The results showed that there were significant differences between pretreatment and post-treatment at the corrected level of significance ( p < 0.017) on all clinical measures. The paired Wilcoxon test on the FMA-UL total scores revealed that participants showed significant improvements in levels of motor impairment from pre-treatment to the end of RBAT (Z = 2.82, p = 0.005). Moreover, the WMFT-FAS and FIM data indicatedthat eligible participants had better motor function (Z  = 2.81, p=0.005)andrunctional independence(Z =2.80, p=0.005) after RBAT relative to pre-treatment.
Functional Connectivity Results
The paired Wilcoxon test on the value of the M1-M1 RS-FCshowed that participants had significantly increased M1-M1functional connectivity from pre-treatment to the end of RBAT(Z  = 2.80, p = 0.005). A one sample t-test showed that for the ipsilesional M1pre-treatment, participants had positive RS-FC with the bilateral middle frontal gyrus, bilateral cerebellum, bilateral inferior frontal gyrus, bilateral thalamus, ipsilesional angular gyrus,ipsilesional posterior cingulate cortex, ipsilesional superiorfrontal gyrus, contralesional M1, contralesional caudatenucleus, and contralesional precuneus. Moreover, negativeRS-FC was observed before treatment between the ipsilesionalM1 and the bilateral middle temporal gyrus, ipsilesionalsomatosensory cortex ipsilesional SMA, ipsilesional insula,ipsilesional superior parietal lobule, and contralesional M1(Figure 1A and Table 2). Upon completion of RBAT, positiveRS-FC with the ipsilesional M1 was seen in the bilateralsomatosensory cortex (SI/SII), bilateral posterior cingulatecortex, bilateral cerebellum, bilateral thalamus, ipsilesionalSMA, ipsilesional middle temporal gyrus, contralesional M1,contralesional inferior frontal gyrus, contralesional caudatenucleus, contralesional medial prefrontal cortex, contralesionalanterior cingulate cortex (ACC), and contralesional middlefrontal gyrus. However, participants had negative RS-FCbetween the ipsilesional M1 and the ipsilesional inferior frontalgyrus, ipsilesional middle frontal gyrus, ipsilesional superiorfrontal gyrus, contralesional temporal pole, contralesionalinferior temporal gyrus, and contralesional insula after RBAT(Figure 1B and Table 2).
Figure 2
 shows the maps exhibiting significant differences in RS-FC between pre-treatment and post-treatment. Thesebrain regions are summarized in
 Table 3
. When compared with post-treatment, greater RS-FC of the ipsilesional M1 withcontralesional-lateralized brain regions was observed before treatment (Figure 2A). In contrast, increases in RS-FC were observed between the ipsilesional M1 seed and bilateral medial prefrontal cortex, bilateral M1, bilateral cerebellum,bilateral superior temporal gyrus, ipsilesional middle temporal gyrus, ipsilesional inferior parietal lobule (IPL), ipsilesional SMA, ipsilesional posterior cingulate cortex, ipsilesional SI/SII, ipsilesional caudate nucleus, contralesional ACC, contralesional insula, and contralesional middle occipital gyrus after RBAT relative to pre-treatment (Figure 2B).
Correlation of the RS-FC with Motor and Functional Recovery
Spearman correlation analysis showed that the pre-to-post difference in M1-M1 RS-FC was significantly positively correlated with changes in the WMFT-FAS score (R = 0.79, p = 0.006) and FIM total score (R = 0.92, p < 0.001). Theseindicated that participants with increased M1-M1 RS-FC afterthe intervention had greater gains in functional use of theaffected arm and daily function. However, the relations betweenthe pre-to-post difference M1-M1 connectivity and the changes of FMA-UL score were not significant (R = 0.55, p = 0.09). Mediation Analysis Results
On the basis of a standard three-variable path model with a bootstrap test for the statistical significance of the product a × b, a single-level version of the mediation path model was usedtogetfurther insight of linkage between the clinical measures and RS-FC. Matlab coding implementing mediation analyses, developed by  Wager et al. (2009) is freely available at
2
. In all participants,the change of interhemispheric M1-M1 functional connectivity from pre-treatment to post-treatment was a significant mediatorin predicting the WMFT-FIM relation. The increased change inM1-M1 connectivity was associated with greater improvementsin functional use of the affected arm and daily function after the intervention (a = 1.27, standard error = 0.61, p = 0.044; b = 0.17, standard error=0.057, p=0.021;a×b=0.21,Z =2.03, p=0.042;Figure 3).