Evolution of fMRI Activation in the Perilesional Primary Motor Cortex and Cerebellum With Rehabilitation Training-Related Motor Gains After Stroke: A Pilot Study

WHOM do we go ask what happened to this(14 years old)? Did it get turned into a protocol? What hospitals are using it?  A great stroke association  would have this all publicly available in a database of everything related to stroke.  A huge chunk of my primary motor cortex was destroyed although that info didn't come from my doctor. He knew nothing and did nothing. I had to figure that out myself from fMRI scans in a research project, see images at bottom of blog.

Evolution of fMRI Activation in the Perilesional Primary Motor Cortex and Cerebellum With Rehabilitation Training-Related Motor Gains After Stroke: A Pilot Study

Copyright © 2007 The American Society ofNeurorehabilitation

Yun Dong,MD,PhD,Carolee J.Winstein,PhD,Richard Albistegui-DuBois,PhD,andBruce H.Dobkin,MD
Background
Previous studies report that motor recovery after partial destruction of the primary motor cortex (M1) may be associated with adaptive functional reorganization within spared M1.
Objective
To test feasible methodologies for evaluating relationships between behavioral gains facilitated by rehabilitative training and functional adaptations in perilesional M1 and the cerebellum.
Methods
Four patients with hemiparesis for more than 3 months after a cortical lesion partially within M1 and 12 healthy volunteers participated.  Functional magnetic resonance imaging (fMRI) using a finger-tapping task(If you can finger tap your affected side you are pretty high functioning. Lucky you.) and concurrent behavioral assessments,including the Fugl-Meyer Motor Assessment of  the upper extremity and the Wolf Motor Function Test,were conducted before and after 2 weeks of arm focused training;2 patients were further examined 6 and 12 months later to evaluate long-term persistence of brain behavior adaptations.
Results
All patients showed higher activation magnitude in perilesional M1 than healthy controls before and after therapy.Further long term functional gains paralleled the decrease of activation magnitude in perilesional M1 in the 2 more impaired cases.
Conclusion
The evolution of suggestive correlations between serial scans of fMRI adaptive activity within the primary motor cortex and the cerebellum in relation to relevant behavioral changes over the course of2 weeks of task specific therapy and then no formal therapy suggests that repeated assessments may be best for monitoring therapy-induced neuroplasticity.This approach may help develop optimal rehabilitation strategies to maximize post stroke motor recovery as well as improve the search for brain behavior correlations in functional neuroimaging research.

 Post stroke recovery of motor function with and without specific rehabilitation training has been attributed in part to adaptive functional reorganization within the central nervous system.^1,2 The underlying neurophysiological mechanisms may include changes in neuronal membrane excitability, synaptic strengthening,synaptogenesis, dendritic arborization,fiber sprouting from surviving neurons,and recruitment of nearby and remote neuronal ensembles after focal brain injury.^3,4 Functional reorganization within the intact area surrounding an infarct restricted to the primary motor cortex (M1) was observed over the temporal course of recovery from stroke using functional magnetic resonance imaging (fMRI). The studies supported the notion that human M1 is capable of functional adaptation comparable to that seen in primate experiments.^5,6  Growing evidence from both animal and human studies suggests the importance of perilesional adaptive reorganization and the potential modulative effects of focused,intensive rehabilitative training in facilitating this use-dependent reorganization.^7,8  With the use of advanced neuroimaging technologies,rehabilitation therapy-induced adaptive reorganization within putative motor networks has been investigated in chronic stroke patients who received constraint induced movement therapy (CIMT).^9-12 The correlates between motor functional gains and changes in physiological signals have differed across studies,however.To best elucidate the mechanisms mediating cerebral adaptations after stroke,studies must account for intersubject variability in initial impairment level,lesion location and size,trajectory of behavioral gains associated with time and motor learning experience,and dose of rehabilitation therapy.¹³ This pilot study attempted to determine direct relationships between intensive training-related motor functional improvement and adaptive reorganization in perilesional M1 in patients with partial M1 damage.We performed consecutive fMRI scans with concurrent behavioral assessments in 4 patients who had a single stroke involving a portion ofM1 before,immediately after 2 weeks of CIMT, and in 2 willing subjects,6 and 12 months later.The aims of the study were 2-fold:1) to test the hypothesis that rehabilitative training-related behavioral gains are associated with specific functional adaptations within the intact perilesional M1 and the remotely connected cerebellum and 2) to test methods for evaluating direct brain-behavior correlates and generate preliminary data for larger scale studies.