I don't see one damn thing here that gets survivors recovered!
Evolution of Brain Activation with Good and Poor Motor Recovery after Stroke
Neurorehabil Neural Repair 2006 20: 24
DOI: 10.1177/1545968305283053
DOI: 10.1177/1545968305283053
Leeanne M. Carey, PhD, David F. Abbott, PhD, Gary F. Egan, PhD,Graham J. O’Keefe, PhD, Graham D. Jackson, MD, Julie Bernhardt, PhD,and Geoffrey A. Donnan, MD
Objective
Objective
To characterize the evolution of brain activation in stroke patients with variable motor recovery and quantify changes relative to healthy controls.
Methods Serial PET activation studies, using a simple finger-tapping task, and quantitative measures of motor performance were obtained in 9 patients (2–7 weeks post stroke and 6 months later) and compared with serial healthy volunteer data. Results. Patients with moderate impairment and good recovery (n= 5) activated the primary sensorimotor cortex (SM1) contralateral to the paretic hand moved, bilateral supplementary motor area(SMA), contralateral cingulate gyrus, and ipsilateral lateral premotor cortex. Activation in the bilateral SMA was greater at the initial study but reduced over time com-pared to healthy controls and poor recoverers. Patients with severe impairment and poor recovery (n = 4) showed limited activation of contralateral SM1 and SMAat both studies and no significant change over time. A posterior shift in SM1 activation was evident in good and poor recoverers.
Conclusions.
Activation of typical motor regions and recruitment of additional sites occur subacutely post stroke, with evolution to normal patterns in moderately impaired patients who recover well. In comparison, severely impaired, poor-recovery patients show persistent, reduced activation. Dynamic changes in SMA, differentially observed in good recoverers over6 months, highlight its importance in recovery.
Methods Serial PET activation studies, using a simple finger-tapping task, and quantitative measures of motor performance were obtained in 9 patients (2–7 weeks post stroke and 6 months later) and compared with serial healthy volunteer data. Results. Patients with moderate impairment and good recovery (n= 5) activated the primary sensorimotor cortex (SM1) contralateral to the paretic hand moved, bilateral supplementary motor area(SMA), contralateral cingulate gyrus, and ipsilateral lateral premotor cortex. Activation in the bilateral SMA was greater at the initial study but reduced over time com-pared to healthy controls and poor recoverers. Patients with severe impairment and poor recovery (n = 4) showed limited activation of contralateral SM1 and SMAat both studies and no significant change over time. A posterior shift in SM1 activation was evident in good and poor recoverers.
Conclusions.
Activation of typical motor regions and recruitment of additional sites occur subacutely post stroke, with evolution to normal patterns in moderately impaired patients who recover well. In comparison, severely impaired, poor-recovery patients show persistent, reduced activation. Dynamic changes in SMA, differentially observed in good recoverers over6 months, highlight its importance in recovery.
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