Lots of words but NOTHING SPECIFIC THAT WILL GET SURVIVORS RECOVERED! Useless. I'd fire everyone.
Movement-dependent stroke recovery: A systematic review and meta-analysis of TMS and fMRI evidence
Lorie G. Richards
1,2
, Kim C. Stewart
4
, Michelle L. Woodbury
1,2
, Claudia Senesac
1,3
, and
James H. Cauraugh
1,4
1 North Florida/South Georgia Veterans Health System
2 Occupational Therapy
3 Physical Therapy
4 Applied Physiology and Kinesiology, University of Florida
Abstract
Evidence indicates that experience-dependent cortical plasticity underlies post-stroke motor recovery
of the impaired upper extremity. Motor skill learning in neurologically intact individuals is thought
to involve the primary motor cortex, and the majority of studies in the animal literature have studied
changes in the primary sensorimotor cortex with motor rehabilitation. Whether changes in
engagement in the sensorimotor cortex occur in humans after stroke currently is an area of much
interest. The present study conducted a meta-analysis on stroke studies examining changes in neural
representations following therapy specifically targeting the upper extremity to determine if
rehabilitation-related motor recovery is associated with neural plasticity in the sensorimotor cortex
of the lesioned hemisphere. Twenty-eight studies investigating upper extremity neural
representations (e.g., TMS, fMRI, PET, or SPECT) were identified, and 13 met inclusion criteria as
upper extremity intervention training studies. Common outcome variables representing changes in
the primary motor and sensorimotor cortices were used in calculating standardized effect sizes for
each study. The primary fixed effects model meta-analysis revealed a large overall effect size (E.S.
= 0.84, S.D. = 0.15, 95% C.I. = 0.76 – 0.93). Moreover, a fail-safe analysis indicated that 42 null
effect studies would be necessary to lower the overall effect size to an insignificant level. These
results indicate that neural changes in the sensorimotor cortex of the lesioned hemisphere accompany
functional paretic upper extremity motor gains achieved with targeted rehabilitation interventions.
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