Application of fMRI to monitor motor rehabilitation

Abstract

Motor deficits contribute to disability in a number of neurological conditions. A wide range of emerging restorative therapies have the potential to reduce this by favorably modifying function. In many medical contexts, a study of target organ function improves efficacy of a therapeutic intervention. However, the optimal methods to prescribe a restorative therapy in the setting of central nervous system (CNS) disease are not clear. Brain mapping studies have the potential to provide useful insights in this regard. Examples of restorative therapies are provided, and human trials are summarized whereby brain mapping data have proven useful in promoting motor improvements in subjects with a neurological condition. A number of forms of brain mapping metrics are under study, including those emphasizing network connectivity obtained using resting-state fMRI. In some cases, brain mapping findings that correlate with better outcome with spontaneous behavioral recovery correspond to findings that predict better treatment response in the context of a clinical trial. Similarities across CNS conditions, such as stroke and multiple sclerosis, are discussed. Further studies are needed to understand which methods have the greatest value to monitor, predict, triage, and dose restorative therapies in trials that aim to reduce motor, and other neurological, deficits.