Motor rehabilitation therapy is commonly employed after strokes, but outcomes are variable and there is little speci®c information about the changes in brain activity that are associated with improved function. We performed serial functional MRI (fMRI) on a group of seven patients receiving a form of rehabilitation therapy after stroke in order to characterize functional changes in the brain that correlate with behavioural improve-ments. Patients were scanned while performing a hand ¯exion±extension movement twice before and twice after a two-week home-based therapy programme com-bining restraint of the unaffected limb with progressive exercises for the affected limb. As expected, the extent of improvement in hand function after therapy varied between patients. Therapy-related improvements in hand function correlated with increases in fMRI activity in the premotor cortex and secondary somatosensory cortex contralateral to the affected hand, and in superior posterior regions of the cerebellar hemispheres bilaterally (Crus I and lobule VI). fMRI offers a promising, objective approach for speci®cally identify-ing changes in brain activity potentially responsible for rehabilitation-mediated recovery of function after stroke. Our results suggest that activity changes in sensorimotor regions are associated with successful motor rehabilitation.
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