Association between imbalance of cortical brain activity and successful motor recovery in sub-acute stroke patients with upper limb hemiparesis: a functional near-infrared spectroscopy study.

Abstract

This study was designed to determine the association between motor functional recovery and interhemispheric imbalance in cortical brain activity in sub-cortical stroke patients with moderate-to-severe upper limb hemiparesis admitted to the convalescent rehabilitation ward. The study included first-ever stroke patients with moderate-to-severe upper limb hemiparesis who received multidisciplinary rehabilitation therapy in the rehabilitation ward. Motor function of the affected upper extremity was evaluated by the Fugl-Meyer assessment and action research arm test at 1 (T1) and 3 months (T2) after stroke onset. We also conducted serial functional near-infrared spectroscopy at the same time points and calculated the laterality index, which is based on changes in oxyhaemoglobin in primary sensorimotor cortex (Brodmann Area 4), pre-motor cortex and supplementary motor cortex (PMC + SMA, BA6). The study included eight patients (seven females, mean age: 68.8). Both the Fugl-Meyer assessment and action research arm test scores improved significantly during the study. Laterality index did not change significantly from T1 to T2. There was a no significant correlation between changes in laterality index in each region and improvement in Fugl-Meyer assessment score. In contrast, a significant and negative correlation was noted between ΔLI in Brodmann Area 4 and improvement in action research arm test score. Our results suggested that activation of the non-lesional hemisphere in sub-acute stroke associated with motor recovery in moderate-to-severe upper limb hemiparesis. A multidisciplinary rehabilitation of stroke patients with moderate-to-severe upper limb hemiparesis might enhance the compensatory movements and pre-existing motor network from the non-lesional motor cortex.