Post-stroke Motor Rehabilitation Research Articles

The neural basis of constraint-induced movement therapy

This review describes our current understanding of the changes in brain function and structure that occur in response to an intensive form of motor rehabilitation, constraint-induced movement therapy (CIMT), that has been shown to be efficacious in promoting motor function of the paretic upper limb of stroke patients. Studies using transcranial magnetic stimulation have demonstrated consistently an increase in the size of the representation of paretic hand muscles in the ipsilesional motor cortex after CIMT. This motor map expansion occurs in response to CIMT delivered at all time periods after stroke, from within days to after several years. Functional neuroimaging studies have shown varying patterns of change in activation within the sensorimotor network after CIMT. This variability may depend on the extent of stroke-induced damage to the corticospinal tract, the major descending motor pathway in the brain. This variability may also stem from interacting plastic changes in brain structure occurring in response to CIMT. CIMT is the first well defined poststroke motor rehabilitation to have identified changes in brain function and structure that accompany gains in motor function of the paretic upper limb. However, a causal link between observed changes in brain function/structure and motor gains due to CIMT has not yet been established. There is still much work to be done to understand the relationship between changes in brain function/structure and gains in motor function. Such studies should employ rigorous experimental controls to enable strong conclusions to be drawn regarding the neural effects of CIMT and how those effects confer behavioral efficacy of the therapy.

Bilateral movement training and stroke rehabilitation: A systematic review and meta-analysis

Objective and design Bilateral movement training is being increasingly used as a post-stroke motor rehabilitation protocol. The contemporary emphasis on evidence-based medicine warrants a prospective meta-analysis to determine the overall effectiveness of rehabilitating with bilateral movements. Methods After searching reference lists of bilateral motor recovery articles as well as PubMed and Cochrane databases, 11 stroke rehabilitation studies qualified for this systematic review. An essential requirement for inclusion was that the bilateral training protocols involved either functional tasks or repetitive arm movements. Each study had one of three common arm and hand functional outcome measures: Fugl-Meyer, Box and Block, and kinematic performance. Results The fixed effects model primary meta-analysis revealed an overall effect size (ES = 0.732, S.D. = 0.13). These findings indicate that bilateral movement training was beneficial for improving motor recovery post-stroke. Moreover, a fail-safe analysis indicated that 48 null effects would be necessary to lower the mean effect size to an insignificant level. Conclusion These meta-analysis findings indicate that bilateral movements alone or in combination with auxiliary sensory feedback are effective stroke rehabilitation protocols during the sub-acute and chronic phases of recovery.

Imagery-induced Cortical Excitability Changes in Stroke: A Transcranial Magnetic Stimulation Study

Focal transcranial magnetic stimulation (TMS) was employed in a population of hemiparetic stroke patients in a post-acute stage to map out the abductor digiti minimi (ADM) muscle cortical representation of the affected (AH) and unaffected (UH) hemisphere at rest, during motor imagery and during voluntary contraction. Imagery induced an enhancement of the ADM map area and volume in both hemispheres in a way which partly corrected the abnormal asymmetry between AH and UH motor output seen in rest condition. The voluntary contraction was the task provoking maximal facilitation in the UH, whereas a similar degree of facilitation was obtained during voluntary contraction and motor imagery in the AH. We argued that motor imagery could induce a pronounced motor output enhancement in the hemisphere affected by stroke. Further, we demonstrated that imagery-induced excitability changes were specific for the muscle 'prime mover' for the imagined movement, while no differences were observed with respect to the stroke lesion locations. Present findings demonstrated that motor imagery significantly enhanced the cortical excitability of the hemisphere affected by stroke in a post-acute stage. Further studies are needed to correlate these cortical excitability changes with short-term plasticity therefore prompting motor imagery as a 'cortical reservoir' in post-stroke motor rehabilitation.

Traditional Chinese acupuncture does not improve outcomes from post-stroke motor rehabilitation

Sze FK, Wong E, Yi X and Woo J (2002): Does acupuncture have additional value to standard poststroke motor rehabilitation?

Thalamic relay to motor cortex: afferent pathways from brain stem, cerebellum, and spinal cord in monkeys.

Thalamic relay to motor cortex: afferent pathways from brain stem, cerebellum, and spinal cord in monkeys.