Published Online
on April 27, 2006

A more recent version of this article appeared on June 1, 2006

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Submitted on December 8, 2005
Revised on January 31, 2006
Accepted on March 8, 2006

Motor Cortex Activation During Treatment May Predict Therapeutic Gains in Paretic Hand Function After Stroke

Yun Dong MD, PhD; Bruce H. Dobkin MD; Steven Y. Cen PhD; Allan D. Wu MD; and Carolee J. Winstein PhD^*

From the Laboratory of Motor Behavior and Neurorehabilitation (Y.D., C.J.W.), Department of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles; Department of Neurology (C.J.W.), Keck School of Medicine, University of Southern California; Department of Neurology (B.H.D., A.D.W.), University of California Los Angeles; and Biostatistics Division (S.Y.C.), Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles.

^* To whom correspondence should be addressed. E-mail: winstein{at}usc.edu.

Background and Purpose--Functional brain imaging after stroke offers insight into motor network adaptations. This exploratory study examined whether motor cortical activation captured during arm-focused therapy can predict paretic hand functional gains.

Methods--Eight hemiparetic patients had serial functional MRI (fMRI) while performing a pinch task before, midway, and after 2 weeks of constraint-induced therapy. The Wolf Motor Function Test (WMFT) was performed before and after intervention.

Results--There was a linear reduction in ipsilateral (contralesional) primary motor (M1) activation (voxel counts) across time. The midpoint M1 Laterality Index anticipated post-therapeutic change in time to perform the WMFT. The change in ipsilateral M1 voxel count (pre- to mid-) correlated with the change in mean WMFT time (pre- to post-).

Conclusions--The relationship between brain activation during treatment and functional gains suggests a use for serial fMRI in predicting the success and optimal duration for a focused therapeutic intervention.

Key words: magnetic resonance imaging • rehabilitation

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