(Stroke. 2000;31:1210.)
© 2000 American Heart Association, Inc.
Original Contributions |
Treatment-Induced Cortical Reorganization After Stroke in Humans
From the Departments of Neurology (J.L., C.W.) and Biological and Clinical Psychology (H.B., W.H.R.M.), Friedrich-Schiller-University of Jena, Jena, Germany; and Department of Psychology (E.T.), University of Alabama at Birmingham and Physical Medicine Service, Birmingham VA Medical Center.
Correspondence to Priv-Doz Dr J. Liepert, Neurologische Klinik der Friedrich Schiller Universität, Philosophenweg 3, D-07743 Jena, Germany. E-mail liepert{at}neuro.uni-jena.de
Background and Purpose—Injury-induced cortical reorganization is a widely recognized phenomenon. In contrast, there is almost no information on treatment-induced plastic changes in the human brain. The aim of the present study was to evaluate reorganization in the motor cortex of stroke patients that was induced with an efficacious rehabilitation treatment.
Methods—We used focal transcranial magnetic stimulation to map the cortical motor output area of a hand muscle on both sides in 13 stroke patients in the chronic stage of their illness before and after a 12-day-period of constraint-induced movement therapy.
Results—Before treatment, the cortical representation area of the affected hand muscle was significantly smaller than the contralateral side. After treatment, the muscle output area size in the affected hemisphere was significantly enlarged, corresponding to a greatly improved motor performance of the paretic limb. Shifts of the center of the output map in the affected hemisphere suggested the recruitment of adjacent brain areas. In follow-up examinations up to 6 months after treatment, motor performance remained at a high level, whereas the cortical area sizes in the 2 hemispheres became almost identical, representing a return of the balance of excitability between the 2 hemispheres toward a normal condition.
Conclusions—This is the first demonstration in humans of a long-term alteration in brain function associated with a therapy-induced improvement in the rehabilitation of movement after neurological injury.
Key Words: plasticity, neuronal • transcranial magnetic stimulation • reorganization • physical therapy • stroke
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A. Sterr and S. Freivogel Motor-improvement following intensive training in low-functioning chronic hemiparesis Neurology, September 23, 2003; 61(6): 842 - 844. [Abstract] [Full Text] [PDF]
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N. Byl, J. Roderick, O. Mohamed, M. Hanny, J. Kotler, A. Smith, M. Tang, and G. Abrams Effectiveness of Sensory and Motor Rehabilitation of the Upper Limb Following the Principles of Neuroplasticity: Patients Stable Poststroke Neurorehabil Neural Repair, September 1, 2003; 17(3): 176 - 191. [Abstract] [PDF]
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P. Duncan, S. Studenski, L. Richards, S. Gollub, S. M. Lai, D. Reker, S. Perera, J. Yates, V. Koch, S. Rigler, et al. Randomized Clinical Trial of Therapeutic Exercise in Subacute Stroke Stroke, September 1, 2003; 34(9): 2173 - 2180. [Abstract] [Full Text] [PDF]
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 L. Lee, H. R. Siebner, J. B. Rowe, V. Rizzo, J. C. Rothwell, R. S. J. Frackowiak, and K. J. Friston Acute Remapping within the Motor System Induced by Low-Frequency Repetitive Transcranial Magnetic Stimulation J. Neurosci., June 15, 2003; 23(12): 5308 - 5318. [Abstract] [Full Text] [PDF]
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S. B. Frost, S. Barbay, K. M. Friel, E. J. Plautz, and R. J. Nudo Reorganization of Remote Cortical Regions After Ischemic Brain Injury: A Potential Substrate for Stroke Recovery J Neurophysiol, June 1, 2003; 89(6): 3205 - 3214. [Abstract] [Full Text] [PDF]
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J. Chae and R. Hart Intramuscular Hand Neuroprosthesis for Chronic Stroke Survivors Neurorehabil Neural Repair, June 1, 2003; 17(2): 109 - 117. [Abstract] [PDF]
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C. Calautti and J.-C. Baron Functional Neuroimaging Studies of Motor Recovery After Stroke in Adults: A Review Stroke, June 1, 2003; 34(6): 1553 - 1566. [Abstract] [Full Text] [PDF]
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N. Bonifer and K. M Anderson Application of Constraint-Induced Movement Therapy for an Individual With Severe Chronic Upper-Extremity Hemiplegia Physical Therapy, April 1, 2003; 83(4): 384 - 398. [Abstract] [Full Text] [PDF]
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G. F. Wittenberg, R. Chen, K. Ishii, K. O. Bushara, E. Taub, L. H. Gerber, M. Hallett, and L. G. Cohen Constraint-Induced Therapy in Stroke: Magnetic-Stimulation Motor Maps and Cerebral Activation Neurorehabil Neural Repair, March 1, 2003; 17(1): 48 - 57. [Abstract] [PDF]
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R. M. Dijkhuizen, A. B. Singhal, J. B. Mandeville, O. Wu, E. F. Halpern, S. P. Finklestein, B. R. Rosen, and E. H. Lo Correlation between Brain Reorganization, Ischemic Damage, and Neurologic Status after Transient Focal Cerebral Ischemia in Rats: A Functional Magnetic Resonance Imaging Study J. Neurosci., January 15, 2003; 23(2): 510 - 517. [Abstract] [Full Text] [PDF]
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J. L. Tillerson and G. W. Miller Book Review: Forced Limb-Use and Recovery following Brain Injury Neuroscientist, December 1, 2002; 8(6): 574 - 585. [Abstract] [PDF]
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J. D. Schaechter, E. Kraft, T. S. Hilliard, R. M. Dijkhuizen, T. Benner, S. P. Finklestein, B. R. Rosen, and S. C. Cramer Motor Recovery and Cortical Reorganization after Constraint-Induced Movement Therapy in Stroke Patients: A Preliminary Study Neurorehabil Neural Repair, December 1, 2002; 16(4): 326 - 338. [Abstract] [PDF]
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H. Reddy, S. Narayanan, M. Woolrich, T. Mitsumori, Y. Lapierre, D. L. Arnold, and P. M. Matthews Functional brain reorganization for hand movement in patients with multiple sclerosis: defining distinct effects of injury and disability Brain, December 1, 2002; 125(12): 2646 - 2657. [Abstract] [Full Text] [PDF]
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H. Johansen-Berg, H. Dawes, C. Guy, S. M. Smith, D. T. Wade, and P. M. Matthews Correlation between motor improvements and altered fMRI activity after rehabilitative therapy Brain, December 1, 2002; 125(12): 2731 - 2742. [Abstract] [Full Text] [PDF]
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J. Chae, G. Yang, B. K. Park, and I. Labatia Muscle Weakness and Cocontraction in Upper Limb Hemiparesis: Relationship to Motor Impairment and Physical Disability Neurorehabil Neural Repair, September 1, 2002; 16(3): 241 - 248. [Abstract] [PDF]
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A. S Merians, D. Jack, R. Boian, M. Tremaine, G. C Burdea, S. V Adamovich, M. Recce, and H. Poizner Virtual Reality-Augmented Rehabilitation for Patients Following Stroke Physical Therapy, September 1, 2002; 82(9): 898 - 915. [Abstract] [Full Text] [PDF]
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T. Shimizu, A. Hosaki, T. Hino, M. Sato, T. Komori, S. Hirai, and P. M. Rossini Motor cortical disinhibition in the unaffected hemisphere after unilateral cortical stroke Brain, August 1, 2002; 125(8): 1896 - 1907. [Abstract] [Full Text] [PDF]
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