Published Online
on January 27, 2005

A more recent version of this article appeared on March 1, 2005

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Submitted on August 5, 2004
Revised on October 29, 2004
Accepted on December 7, 2004

Motor Impairment and Recovery in the Upper Limb After Stroke. Behavioral and Neuroanatomical Correlates

Leeanne M. Carey PhD^*; David F. Abbott PhD; Gary F. Egan PhD; Julie Bernhardt PhD; and Geoffrey A. Donnan MD

From the National Stroke Research Institute (L.M.C., J.B., G.A.D.) and Brain Research Institute (D.F.A.), Austin Health, Heidelberg West; LaTrobe University (L.M.C.), Bundoora; and Howard Florey Institute (G.F.E.), Melbourne, Victoria, Australia.

^* To whom correspondence should be addressed. E-mail: lcarey{at}nsri.org.au.

Background and Purpose--Motor recovery after stroke is associated with cerebral reorganization. However, few studies have investigated the relationship directly, and findings are equivocal. We therefore aimed to characterize the relationship between motor impairment, motor recovery, and task-related changes in regional cerebral blood flow (rCBF) longitudinally.

Methods--We obtained a profile of motor impairment and recovery in the upper limb and conducted positron emission tomography motor activation studies using a simple finger-tapping task in 9 stroke patients 2 to 7 weeks after stroke and 6 months later. For correlation analysis, mean images of task-related rCBF for each individual were linearly regressed with motor impairment scores. Motor recovery was correlated with longitudinal rCBF images.

Results--Patients (7 males; 72.0±9.8 years) demonstrated a wide range of impairment severity and variable recovery. Upper-limb motor function was linearly correlated with task-related rCBF. Importantly, sites of correlated rCBF differed over time. Subacutely correlated rCBF was observed in supplementary motor area (SMA), bilateral cingulate, and contralesional insula with a small area in ipsilesional primary sensorimotor cortex (SM1). Conversely, at the 6-month study, correlated rCBF was primarily in ipsilesional SM1, extending to the cingulate gyrus. Better motor recovery was correlated with reduction in contralesional activity and increase in ipsilesional SM1.

Conclusions--Upper-limb motor function and recovery are correlated with rCBF in SMA, cingulate, insula, and SM1, highlighting the role of these areas in the recovery process. The dynamic nature of the relationship suggests ongoing adaptation within motor networks.

Key words: brain mapping • cerebrovascular accident • neuronal plasticity • recovery of function • upper extremity

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