(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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|
|
|
|
|
|
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|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
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|
|
|
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|
|
|
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 |
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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