BACKGROUND: The effects of physiotherapy are difficult to assess in very impaired early stroke patients. OBJECTIVE: The aim of the study was to characterize the impact of 4 weeks of passive proprioceptive training of the wrist on brain sensorimotor activation after stroke. METHODS:Patients with a subcortical ischemic lesion of the pyramidal tract were randomly assigned to a control or a wrist-training group. All patients had a single pure motor hemiplegia with severe motor deficit. The control group (6 patients) underwent standard Bobath rehabilitation. The second, "trained," group (7 patients) received Bobath rehabilitation plus 4 weeks of proprioceptive training with daily passive calibrated wrist extension. Before and after the training period, patients were examined with validated clinical scales and functional MRI (fMRI) while executing a passive movement versus rest. The effect of standard rehabilitation on sensorimotor activation was assessed in the control group on the wrist, and the effect of standard rehabilitation plus proprioceptive training was assessed in the trained group. The effect of 4-week proprioceptive training alone was statistically evaluated by difference between groups. RESULTS:Standard rehabilitation along with natural recovery mainly led to increases in ipsilesional activation and decreases in contralesional activation. On the contrary, standard rehabilitation and paretic wrist proprioceptive training increased contralesional activation. Proprioceptive training produced change in the supplementary motor area (SMA), prefrontal cortex, and a contralesional network including inferior parietal cortex (lower part of BA 40), secondary sensory cortex, and ventral premotor cortex (PMv). CONCLUSION: We have demonstrated that purely passive proprioceptive training applied for 4 weeks is able to modify brain sensorimotor activity after a stroke. This training revealed fMRI change in the ventral premotor and parietal cortices of the contralesional hemisphere, which are secondary sensorimotor areas. Recent studies have demonstrated the crucial role of these areas in severely impaired patients. We propose that increased contralesional activity in secondary sensorimotor areas likely facilitates control of recovered motor function by simple proprioceptive integration in those patients with poor recovery.
RCT Entities:
BACKGROUND: The effects of physiotherapy are difficult to assess in very impaired early strokepatients. OBJECTIVE: The aim of the study was to characterize the impact of 4 weeks of passive proprioceptive training of the wrist on brain sensorimotor activation after stroke. METHODS:Patients with a subcortical ischemic lesion of the pyramidal tract were randomly assigned to a control or a wrist-training group. All patients had a single pure motor hemiplegia with severe motor deficit. The control group (6 patients) underwent standard Bobath rehabilitation. The second, "trained," group (7 patients) received Bobath rehabilitation plus 4 weeks of proprioceptive training with daily passive calibrated wrist extension. Before and after the training period, patients were examined with validated clinical scales and functional MRI (fMRI) while executing a passive movement versus rest. The effect of standard rehabilitation on sensorimotor activation was assessed in the control group on the wrist, and the effect of standard rehabilitation plus proprioceptive training was assessed in the trained group. The effect of 4-week proprioceptive training alone was statistically evaluated by difference between groups. RESULTS: Standard rehabilitation along with natural recovery mainly led to increases in ipsilesional activation and decreases in contralesional activation. On the contrary, standard rehabilitation and paretic wrist proprioceptive training increased contralesional activation. Proprioceptive training produced change in the supplementary motor area (SMA), prefrontal cortex, and a contralesional network including inferior parietal cortex (lower part of BA 40), secondary sensory cortex, and ventral premotor cortex (PMv). CONCLUSION: We have demonstrated that purely passive proprioceptive training applied for 4 weeks is able to modify brain sensorimotor activity after a stroke. This training revealed fMRI change in the ventral premotor and parietal cortices of the contralesional hemisphere, which are secondary sensorimotor areas. Recent studies have demonstrated the crucial role of these areas in severely impaired patients. We propose that increased contralesional activity in secondary sensorimotor areas likely facilitates control of recovered motor function by simple proprioceptive integration in those patients with poor recovery.
Authors: Ann Van de Winckel; Nicole Wenderoth; Willy De Weerdt; Stefan Sunaert; Ron Peeters; Wim Van Hecke; Vincent Thijs; Stephan P Swinnen; Carlo Perfetti; Hilde Feys Journal: Exp Brain Res Date: 2012-05-31 Impact factor: 1.972
Authors: Lara A Boyd; Kathryn S Hayward; Nick S Ward; Cathy M Stinear; Charlotte Rosso; Rebecca J Fisher; Alexandre R Carter; Alex P Leff; David A Copland; Leeanne M Carey; Leonardo G Cohen; D Michele Basso; Jane M Maguire; Steven C Cramer Journal: Int J Stroke Date: 2017-07 Impact factor: 5.266
Authors: Morgan L Ingemanson; Justin R Rowe; Vicky Chan; Jeff Riley; Eric T Wolbrecht; David J Reinkensmeyer; Steven C Cramer Journal: Neurorehabil Neural Repair Date: 2019-07-18 Impact factor: 3.919
Authors: Dionyssios Mintzopoulos; Loukas G Astrakas; Azadeh Khanicheh; Angelos A Konstas; Aneesh Singhal; Michael A Moskowitz; Bruce R Rosen; A Aria Tzika Journal: Neuroimage Date: 2009-03-12 Impact factor: 6.556