- Motor Recovery in Stroke Patients.
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Sung Ho Jang, Yong Hyun Kwon
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Yeungnam Univ J Med. 2005;22(2):119-130. Published online December 31, 2005
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DOI: https://doi.org/10.12701/yujm.2005.22.2.119
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 Abstract
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- Stroke is a leading cause of chronic physical disability. The recent randomized controlled trials have that motor function of chronic stroke survivors could be improved through physical or pharmacologic intervention in the stroke rehabilitation setting. In addition, several functional neuroimaging techniques have recently developed, it is available to study the functional topography of sensorimotor area of the brain. However, the mechanisms involved in motor recovery after stroke, are still poorly understood. Four motor recovery mechanisms have been suggested, such as reorganization into areas adjacent to the injured primary motor cortex (M1), unmasking of the motor pathway from the unaffected motor cortex to the affected hand, attribution of secondary motor areas, and recovery of the damaged contralateral corticospinal tract. Understanding the motor recovery mechanisms would provide neurorehabilitation specialists with more information to allow for precise prognosis and therapeutic strategies based on the scientific evidence; this may help promote recovery of motor function. This review introduces several methodologies for neuroimaging techniques and discusses theoretical issues that impact interpretation of functional imaging studies of motor recovery after stroke. Perspectives, for future research are presented.
- Evidence of Cortical Reorganization in a Monoparetic Patient with Cerebral Palsy Detected by Combined Functional MRI and TMS.
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Yong Hyun Kwon, Sung Ho Jang, Mi Young Lee, Woo Mok Byun, Yoon Woo Cho, Sang Ho Ahn
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Yeungnam Univ J Med. 2005;22(1):96-103. Published online June 30, 2005
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DOI: https://doi.org/10.12701/yujm.2005.22.1.96
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Abstract
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- The motor recovery mechanism of a 21-year-old male monoparetic patient with cerebral palsy, who had complained of a mild weakness on his right hand since infancy, was examined using functional Magnetic Resonance Imaging (fMRI) and Transcranial Magnetic Stimulation (TMS). The patient showed mild motor impairment on the right hand. MRI located the main lesion on the left precentral knob of the brain. fMRI was performed on this patient as well as 8 control subjects using the Blood Oxygen Level Dependent technique at 1.5 T with a standard head coil. The motor activation task consisted of finger flexion- extension exercises at 1 Hz cycles. TMS was carried out using a round coil. The anterior portion of the coil was applied tangentially to the scalp at a 1.0 cm separation. Magnetic stimulation was carried out with the maximal output. The Motor Evoked Potentials (MEPs) from both Abductor Pollicis Brevis muscles (APB) were obtained simultaneously. fMRI revealed that the unaffected (right) primary sensori-motor cortex (SM1), which was centered on precentral knob, was activated by the hand movements of the control subjects as well as by the unaffected (left) hand movements of the patient. However, the affected (right) hand movements of the patient activated the medial portion of the injured precentral knob of the left SM1. The optimal scalp site for the affected (right) APB was located at 1 cm medial to that of the unaffected (left) APB. When the optimal scalp site was stimulated, the MEP characteristics from the affected (right) APB showed a delayed latency, lower amplitude, and a distorted figure compared with that of the unaffected (left) APB. Therefore, the motor function of the affected (right) hand was shown to be reorganized in the medial portion of the injured precentral knob.
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Yeungnam University College of Medicine
