The predictive value of cortical activation by passive movement for motor recovery in stroke patients.
OBJECTIVE
Contralateral primary sensori-motor cortex (SM1) activation by passive movement was investigated by functional MRI (fMRI) at the early stage of stroke, to determine whether SM1 activation can be used to predict the degree of motor recovery of the hemiplegic hand.


METHODS
We studied 17 stroke patients who showed complete paralysis of a hemiplegic hand at onset. The motor function of the hemiplegic hand was assessed on 4 separate occasions (at onset, at fMRI evaluation (performed < 4 weeks after onset), and 3 and 6 months after onset). Significant motor recovery was defined as recovery of the affected hand to the extent of it being able to prehend an object against gravity at least at 6 months after onset.


RESULTS
The patients having an activated contralateral SM1 showed better motor recovery than those who did not. Only a fourth of the patients with an activated contralateral SM1 experienced a significant motor recovery, whereas none of the patients with an inactivated SM1 showed an improvement 6 months after onset, however, the incidence of significant motor recovery was not significantly difference between the two groups.


CONCLUSIONS
It appears that contralateral SM1 activation by passive movement in the early stage of stroke has a low predictive value for the motor recovery of the hemiplegic hand, because the activation of the contralateral SM1 by passive movement appears to be mediated by somatosensory input to the cortex from the thalamus rather than from the motor pathway.
Department of Physical Medicine and Rehabilitation, School of Medicine, Yeungnam University, Republic of Korea. belado@med.yu.ac.kr
Sung Ho
SH
Jang
Yun-Hee
YH
Kim
Yongmin
Y
Chang
Bong Soo
BS
Han
Woo Mok
WM
Byun
Chul Hoon
CH
Chang
D000328:Adult; D000368:Aged; D005260:Female; D006225:Hand; D006429:Hemiplegia / Q000175:diagnosis / Q000503:physiopathology; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009044:Motor Cortex / Q000503:physiopathology*; D011237:Predictive Value of Tests; D011379:Prognosis; D020127:Recovery of Function; D020521:Stroke / Q000175:diagnosis* / Q000503:physiopathology*