title: Motor impairment and recovery in the upper limb after stroke: behavioral and neuroanatomical correlates.
abstract: OBJECTIVE
  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 (DeltarCBF) 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 DeltarCBF for each individual were linearly regressed with motor impairment scores. Motor recovery was correlated with longitudinal DeltarCBF 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 DeltarCBF. Importantly, sites of correlated DeltarCBF differed over time. Subacutely correlated DeltarCBF 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 DeltarCBF 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 DeltarCBF 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.
authors.affiliation: National Stroke Research Institute, Austin Health, Level 2, Neurosciences Building, Banksia St, Heidelberg West, Victoria, Australia 3081. lcarey@nsri.org.au
authors.forename: Leeanne M
authors.initials: LM
authors.lastname: Carey
authors.forename: David F
authors.initials: DF
authors.lastname: Abbott
authors.forename: Gary F
authors.initials: GF
authors.lastname: Egan
authors.forename: Julie
authors.initials: J
authors.lastname: Bernhardt
authors.forename: Geoffrey A
authors.initials: GA
authors.lastname: Donnan
mesh_terms: D000368:Aged; D001921:Brain / Q000473:pathology; D002540:Cerebral Cortex / Q000098:blood supply / Q000473:pathology / Q000503:physiopathology; D002544:Cerebral Infarction / Q000473:pathology / Q000503:physiopathology; D005260:Female; D006801:Humans; D008297:Male; D049268:Positron-Emission Tomography / Q000379:methods; D011597:Psychomotor Performance / Q000502:physiology; D020127:Recovery of Function / Q000502:physiology*; D012039:Regional Blood Flow / Q000502:physiology; D020521:Stroke / Q000473:pathology / Q000503:physiopathology*; D034941:Upper Extremity / Q000503:physiopathology*