title: Neural reorganization accompanying upper limb motor rehabilitation from stroke with virtual reality-based gesture therapy.
abstract: BACKGROUND
  Gesture Therapy is an upper limb virtual reality rehabilitation-based therapy for stroke survivors. It promotes motor rehabilitation by challenging patients with simple computer games representative of daily activities for self-support. This therapy has demonstrated clinical value, but the underlying functional neural reorganization changes associated with this therapy that are responsible for the behavioral improvements are not yet known.
  
  
  OBJECTIVE
  We sought to quantify the occurrence of neural reorganization strategies that underlie motor improvements as they occur during the practice of Gesture Therapy and to identify those strategies linked to a better prognosis.
  
  
  METHODS
  Functional magnetic resonance imaging (fMRI) neuroscans were longitudinally collected at 4 time points during Gesture Therapy administration to 8 patients. Behavioral improvements were monitored using the Fugl-Meyer scale and Motricity Index. Activation loci were anatomically labelled and translated to reorganization strategies. Strategies are quantified by counting the number of active clusters in brain regions tied to them.
  
  
  RESULTS
  All patients demonstrated significant behavioral improvements (P < .05). Contralesional activation of the unaffected motor cortex, cerebellar recruitment, and compensatory prefrontal cortex activation were the most prominent strategies evoked. A strong and significant correlation between motor dexterity upon commencing therapy and total recruited activity was found (r2 = 0.80; P < .05), and overall brain activity during therapy was inversely related to normalized behavioral improvements (r2 = 0.64; P < .05).
  
  
  CONCLUSIONS
  Prefrontal cortex and cerebellar activity are the driving forces of the recovery associated with Gesture Therapy. The relation between behavioral and brain changes suggests that those with stronger impairment benefit the most from this paradigm.
authors.affiliation: National Institute of Astrophysics, Optics and Electronics (INAOE), Puebla, Mexico.
authors.forename: Felipe
authors.initials: F
authors.lastname: Orihuela-Espina
authors.forename: Isabel
authors.initials: I
authors.lastname: Fernández del Castillo
authors.forename: Lorena
authors.initials: L
authors.lastname: Palafox
authors.forename: Erick
authors.initials: E
authors.lastname: Pasaye
authors.forename: Israel
authors.initials: I
authors.lastname: Sánchez-Villavicencio
authors.forename: Ronald
authors.initials: R
authors.lastname: Leder
authors.forename: Jorge Hernández
authors.initials: JH
authors.lastname: Franco
authors.forename: Luis Enrique
authors.initials: LE
authors.lastname: Sucar
mesh_terms: D000328:Adult; D015331:Cohort Studies; D005260:Female; D005868:Gestures; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009043:Motor Activity / Q000502:physiology; D009473:Neuronal Plasticity / Q000502:physiology; D020521:Stroke / Q000473:pathology* / Q000503:physiopathology; D000071939:Stroke Rehabilitation; D034941:Upper Extremity / Q000502:physiology; D014584:User-Computer Interface; D018910:Video Games; D063367:Virtual Reality Exposure Therapy; D055815:Young Adult