Motor recovery by improvement of limb-kinetic apraxia in a chronic stroke patient.
OBJECTIVE
We report on a chronic stroke patient who showed motor recovery by improvement of limb-kinetic apraxia (LKA) after undergoing intensive rehabilitation for a period of one month, which was demonstrated by diffusion tensor tractography (DTT) and transcranial magnetic stimulation (TMS).


METHODS
A 50-year-old male patient presented with severe paralysis of the left extremities at the onset of thalamic hemorrhage. At thirty months after onset, the patient exhibited moderate weakness of his left upper and lower extremities. In addition, he exhibited a slow, clumsy, and mutilated movement pattern during grasp-release movements of his left hand. During a one-month period of intensive rehabilitation, which was started at thrity months after onset, the patient showed 22% motor recovery of the left extremities. The slow, clumsy, and mutilated movement pattern of the left hand almost disappeared.


RESULTS
DTTs of the corticospinal tract (CST) in both hemispheres originated from the cerebral cortex, including the primary motor cortex, and passed along the known CST pathway. The DTT of the right CST was located anterior to the old hemorrhagic lesion. TMS study performed at thirty and thirty-one months after onset showed normal and similar findings for motor evoked potential in terms of latency and amplitude of the left hand muscle.


CONCLUSIONS
We think that the motor weakness of the left extremities in this patient was mainly ascribed to LKA and that most of the motor recovery during a one-month period of rehabilitation was attributed to improvement of LKA.
Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University 317-1, Daemyungdong, Namku, Taegu, 705-717, Republic of Korea. Tel./Fax: +82 53 620 3269; E-mail: strokerehab@hanmail.net.
Sung Ho
SH
Jang
D020240:Apraxia, Ideomotor / Q000175:diagnosis* / Q000209:etiology / Q000534:rehabilitation*; D002908:Chronic Disease; D056324:Diffusion Tensor Imaging; D019054:Evoked Potentials, Motor; D005121:Extremities / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009043:Motor Activity; D011712:Pyramidal Tracts / Q000473:pathology*; D020127:Recovery of Function; D020521:Stroke / Q000150:complications / Q000503:physiopathology*; D000071939:Stroke Rehabilitation; D013788:Thalamus / Q000473:pathology; D050781:Transcranial Magnetic Stimulation
Motor recovery; apraxia; diffusion tensor tractography; limb-kinetic apraxia; stroke; transcranial magnetic stimulation