title: Task-specific brain reorganization in motor recovery induced by a hybrid-rehabilitation combining training with brain stimulation after stroke.
abstract: Recently, we have developed a new hybrid-rehabilitation combining 5Hz repetitive transcranial magnetic stimulation and extensor motor training of the paretic upper-limb for stroke patients with flexor hypertonia. We previously showed that the extensor-specific plastic change in M1 was associated with beneficial effects of our protocol (Koganemaru et al., 2010). Here, we investigated whether extensor-specific multiregional brain reorganization occurred after the hybrid-rehabilitation using functional magnetic resonance imaging. Eleven chronic stroke patients were scanned while performing upper-limb extensor movements. Untrained flexor movements were used as a control condition. The scanning and clinical assessments were done before, immediately and 2 weeks after the hybrid-rehabilitation. As a result, during the trained extensor movements, the imaging analysis showed a significant reduction of brain activity in the ipsilesional sensorimotor cortex, the contralesional cingulate motor cortex and the contralesional premotor cortex in association with functional improvements of the paretic hands. The activation change was not found for the control condition. Our results suggested that use-dependent plasticity induced by repetitive motor training with brain stimulation might be related to task-specific multi-regional brain reorganization. It provides a key to understand why repetitive training of the target action is one of the most powerful rehabilitation strategies to help patients.
authors.affiliation: Brain Integrative Science, Kyoto University School of Medicine, Sakyo-ku, Kyoto 606-8507, Japan; Human Brain Research Center, Kyoto University School of Medicine, Sakyo-ku, Kyoto 606-8507, Japan. Electronic address: kogane@kuhp.kyoto-u.ac.jp.
authors.forename: Satoko
authors.initials: S
authors.lastname: Koganemaru
authors.affiliation: Department of Neurology, Kyoto University School of Medicine, Shogoin, Sakyo-ku, Kyoto 606-8507, Japan.
authors.forename: Nobukatsu
authors.initials: N
authors.lastname: Sawamoto
authors.affiliation: Human Brain Research Center, Kyoto University School of Medicine, Sakyo-ku, Kyoto 606-8507, Japan.
authors.forename: Toshihiko
authors.initials: T
authors.lastname: Aso
authors.affiliation: Department of Physical and Rehabilitation Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo 663-8501, Japan.
authors.forename: Akiko
authors.initials: A
authors.lastname: Sagara
authors.affiliation: Department of Physical and Rehabilitation Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo 663-8501, Japan.
authors.forename: Tomoko
authors.initials: T
authors.lastname: Ikkaku
authors.affiliation: Department of Physical and Rehabilitation Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo 663-8501, Japan.
authors.forename: Kenji
authors.initials: K
authors.lastname: Shimada
authors.affiliation: Department of Physical and Rehabilitation Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo 663-8501, Japan.
authors.forename: Madoka
authors.initials: M
authors.lastname: Kanematsu
authors.affiliation: Department of Neurology, Kyoto University School of Medicine, Shogoin, Sakyo-ku, Kyoto 606-8507, Japan.
authors.forename: Ryosuke
authors.initials: R
authors.lastname: Takahashi
authors.affiliation: Department of Physical and Rehabilitation Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo 663-8501, Japan.
authors.forename: Kazuhisa
authors.initials: K
authors.lastname: Domen
authors.affiliation: Human Brain Research Center, Kyoto University School of Medicine, Sakyo-ku, Kyoto 606-8507, Japan.
authors.forename: Hidenao
authors.initials: H
authors.lastname: Fukuyama
authors.affiliation: Human Brain Research Center, Kyoto University School of Medicine, Sakyo-ku, Kyoto 606-8507, Japan.
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Mima
mesh_terms: D000368:Aged; D001931:Brain Mapping; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009044:Motor Cortex / Q000503:physiopathology*; D009122:Muscle Hypertonia / Q000209:etiology; D009473:Neuronal Plasticity; D020127:Recovery of Function; D066191:Sensorimotor Cortex / Q000503:physiopathology*; D020521:Stroke / Q000150:complications; D000071939:Stroke Rehabilitation; D050781:Transcranial Magnetic Stimulation / Q000379:methods*
keywords: Hemiparesis; Neuroplasticity; Rehabilitation; Stroke; Task specificity; Transcranial magnetic stimulation