title: Neuroplastic changes in resting-state functional connectivity after stroke rehabilitation.
abstract: Most neuroimaging research in stroke rehabilitation mainly focuses on the neural mechanisms underlying the natural history of post-stroke recovery. However, connectivity mapping from resting-state fMRI is well suited for different neurological conditions and provides a promising method to explore plastic changes for treatment-induced recovery from stroke. We examined the changes in resting-state functional connectivity (RS-FC) of the ipsilesional primary motor cortex (M1) in 10 post-acute stroke patients before and immediately after 4 weeks of robot-assisted bilateral arm therapy (RBAT). Motor performance, functional use of the affected arm, and daily function improved in all participants. Reduced interhemispheric RS-FC between the ipsilesional and contralesional M1 (M1-M1) and the contralesional-lateralized connections were noted before treatment. In contrast, greater M1-M1 functional connectivity and disturbed resting-state networks were observed after RBAT relative to pre-treatment. Increased changes in M1-M1 RS-FC after RBAT were coupled with better motor and functional improvements. Mediation analysis showed the pre-to-post difference in M1-M1 RS-FC was a significant mediator for the relationship between motor and functional recovery. These results show neuroplastic changes and functional recoveries induced by RBAT in post-acute stroke survivors and suggest that interhemispheric functional connectivity in the motor cortex may be a neurobiological marker for recovery after stroke rehabilitation.
authors.affiliation: School of Occupational Therapy, College of Medicine, National Taiwan University and Division of Occupational Therapy, Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital Taipei, Taiwan.
authors.forename: Yang-Teng
authors.initials: YT
authors.lastname: Fan
authors.affiliation: Department of Occupational Therapy and Graduate Institute of Behavioral Sciences, College of Medicine, Chang Gung University Taoyuan, Taiwan ; Healthy Aging Research Center, Chang Gung University Taoyuan, Taiwan.
authors.forename: Ching-Yi
authors.initials: CY
authors.lastname: Wu
authors.affiliation: Department of Imaging Physics, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center Houston, TX, USA ; Department of Medical Imaging and Radiological Sciences, Chang Gung University Taoyuan, Taiwan.
authors.forename: Ho-Ling
authors.initials: HL
authors.lastname: Liu
authors.affiliation: School of Occupational Therapy, College of Medicine, National Taiwan University and Division of Occupational Therapy, Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital Taipei, Taiwan ; Department of Physical Medicine and Rehabilitation, Division of Occupational Therapy, National Taiwan University Hospital Taipei, Taiwan.
authors.forename: Keh-Chung
authors.initials: KC
authors.lastname: Lin
authors.affiliation: Department of Diagnostic Radiology, Chang Gung Memorial Hospital Keelung, Taiwan ; MRI Center, Chang Gung Memorial Hospital Taoyuan, Taiwan.
authors.forename: Yau-Yau
authors.initials: YY
authors.lastname: Wai
authors.affiliation: MRI Center, Chang Gung Memorial Hospital Taoyuan, Taiwan.
authors.forename: Yao-Liang
authors.initials: YL
authors.lastname: Chen
keywords: fMRI; functional connectivity; motor cortex; rehabilitation; robot; stroke