title: Functional versus Nonfunctional Rehabilitation in Chronic Ischemic Stroke: Evidences from a Randomized Functional MRI Study.
abstract: Motor rehabilitation of stroke survivors may include functional and/or nonfunctional strategy. The present study aimed to compare the effect of these two rehabilitation strategies by means of clinical scales and functional Magnetic Resonance Imaging (fMRI). Twelve hemiparetic chronic stroke patients were selected. Patients were randomly assigned a nonfunctional (NFS) or functional (FS) rehabilitation scheme. Clinical scales (Fugl-Meyer, ARA test, and modified Barthel) and fMRI were applied at four moments: before rehabilitation (P1) and immediately after (P2), 1 month after (P3), and three months after (P4) the end of rehabilitation. The NFS group improved significantly and exclusively their Fugl-Meyer scores at P2, P3, and P4, when compared to P1. On the other hand, the FS group increased significantly in Fugl-Meyer at P2, when compared to P1, and also in their ARA and Barthel scores. fMRI inspection at the individual level revealed that both rehabilitation schemes most often led to decreased activation sparseness, decreased activity of contralesional M1, increased asymmetry of M1 activity to the ipsilesional side, decreased perilesional activity, and decreased SMA activity. Increased M1 asymmetry with rehabilitation was also confirmed by Lateralization Indexes. Our clinical analysis revealed subtle differences between FS and NFS.
authors.affiliation: Radiology Division, Department of Internal Medicine, Ribeirao Preto School of Medicine, University of Sao Paulo, 14049-900 Ribeirao Preto, SP, Brazil.
authors.forename: Maristela C X
authors.initials: MC
authors.lastname: Pelicioni
authors.affiliation: Brain Institute/Onofre Lopes University Hospital, Federal University of Rio Grande do Norte, 59153-155 Natal, RN, Brazil.
authors.forename: Morgana M
authors.initials: MM
authors.lastname: Novaes
authors.affiliation: Brain Institute/Onofre Lopes University Hospital, Federal University of Rio Grande do Norte, 59153-155 Natal, RN, Brazil.
authors.forename: Andre S C
authors.initials: AS
authors.lastname: Peres
authors.affiliation: Department of Psychobiology, Federal University of Sao Paulo (UNIFESP), Sao Paulo, SP, Brazil.
authors.forename: Altay A
authors.initials: AA
authors.lastname: Lino de Souza
authors.affiliation: Department of Neuroscience and Behavior, Ribeirao Preto School of Medicine, University of Sao Paulo, 14049-900 Ribeirao Preto, SP, Brazil.
authors.forename: Cesar
authors.initials: C
authors.lastname: Minelli
authors.affiliation: Department of Neuroscience and Behavior, Ribeirao Preto School of Medicine, University of Sao Paulo, 14049-900 Ribeirao Preto, SP, Brazil.
authors.forename: Soraia R C
authors.initials: SR
authors.lastname: Fabio
authors.affiliation: Department of Neuroscience and Behavior, Ribeirao Preto School of Medicine, University of Sao Paulo, 14049-900 Ribeirao Preto, SP, Brazil.
authors.forename: Octavio M
authors.initials: OM
authors.lastname: Pontes-Neto
authors.affiliation: Radiology Division, Department of Internal Medicine, Ribeirao Preto School of Medicine, University of Sao Paulo, 14049-900 Ribeirao Preto, SP, Brazil; Department of Neuroscience and Behavior, Ribeirao Preto School of Medicine, University of Sao Paulo, 14049-900 Ribeirao Preto, SP, Brazil.
authors.forename: Antonio C
authors.initials: AC
authors.lastname: Santos
authors.affiliation: Brain Institute/Onofre Lopes University Hospital, Federal University of Rio Grande do Norte, 59153-155 Natal, RN, Brazil.
authors.forename: Draulio B
authors.initials: DB
authors.lastname: de Araujo
mesh_terms: D000328:Adult; D000368:Aged; D001921:Brain / Q000503:physiopathology*; D002545:Brain Ischemia / Q000503:physiopathology / Q000534:rehabilitation*; D005260:Female; D007839:Functional Laterality / Q000502:physiology*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D020127:Recovery of Function / Q000502:physiology*; D020521:Stroke / Q000503:physiopathology; D000071939:Stroke Rehabilitation; D016896:Treatment Outcome
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