title: Brain activation is related to smoothness of upper limb movements after stroke.
abstract: It is unclear whether additionally recruited sensorimotor areas in the ipsilesional and contralesional hemisphere and the cerebellum can compensate for lost neuronal functions after stroke. The objective of this study was to investigate how increased recruitment of secondary sensorimotor areas is associated with quality of motor control after stroke. In seventeen patients (three females, fourteen males; age: 59.9 ± 12.6 years), cortical activation levels were determined with functional magnetic resonance imaging (fMRI) in 12 regions of interest during a finger flexion-extension task in weeks 6 and 29 after stroke. At the same time points and by using 3D kinematics, the quality of motor control was assessed by smoothness of the grasp aperture during a reach-to-grasp task, quantified by normalized jerk. Ipsilesional premotor cortex, insula and cerebellum, as well as the contralesional supplementary motor area, insula and cerebellum, correlated significantly and positively with the normalized jerk of grasp aperture at week 6 after stroke. A positive trend towards this correlation was observed in week 29. This study suggests that recruitment of secondary motor areas at 6 weeks after stroke is highly associated with increased jerk during reaching and grasping. As jerk represents the change in acceleration, the recruitment of additional sensorimotor areas seems to reflect a type of control in which deviations from an optimal movement pattern are continuously corrected. This relationship suggests that additional recruitment of sensorimotor areas after stroke may not correspond to restitution of motor function, but more likely to adaptive motor learning strategies to compensate for motor impairments.
authors.affiliation: Center of Excellence for Rehabilitation, Rehabilitation Centre De Hoogstraat, Rembrandtkade 10, 3583TM, Utrecht, The Netherlands. f.buma@vumc.nl.|Department of Neurology and Neurosurgery, Rudolf Magnus Institute of Neuroscience, UMC Utrecht, PO Box 85060, 3508AB, Utrecht, The Netherlands. f.buma@vumc.nl.
authors.forename: Floor E
authors.initials: FE
authors.lastname: Buma
authors.affiliation: Department of Rehabilitation Medicine, MOVE Research Institute Amsterdam, VU University Medical Center, PO Box 7057, 1007MB, Amsterdam, The Netherlands.
authors.forename: Joost
authors.initials: J
authors.lastname: van Kordelaar
authors.affiliation: Department of Neurology and Neurosurgery, Rudolf Magnus Institute of Neuroscience, UMC Utrecht, PO Box 85060, 3508AB, Utrecht, The Netherlands.
authors.forename: Matthijs
authors.initials: M
authors.lastname: Raemaekers
authors.affiliation: Department of Rehabilitation Medicine, MOVE Research Institute Amsterdam, VU University Medical Center, PO Box 7057, 1007MB, Amsterdam, The Netherlands.
authors.forename: Erwin E H
authors.initials: EEH
authors.lastname: van Wegen
authors.affiliation: Department of Neurology and Neurosurgery, Rudolf Magnus Institute of Neuroscience, UMC Utrecht, PO Box 85060, 3508AB, Utrecht, The Netherlands.
authors.forename: Nick F
authors.initials: NF
authors.lastname: Ramsey
authors.affiliation: Department of Rehabilitation Medicine, MOVE Research Institute Amsterdam, VU University Medical Center, PO Box 7057, 1007MB, Amsterdam, The Netherlands.|Amsterdam Rehabilitation Research Center, Reade Centre for Rehabilitation and Rheumatology, PO Box 58271, 1040HG, Amsterdam, The Netherlands.
authors.forename: Gert
authors.initials: G
authors.lastname: Kwakkel
mesh_terms: D000368:Aged; D002531:Cerebellum / Q000503:physiopathology; D005260:Female; D005385:Fingers / Q000502:physiology; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009043:Motor Activity / Q000502:physiology*; D009044:Motor Cortex / Q000503:physiopathology*; D020127:Recovery of Function / Q000502:physiology*; D020521:Stroke / Q000503:physiopathology*; D034941:Upper Extremity / Q000502:physiology*
keywords: Brain activation; Motor control; Neuroplasticity; Recovery; Stroke; Upper extremity