Functional Reorganization in Chronic Hemiparetic Patients after Training: fMRI Studies

Abstract

The aim of this study was to evaluate effects of short-term repetitive-bilateral exercise on the activation of motor network using functional magnetic resonance imaging (fMRI). Eight control subjects and four chronic hemiparetic patients were investigated for the present study. The training program with a symmetrical upper-limb motion trainer was performed at 1 hr/day, 5 days/week during 6 weeks. Fugl-Meyer assessments (FMA) were performed every two weeks during the training. We compared cerebral and cerebellar cortical activations in two different tasks before and after the training program: (1) the only unaffected hand movement (Task 1), and (2) passive movements of the affected hand by the active movement of the unaffected hand (Task 2). fMRI was performed at 3T with wrist flexion-extension movement at 1 Hz during the motor tasks. All patients showed significant improvements of FMA scores in their paretic limbs after training. fMRI studies in Task 1 showed that cortical activations decreased in ipsilateral SMC but increased in contralateral sensorimotor cortex (SMC) and ipsilateral cerebellum (CRB). Task 2 showed cortical reorganizations in bilateral SMC, pre-motor area (PMA), supplementary area (SMA) and CRB. This study demonstrated that plastic changes of motor network occurred as a neural basis of the improvement subsequent to repetitive-bilateral exercises using the symmetrical upper-limb motion trainer.