Motor Imagery After Subcortical Stroke A Functional Magnetic Resonance Imaging Study

被引:116
作者
Sharma, Nikhil [1 ]
Simmons, Lucy H. [1 ]
Jones, P. Simon [1 ]
Day, Diana J. [1 ]
Carpenter, T. Adrian [1 ]
Pomeroy, Valerie M. [2 ]
Warburton, Elizabeth A. [1 ]
Baron, Jean-Claude [1 ]
机构
[1] Univ Cambridge, Dept Clin Neurosci, Cambridge CB2 2QQ, England
[2] Univ E Anglia, Norwich NR4 7TJ, Norfolk, England
基金
英国惠康基金; 英国医学研究理事会;
关键词
functional imaging; motor imagery; motor recovery; stroke; PREMOTOR CORTEX; ACTIVATION BALANCE; HAND MOVEMENTS; FOOT MOVEMENTS; AREAS; FMRI; RECOVERY; SYSTEM; REPRESENTATIONS; REORGANIZATION;
D O I
10.1161/STROKEAHA.108.525766
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Background and Purpose-In recovered subcortical stroke, the pattern of motor network activation during motor execution can appear normal or not, depending on the task. Whether this applies to other aspects of motor function is unknown. We used functional MRI to assess motor imagery (MI), a promising new approach to improve motor function after stroke, and contrasted it to motor execution. Methods-Twenty well-recovered patients with hemiparetic subcortical stroke (14 males; mean age, 66.5 years) and 17 aged-matched control subjects were studied. Extensive behavioral screening excluded 8 patients and 4 control subjects due to impaired MI abilities. Subjects performed MI and motor execution of a paced finger-thumb opposition sequence using a functional MRI paradigm that monitored compliance. Activation within the primary motor cortex (BA4a and 4p), dorsal premotor, and supplementary motor areas was examined. Results-The pattern of activation during affected-hand motor execution was not different from control subjects. Affected-hand MI activation was also largely similar to control subjects, including involvement of BA4, but with important differences: (1) unlike control subjects and the nonaffected hand, activation in BA4a and dorsal premotor was not lower during MI as compared with motor execution; (2) the hemispheric balance of BA4p activation was significantly less lateralized than control subjects; and (3) ipsilesional BA4p activation positively correlated with motor performance. Conclusions-In well-recovered subcortical stroke, the motor system, including ipsilesional BA4, is activated during MI despite the lesion. It, however, remains disorganized in proportion to residual motor impairment. Thus, components of movement upstream from execution appear differentially affected after stroke and could be targeted by rehabilitation in more severely affected patients. (Stroke. 2009;40:1315-1324.)
引用
收藏
页码:1315 / 1324
页数:10
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