Evolution of brain activation after stroke in a constant-effort versus constant-output motor task

Purpose: Recovery of hand function after stroke has been associated with transient overactivation of the cerebral sensorimotor network. One open question has been as to how much this transient overactivation is related to 'true' reorganisation of the network or reflecting the fact that a simple motor task is difficult to perform for a patient with a motor deficit, i.e. reflecting 'effort'. Methods: To address this, we combined a constant-output (varying effort) and constant-effort (varying output) task in a longitudinal (T1 = 3-5 days, T2 = 6 weeks, T3 = 3 months after stroke) multimodal (functional magnetic resonance imaging (FMRI), electroencephalography (EEG)) study of 12 (EEG)18 (FMRI) patients (7 male, age 67 +/- 9 years) showing significant recovery from a hand motor deficit. Results: The reduction of sensorimotor activation from T1 to T3 was significant (p = 0.012). But task effort did not exhibit any significant impact on the evolution of task-related brain activation overtime. This proved to be equally applicable to FMRI and EEG data. Conclusion: We conclude that initial up-regulation of brain activity after stroke is not simply a consequence of enhanced effort early after stroke but rather reflects neural processes involved in reorganisation and recovery of function.