Effect of finger tracking combined with electrical stimulation on brain reorganization and hand function in subjects with stroke |
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Authors: | Ela Bhatt Ashima Nagpal Kristine H Greer Tiffany K Grunewald Jennifer L Steele Jeff W Wiemiller Scott M Lewis James R Carey |
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Institution: | (1) Program in Physical Therapy and Program in Rehabilitation Science, MMC 388, University of Minnesota, 420 Delaware St. SE, Minneapolis, MN 55455, USA;(2) Gillette Children’s Specialty Healthcare, Minnetonka, MN, USA;(3) Rehabilitation Institute of Chicago, Chicago, IL, USA;(4) United Hospital, St Paul, MN, USA;(5) Institute for Athletic Medicine, Minneapolis, MN, USA;(6) Department of Neurology, University of Minnesota Medical School, Minneapolis, MN, USA;(7) Brain Sciences Center (11B), VA Medical Center, Minneapolis, MN, USA |
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Abstract: | Synergism of rehabilitative interventions could maximize recovery following stroke. We examined whether the combination of
peripherally initiated electrical stimulation of finger extensors and centrally operating finger tracking training could accentuate
brain reorganization and its relationship to recovery, beyond the effects of either treatment alone. Twenty subjects with
stroke were randomly assigned to an electrical stimulation (ES), tracking training (TR) or combination (CM) group. Each group
was trained for ten 1-h sessions over 2–3 weeks. Pretest and posttest measurements consisted of the Box and Block and Jebsen
Taylor tests of manual dexterity and a finger tracking test that was performed during functional magnetic resonance imaging
(fMRI). fMRI variables included laterality index and BOLD signal intensity of primary motor (M1), primary sensory (S1), sensorimotor
(SMC) and premotor (PMC) cortices as well as, supplementary motor area (SMA). ES and CM groups improved on dexterity, whereas
the TR group did not. Improvement in the CM group was not greater than the other two groups. Subjects who had an intact M1
showed greater functional improvement than those who had direct involvement of M1. fMRI analysis did not yield significant
changes from pretest to posttest. In the CM group only, functional improvement was positively correlated with laterality index
change in M1, S1, SMC and PMC, indicating greater ipsilesional control and was negatively correlated with BOLD Signal Intensity
change in ipsilesional S1 and SMA, indicating neurophysiological trimming of irrelevant neurons. The correlational results
suggest that the combined intervention may be more influential on brain reorganization than either treatment alone but a larger
sample size, longer duration of training, or a restricted inclusion of stroke location and volume may be needed to demonstrate
a difference in efficacy for producing behavioral changes. |
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