| An fMRI study of active, passive and imagery movement in healthy adult subjects[Abstract] Objective To assess differences in brain activations between active, passive and imagery movement of hands using block design functional MRI (fMRI) and to provide the evidences of cortical reorganization of motor imagery training. Methods Twenty adult right handedness healthy volunteers were studied. fMRI was performed with three different paradigms, namely, active, passive and imagery fist clutch task. fMRI data were analyzed using SPM8. The whole brain analysis and group analysis were applied to get the results of the number of voxels, volume of activation, peak t-score and its coordinate. Results The areas of activation of active and passive movement were almost similar. They both produced significant activation in contralateral sensorimotor cortex (cSMC), contralateral supplementary motor area (cSMA) and ipsilateral cerebellum (iCL). The cSMC was the greatest and the most frequently actived brain area. Imagery movement produced significant activation in bilateral SMA. Conclusion The study proved that active and passive movement led to similar significant activation in the brain areas. It indicates that passive movement task might represent the active movement task to oberve the activation of brain cortex during the recovery of the stroke with severe hemiplegia. Effects of motor imagery training on functional recovery after stroke: a randomized controlled study[Abstract] Objective To investigate the effects of motor imagery training (MIT) on motor function and activities of daily living in chronic stroke patients. Methods Thirty-two stroke patients keeping with enrolling criterion were randomly divided into2groups:EXP group and CON group (16cases in each group). All patients of two groups received conventional rehabilitation therapy for four weeks (40minutes a day,5days a week) and the same therapy such as acupuncture, Chinese massage, biofeedback stimulation, etc. Patients in EXP group received motor imagery training for four weeks (30minutes a day,5days a week) and patients in CON group received health education and psychological communication for four weeks (30minutes a day,5days a week). Functional evaluation was assessed by the upper extremity of Fugl-Meyer assessment (FM-UL), Motor Activity Log (MAL) including two sections the amount of use (AOU) and the quality of movement (QOM), Modified Barthel Index (MBI) and the kinesthetic and visual imagery questionnaire (KVIQ-20) which were carried out before treatment and four weeks after treatment. Results When comparing among the2groups before interventions, there were no significant differences of FM-UL, MBI, AOU, QOM and KVIQ-20(P>0.05). After four-week treatments, the FM-UL, MBI, AOU and QOM significantly increased both in EXP group and CON group (P<0.05). The scores in EXP group were higher than those in CON group (P<0.05). The KVIQ-20significantly increased only in EXP group, not in the CON group. Four weeks later the score of KVIQ-20in EXP group was higher than that in CON group (P<0.05). Conclusion Motor imagery training can improve the motor function of upper extremity, the activities of daily living and the abilities of motor imagery in chronis stroke patients. Motor imagery training in chronic stroke patients:a longitudinal fMRI study[Abstract] Objective To measure the efficacy of motor imagery training (MIT) in improving chronic stroke patients’upper-extremity functional outcomes and to find the possible cortical reorganization patterns associated with the improvement of motor function with functional magnetic resonance imaging (fMRI) response during a passive hand task. Methods Eighteen chronic stroke patients with stable, pure and severe motor deficits were enrolled. Nine patients were in the EXP group and nine in the CON group. The methods of intervention and evaluation were the same as the second section of our study. fMRI was also administered to assess cortical activation changes in regions of interest (ROIs) that included the primary and secondary motor and sensory areas while the patients executed a passive fist clutch task at the two time points before and after four-week interventions. Results After the interventions, changes in FM-UL scores in MIT group were dramatically greater than those in the CRT group (P=0.004). We found that two types of cortical reorganization patterns existed in the MIT and CRT groups. One pattern consisted of persistent growth in activation in the contralateral sensorimotor cortex (cSMC) for most patients (six in the MIT group, five in the CRT group), and the other pattern consisted of focusing of the activation in the cSMC with increasing of the laterality index of the SMC (LI-SMC) for a small portion of patients (three in the MIT group, one in the CRT group). For the former pattern, the relative change of activation in the cSMC (relative△cSMC was calculated using the increase in the number of activated voxels in the cSMC divided by the sum of that over the two scan sessions) in the MIT group was greater than that in the CRT group, but the difference between the two groups was not statistically significant (P=0.176). However, when we applied correlation analyses to the variables of relative△cSMC and relative△FM-UL (calculated in the same manner as relative△cSMC) in the11patients of the two groups who experienced the first type of cortical reorganization pattern, a positive relationship was detected (R=0.68, P=0.02). Conclusion This study indicated that, for the chronic stroke patients with severe upper-extremity impairments, a4-week regimen of MIT plus CRT resulted in functional improvement in the upper limbs. We describe how these interventions may elicit plastic changes; i.e., the possible two cortical reorganization patterns in the brain:increasing recruitment and focusing recruitment in cSMC. After interventions for the first cortical reorganization pattern, the more activation in cSMC, the better scores of the upper limbs in chronic stroke patients.
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