Rethinking interhemispheric imbalance as a target for stroke neurorehabilitation
| Autor: | Xu, Jing, Branscheidt, Meret, Schambra, Heidi, Steiner, Levke, Widmer, Mario, Diedrichsen, Jörn, Goldsmith, Jeff, Lindquist, Martin, Kitago, Tomoko, Luft, Andreas R., Krakauer, John W., Celnik, Pablo A., Kim, Nathan, Harran, Michelle D., Hertler, Benjamin, Cortes, Juan C. |
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| Rok vydání: | 2019 |
| Předmět: |
Adult
Male 0301 basic medicine medicine.medical_specialty Longitudinal study medicine.medical_treatment Functional Laterality Article Young Adult 03 medical and health sciences 0302 clinical medicine Physical medicine and rehabilitation Reaction Time medicine Humans Psychology Longitudinal Studies Chronic stroke Stroke Neurorehabilitation Aged Chronic stage Rehabilitation business.industry Neurological Rehabilitation Stroke Rehabilitation Neurosciences Recovery of Function Middle Aged medicine.disease Transcranial Magnetic Stimulation 030104 developmental biology Neurology Ischemic stroke Female Motor recovery Neurology (clinical) business 030217 neurology & neurosurgery Follow-Up Studies |
| Zdroj: | Brain and Mind Institute Researchers' Publications Ann Neurol |
| Popis: | © 2019 American Neurological Association Objective: Patients with chronic stroke have been shown to have failure to release interhemispheric inhibition (IHI) from the intact to the damaged hemisphere before movement execution (premovement IHI). This inhibitory imbalance was found to correlate with poor motor performance in the chronic stage after stroke and has since become a target for therapeutic interventions. The logic of this approach, however, implies that abnormal premovement IHI is causal to poor behavioral outcome and should therefore be present early after stroke when motor impairment is at its worst. To test this idea, in a longitudinal study, we investigated interhemispheric interactions by tracking patients’ premovement IHI for one year following stroke. Methods: We assessed premovement IHI and motor behavior five times over a 1-year period after ischemic stroke in 22 patients and 11 healthy participants. Results: We found that premovement IHI was normal during the acute/subacute period and only became abnormal at the chronic stage; specifically, release of IHI in movement preparation worsened as motor behavior improved. In addition, premovement IHI did not correlate with behavioral measures cross-sectionally, whereas the longitudinal emergence of abnormal premovement IHI from the acute to the chronic stage was inversely correlated with recovery of finger individuation. Interpretation: These results suggest that interhemispheric imbalance is not a cause of poor motor recovery, but instead might be the consequence of underlying recovery processes. These findings call into question the rehabilitation strategy of attempting to rebalance interhemispheric interactions in order to improve motor recovery after stroke. Ann Neurol 2019;85:502–513. |
| Databáze: | OpenAIRE |
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