Hebbian-Type Primary Motor Cortex Stimulation: A Potential Treatment of Impaired Hand Function in Chronic Stroke Patients
| Autor: | Cathrin M. Buetefisch, Kate Pirog Revill, Samir Belagaje, Fadi Nahab, Marc W. Haut, Daniel Drake |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
Adult
Male medicine.medical_specialty Stimulation 050105 experimental psychology Article 03 medical and health sciences 0302 clinical medicine Physical medicine and rehabilitation Double-Blind Method Outcome Assessment Health Care medicine Humans 0501 psychology and cognitive sciences Stroke Chronic stroke Neurorehabilitation Aged Ischemic Stroke Hand function Neuronal Plasticity medicine.diagnostic_test business.industry 05 social sciences Motor Cortex Stroke Rehabilitation General Medicine Middle Aged medicine.disease Hand Magnetic Resonance Imaging Transcranial Magnetic Stimulation Hebbian theory Chronic Disease Female Primary motor cortex business Functional magnetic resonance imaging 030217 neurology & neurosurgery |
| Zdroj: | Neurorehabilitation and neural repair. 34(2) |
| ISSN: | 1552-6844 |
| Popis: | Background. Stroke often involves primary motor cortex (M1) and its corticospinal (CST) projections. As hand function is critically dependent on these structures, its recovery is often incomplete. Objective. To determine whether impaired hand function in patients with chronic ischemic stroke involving M1 or CST benefits from the enhancing effect of Hebbian-type stimulation (pairing M1 afferent stimulation and M1 activity in a specific temporal relationship) on M1 plasticity and hand function. Methods. In a double-blind, randomized, sham-controlled design, 20 patients with chronic ischemic stroke affecting M1 or CST were randomly assigned to 5 days of hand motor training that was combined with either Hebbian-type (trainingHebb) or sham stimulation (trainingsham) of the lesioned M1. Measures of hand function and task-based M1 functional magnetic resonance imaging (fMRI) activity were collected prior to, immediately following, and 4 weeks after the intervention. Results. Both interventions were effective in improving affected hand function at the completion of training, but only participants in the trainingHebb group maintained functional gains. Changes in hand function and fMRI activity were positively correlated in both ipsilesional and contralesional M1. Compared with trainingsham, participants in the trainingHebb group showed a stronger relationship between improved hand function and changes in M1 functional activity. Conclusions. Only when motor training was combined with Hebbian-type stimulation were functional gains maintained over time and correlated with measures of M1 functional plasticity. As hand dexterity is critically dependent on M1 function, these results suggest that functional reorganization in M1 is facilitated by Hebbian-type stimulation. ClinicalTrials.gov Identifier: NCT01569607. |
| Databáze: | OpenAIRE |
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