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. 2005 Aug;81(958):510–514. doi: 10.1136/pgmj.2004.030809

Mechanisms underlying recovery of motor function after stroke

N Ward 1
PMCID: PMC1743338  PMID: 16085742

Abstract

Neurological damage, and stroke in particular, is the leading cause of long term disability worldwide. There is growing interest in the part that central nervous system reorganisation plays in recovery of function. Techniques such as functional magnetic resonance imaging and transcranial magnetic stimulation permit the non-invasive study of the working human brain, and suggest that functionally relevant adaptive changes occur in the human brain after focal damage. An understanding of how these changes are related to recovery will facilitate the development of novel therapeutic techniques that are based on neurobiological principles and that are designed to minimise impairment in appropriately targeted patients suffering from stroke.

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Selected References

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  1. Baron Jean-Claude, Cohen Leonardo G., Cramer Steven C., Dobkin Bruce H., Johansen-Berg Heidi, Loubinoux Isabelle, Marshall Randolph S., Ward N. S., First International Workshop on Neuroimaging and Stroke Recovery Neuroimaging in stroke recovery: a position paper from the First International Workshop on Neuroimaging and Stroke Recovery. Cerebrovasc Dis. 2004;18(3):260–267. doi: 10.1159/000080293. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Brown Jeffrey A., Lutsep Helmi, Cramer Steven C., Weinand Martin. Motor cortex stimulation for enhancement of recovery after stroke: case report. Neurol Res. 2003 Dec;25(8):815–818. doi: 10.1179/016164103771953907. [DOI] [PubMed] [Google Scholar]
  3. Buchkremer-Ratzmann I., August M., Hagemann G., Witte O. W. Electrophysiological transcortical diaschisis after cortical photothrombosis in rat brain. Stroke. 1996 Jun;27(6):1105–1111. doi: 10.1161/01.str.27.6.1105. [DOI] [PubMed] [Google Scholar]
  4. Bütefisch Cathrin M., Khurana Vikram, Kopylev Leonid, Cohen Leonardo G. Enhancing encoding of a motor memory in the primary motor cortex by cortical stimulation. J Neurophysiol. 2004 Jan 7;91(5):2110–2116. doi: 10.1152/jn.01038.2003. [DOI] [PubMed] [Google Scholar]
  5. Bütefisch Cathrin M., Netz Johannes, Wessling Marion, Seitz Rüdiger J., Hömberg Volker. Remote changes in cortical excitability after stroke. Brain. 2003 Feb;126(Pt 2):470–481. doi: 10.1093/brain/awg044. [DOI] [PubMed] [Google Scholar]
  6. Calautti C., Leroy F., Guincestre J. Y., Baron J. C. Dynamics of motor network overactivation after striatocapsular stroke: a longitudinal PET study using a fixed-performance paradigm. Stroke. 2001 Nov;32(11):2534–2542. doi: 10.1161/hs1101.097401. [DOI] [PubMed] [Google Scholar]
  7. Calautti Cinzia, Baron Jean-Claude. Functional neuroimaging studies of motor recovery after stroke in adults: a review. Stroke. 2003 May 8;34(6):1553–1566. doi: 10.1161/01.STR.0000071761.36075.A6. [DOI] [PubMed] [Google Scholar]
  8. Carey James R., Kimberley Teresa J., Lewis Scott M., Auerbach Edward J., Dorsey Lisa, Rundquist Peter, Ugurbil Kamil. Analysis of fMRI and finger tracking training in subjects with chronic stroke. Brain. 2002 Apr;125(Pt 4):773–788. doi: 10.1093/brain/awf091. [DOI] [PubMed] [Google Scholar]
  9. Castro-Alamancos M. A., Donoghue J. P., Connors B. W. Different forms of synaptic plasticity in somatosensory and motor areas of the neocortex. J Neurosci. 1995 Jul;15(7 Pt 2):5324–5333. doi: 10.1523/JNEUROSCI.15-07-05324.1995. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Conforto Adriana B., Kaelin-Lang Alain, Cohen Leonardo G. Increase in hand muscle strength of stroke patients after somatosensory stimulation. Ann Neurol. 2002 Jan;51(1):122–125. doi: 10.1002/ana.10070. [DOI] [PubMed] [Google Scholar]
  11. Cramer S. C., Chopp M. Recovery recapitulates ontogeny. Trends Neurosci. 2000 Jun;23(6):265–271. doi: 10.1016/s0166-2236(00)01562-9. [DOI] [PubMed] [Google Scholar]
  12. Delvaux Valérie, Alagona Giovanna, Gérard Pascale, De Pasqua Victor, Pennisi G., de Noordhout Alain Maertens. Post-stroke reorganization of hand motor area: a 1-year prospective follow-up with focal transcranial magnetic stimulation. Clin Neurophysiol. 2003 Jul;114(7):1217–1225. doi: 10.1016/s1388-2457(03)00070-1. [DOI] [PubMed] [Google Scholar]
  13. Feeney D. M. From laboratory to clinic: noradrenergic enhancement of physical therapy for stroke or trauma patients. Adv Neurol. 1997;73:383–394. [PubMed] [Google Scholar]
  14. Feydy A., Carlier R., Roby-Brami A., Bussel B., Cazalis F., Pierot L., Burnod Y., Maier M. A. Longitudinal study of motor recovery after stroke: recruitment and focusing of brain activation. Stroke. 2002 Jun;33(6):1610–1617. doi: 10.1161/01.str.0000017100.68294.52. [DOI] [PubMed] [Google Scholar]
  15. Floel Agnes, Nagorsen Ulrike, Werhahn Konrad J., Ravindran Shashi, Birbaumer Niels, Knecht Stefan, Cohen Leonardo G. Influence of somatosensory input on motor function in patients with chronic stroke. Ann Neurol. 2004 Aug;56(2):206–212. doi: 10.1002/ana.20170. [DOI] [PubMed] [Google Scholar]
  16. Fridman Esteban A., Hanakawa Takashi, Chung Melissa, Hummel Friedhelm, Leiguarda Ramon C., Cohen Leonardo G. Reorganization of the human ipsilesional premotor cortex after stroke. Brain. 2004 Jan 28;127(Pt 4):747–758. doi: 10.1093/brain/awh082. [DOI] [PubMed] [Google Scholar]
  17. Goldstein L. B. Pharmacology of recovery after stroke. Stroke. 1990 Nov;21(11 Suppl):III139–III142. [PubMed] [Google Scholar]
  18. Grotta James C., Noser Elizabeth A., Ro Tony, Boake Corwin, Levin Harvey, Aronowski Jarek, Schallert Timothy. Constraint-induced movement therapy. Stroke. 2004 Sep 16;35(11 Suppl 1):2699–2701. doi: 10.1161/01.STR.0000143320.64953.c4. [DOI] [PubMed] [Google Scholar]
  19. Hagemann G., Redecker C., Neumann-Haefelin T., Freund H. J., Witte O. W. Increased long-term potentiation in the surround of experimentally induced focal cortical infarction. Ann Neurol. 1998 Aug;44(2):255–258. doi: 10.1002/ana.410440217. [DOI] [PubMed] [Google Scholar]
  20. Heald A., Bates D., Cartlidge N. E., French J. M., Miller S. Longitudinal study of central motor conduction time following stroke. 2. Central motor conduction measured within 72 h after stroke as a predictor of functional outcome at 12 months. Brain. 1993 Dec;116(Pt 6):1371–1385. doi: 10.1093/brain/116.6.1371. [DOI] [PubMed] [Google Scholar]
  21. Hikosaka Okihide, Nakamura Kae, Sakai Katsuyuki, Nakahara Hiroyuki. Central mechanisms of motor skill learning. Curr Opin Neurobiol. 2002 Apr;12(2):217–222. doi: 10.1016/s0959-4388(02)00307-0. [DOI] [PubMed] [Google Scholar]
  22. Indredavik B., Bakke F., Slordahl S. A., Rokseth R., Hâheim L. L. Stroke unit treatment. 10-year follow-up. Stroke. 1999 Aug;30(8):1524–1527. doi: 10.1161/01.str.30.8.1524. [DOI] [PubMed] [Google Scholar]
  23. Jang Sung Ho, Kim Yun-Hee, Cho Sang-Hyun, Lee Jin-Hee, Park Ji-Won, Kwon Yong-Hyun. Cortical reorganization induced by task-oriented training in chronic hemiplegic stroke patients. Neuroreport. 2003 Jan 20;14(1):137–141. doi: 10.1097/00001756-200301200-00025. [DOI] [PubMed] [Google Scholar]
  24. Johansen-Berg Heidi, Dawes Helen, Guy Claire, Smith Stephen M., Wade Derick T., Matthews Paul M. Correlation between motor improvements and altered fMRI activity after rehabilitative therapy. Brain. 2002 Dec;125(Pt 12):2731–2742. doi: 10.1093/brain/awf282. [DOI] [PubMed] [Google Scholar]
  25. Johansen-Berg Heidi, Rushworth Matthew F. S., Bogdanovic Marko D., Kischka Udo, Wimalaratna Sunil, Matthews Paul M. The role of ipsilateral premotor cortex in hand movement after stroke. Proc Natl Acad Sci U S A. 2002 Oct 10;99(22):14518–14523. doi: 10.1073/pnas.222536799. [DOI] [PMC free article] [PubMed] [Google Scholar]
  26. Jones T. A., Kleim J. A., Greenough W. T. Synaptogenesis and dendritic growth in the cortex opposite unilateral sensorimotor cortex damage in adult rats: a quantitative electron microscopic examination. Brain Res. 1996 Sep 9;733(1):142–148. doi: 10.1016/0006-8993(96)00792-5. [DOI] [PubMed] [Google Scholar]
  27. Jones T. A., Schallert T. Overgrowth and pruning of dendrites in adult rats recovering from neocortical damage. Brain Res. 1992 May 22;581(1):156–160. doi: 10.1016/0006-8993(92)90356-e. [DOI] [PubMed] [Google Scholar]
  28. Maier M. A., Armand J., Kirkwood P. A., Yang H-W, Davis J. N., Lemon R. N. Differences in the corticospinal projection from primary motor cortex and supplementary motor area to macaque upper limb motoneurons: an anatomical and electrophysiological study. Cereb Cortex. 2002 Mar;12(3):281–296. doi: 10.1093/cercor/12.3.281. [DOI] [PubMed] [Google Scholar]
  29. Marshall R. S., Perera G. M., Lazar R. M., Krakauer J. W., Constantine R. C., DeLaPaz R. L. Evolution of cortical activation during recovery from corticospinal tract infarction. Stroke. 2000 Mar;31(3):656–661. doi: 10.1161/01.str.31.3.656. [DOI] [PubMed] [Google Scholar]
  30. Martinsson Louise, Hårdemark Hans-Göran, Wahlgren Nils Gunnar. Amphetamines for improving stroke recovery: a systematic cochrane review. Stroke. 2003 Oct 16;34(11):2766–2766. doi: 10.1161/01.STR.0000098003.50143.17. [DOI] [PubMed] [Google Scholar]
  31. Miyai Ichiro, Yagura Hajime, Hatakenaka Megumi, Oda Ichiro, Konishi Ichiro, Kubota Kisou. Longitudinal optical imaging study for locomotor recovery after stroke. Stroke. 2003 Nov 13;34(12):2866–2870. doi: 10.1161/01.STR.0000100166.81077.8A. [DOI] [PubMed] [Google Scholar]
  32. Murase Nagako, Duque Julie, Mazzocchio Riccardo, Cohen Leonardo G. Influence of interhemispheric interactions on motor function in chronic stroke. Ann Neurol. 2004 Mar;55(3):400–409. doi: 10.1002/ana.10848. [DOI] [PubMed] [Google Scholar]
  33. Schaechter Judith D., Kraft Eduard, Hilliard Timothy S., Dijkhuizen Rick M., Benner Thomas, Finklestein Seth P., Rosen Bruce R., Cramer Steven C. Motor recovery and cortical reorganization after constraint-induced movement therapy in stroke patients: a preliminary study. Neurorehabil Neural Repair. 2002 Dec;16(4):326–338. doi: 10.1177/154596830201600403. [DOI] [PubMed] [Google Scholar]
  34. Schallert T., Leasure J. L., Kolb B. Experience-associated structural events, subependymal cellular proliferative activity, and functional recovery after injury to the central nervous system. J Cereb Blood Flow Metab. 2000 Nov;20(11):1513–1528. doi: 10.1097/00004647-200011000-00001. [DOI] [PubMed] [Google Scholar]
  35. Scheidtmann K., Fries W., Müller F., Koenig E. Effect of levodopa in combination with physiotherapy on functional motor recovery after stroke: a prospective, randomised, double-blind study. Lancet. 2001 Sep 8;358(9284):787–790. doi: 10.1016/S0140-6736(01)05966-9. [DOI] [PubMed] [Google Scholar]
  36. Shimizu Toshio, Hosaki Akiko, Hino Taro, Sato Masaru, Komori Tetsuo, Hirai Shunsaku, Rossini Paolo M. Motor cortical disinhibition in the unaffected hemisphere after unilateral cortical stroke. Brain. 2002 Aug;125(Pt 8):1896–1907. doi: 10.1093/brain/awf183. [DOI] [PubMed] [Google Scholar]
  37. Strick P. L. Anatomical organization of multiple motor areas in the frontal lobe: implications for recovery of function. Adv Neurol. 1988;47:293–312. [PubMed] [Google Scholar]
  38. Stroemer R. P., Kent T. A., Hulsebosch C. E. Enhanced neocortical neural sprouting, synaptogenesis, and behavioral recovery with D-amphetamine therapy after neocortical infarction in rats. Stroke. 1998 Nov;29(11):2381–2395. doi: 10.1161/01.str.29.11.2381. [DOI] [PubMed] [Google Scholar]
  39. Uy J., Ridding M. C., Hillier S., Thompson P. D., Miles T. S. Does induction of plastic change in motor cortex improve leg function after stroke? Neurology. 2003 Oct 14;61(7):982–984. doi: 10.1212/01.wnl.0000078809.33581.1f. [DOI] [PubMed] [Google Scholar]
  40. Ward N. S., Brown M. M., Thompson A. J., Frackowiak R. S. J. Neural correlates of motor recovery after stroke: a longitudinal fMRI study. Brain. 2003 Aug 22;126(Pt 11):2476–2496. doi: 10.1093/brain/awg245. [DOI] [PMC free article] [PubMed] [Google Scholar]
  41. Ward N. S., Brown M. M., Thompson A. J., Frackowiak R. S. J. Neural correlates of outcome after stroke: a cross-sectional fMRI study. Brain. 2003 Jun;126(Pt 6):1430–1448. doi: 10.1093/brain/awg145. [DOI] [PMC free article] [PubMed] [Google Scholar]
  42. Ward Nick S., Brown Martin M., Thompson Alan J., Frackowiak Richard S. J. The influence of time after stroke on brain activations during a motor task. Ann Neurol. 2004 Jun;55(6):829–834. doi: 10.1002/ana.20099. [DOI] [PMC free article] [PubMed] [Google Scholar]
  43. Werhahn Konrad J., Conforto Adriana B., Kadom Nadja, Hallett Mark, Cohen Leonardo G. Contribution of the ipsilateral motor cortex to recovery after chronic stroke. Ann Neurol. 2003 Oct;54(4):464–472. doi: 10.1002/ana.10686. [DOI] [PubMed] [Google Scholar]

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