Functional imaging of intervention effects in stroke motor rehabilitation

Objective: To assess intervention-specific effects on cortical reorganization after stroke as shown by available functional neuroimaging studies. Data Sources: We searched Medline for clinical trials that contained the terms stroke, reorganization, and recovery, as well as either positron-emission tomography and PET, near-infrared spectroscopy and NIRS, single-photon emission tomography and SPECT, or functional magnetic resonance imaging and functional MRI; we reviewed primary and secondary references. Study Selection: Articles that reported neuroimaging findings as a result of a specific treatment involving more than 1 subject were included. Data Extraction: We included clinical trials that contained the terms stroke, reorganization, and recovery, as well as functional neuroiniaging data findings as a result of a specific treatment involving more than 1 subject. Data Synthesis: Included studies differed clearly from one another with regard to patient characteristics, intervention protocol, and outcome measures. Most studies used functional magnetic resonance imaging and a motor paradigm. Studies were limited in size. Conclusions: Despite the methodologic differences, several common features can be identified based on the reviewed studies. Clinical improvements occurred even late after injury, after subjects were deemed to have reached a recovery plateau. This clinical improvement was accompanied by cortical reorganization that depended on the type of intervention as well as other factors. This review also suggests direction for future research studies.