期刊
NEUROREHABILITATION AND NEURAL REPAIR
卷 34, 期 1, 页码 61-71出版社
SAGE PUBLICATIONS INC
DOI: 10.1177/1545968319876253
关键词
transcranial magnetic stimulation; stroke; hemiparesis; dorsal premotor cortex; nonlesioned hemisphere; rehabilitation
资金
- NIH [K01 HD060886, T32 NS041231, R21 5R21HD090516]
- AHA [14GRNT20460001, 15PRE24920006]
- SCANR: NINDS StrokeNet [1U10 NS086513]
Background. Severe poststroke arm impairment is associated with greater activation of the nonlesioned hemisphere during movement of the affected arm. The circumstances under which this activation may be adaptive or maladaptive remain unclear. Objective. To identify the functional relevance of key lesioned and nonlesioned hemisphere motor areas to reaching performance in patients with mild versus severe arm impairment. Methods. A total of 20 participants with chronic stroke performed a reaching response time task with their affected arm. During the reaction time period, a transient magnetic stimulus was applied over the primary (M1) or dorsal premotor cortex (PMd) of either hemisphere, and the effect of the perturbation on movement time (MT) was calculated. Results. For perturbation of the nonlesioned hemisphere, there was a significant interaction effect of Site of perturbation (PMd vs M1) by Group (mild vs severe; P < .001). Perturbation of PMd had a greater effect on MT in the severe versus the mild group. This effect was not observed with perturbation of M1. For perturbation of the lesioned hemisphere, there was a main effect of site of perturbation (P < .05), with perturbation of M1 having a greater effect on MT than PMd. Conclusions. These results demonstrate that, in the context of reaching movements, the role of the nonlesioned hemisphere depends on both impairment severity and the specific site that is targeted. A deeper understanding of these individual-, task-, and site-specific factors is essential for advancing the potential usefulness of neuromodulation to enhance poststroke motor recovery.
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