Abstract
Stroke is a leading cause of disability in the United States and is likely to have an increasing impact on disability worldwide. In order to develop more effective rehabilitation techniques, it is critical to understand the mechanisms underlying the mature brain’s capacity to reorganize and restore neurologic function. Over the past decade, functional brain imaging has been a principal investigational tool in elucidating mechanisms of stroke recovery. Functional imaging studies of motor performance in patients with stroke consistently demonstrate areas of brain activation not present in healthy subjects. The role of these additional areas in recovery after stroke remains uncertain. This review discusses methodologic and theoretical issues that impact on interpreting functional imaging studies of motor recovery after stroke.
Similar content being viewed by others
References and Recommended Reading
Taylor TN, Davis PH, Torner JC, et al.: Lifetime cost of stroke in the United States. Stroke 1996, 27:1459–1466.
Toga AW, Mazziotta JC (eds): Brain Mapping: The Methods, edn 2. New York: Academic Press; 2002.
Calautti C, Baron JC: Functional neuroimaging studies of motor recovery after stroke in adults. Stroke 2003, 34:1553–1566. Excellent comprehensive review of functional imaging studies of motor recovery after stroke.
Calautti C, Serrati C, Baron JC: Effects of age on brain activation during auditory-cued thumb-to-index opposition: a positron emission tomography study. Stroke 2001, 32:139–146.
D’Esposito M, Zarahn E, Aguirre GK, Rypma B: The effect of normal aging on the coupling of neural activity to the bold hemodynamic response. Neuroimage 1999, 10:6–14.
Shelton FN, Reding MJ: Effect of lesion location on upper limb motor recovery after stroke. Stroke 2001, 32:107–112.
Binkofski F, Seitz RJ, Arnold S, et al.: Thalamic metabolism and corticospinal tract integrity determine motor recovery in stroke. Ann Neurol 1996, 36:460–470.
Shimizu T, Hosaki A, Hino T, et al.: Motor cortical disinhibition in the unaffected hemisphere after unilateral cortical stroke. Brain 2002, 125:1896–1907.
Brett M, Leff AP, Rorden C, Ashburner J: Spatial normalization of brain images with focal lesions using cost function masking. Neuroimage 2001, 14:486–500.
Ward NS, Brown MM, Thompson AJ, Frackowiak RS: Neural correlates of outcome after stroke: a cross-sectional fMRI study. Brain 2003, 126:1430–1448.
Ward NS, Brown MM, Thompson AJ, Frackowiak RS: Neural correlates of motor recovery after stroke: a longitudinal fMRI study. Brain 2003, 126:2476–2496. Well-designed, recent longitudinal fMRI study of motor recovery after stroke.
Powers WJ: Cerebral hemodynamics in ischemic cerebrovascular disease. Ann Neurol 1991, 29:231–240.
Marshall RS, Rundek T, Sproule DM, et al.: Monitoring of cerebral vasodilatory capacity with transcranial Doppler carbon dioxide inhalation in patients with severe carotid artery disease. Stroke 2003, 34:945–949.
Bilecen D, Radu EW, Schulte AC, et al.: fMRI of the auditory cortex in patients with unilateral carotid artery stenoocclusive disease. J Magn Reson Imaging 2002, 15:621–627.
Rother J, Knab R, Hamzei F, et al.: Negative dip in BOLD fMRI is caused by blood flow-oxygen consumption uncoupling in humans. Neuroimage 2002, 15:98–102.
Wade DT: Measurement in Neurological Rehabilitation. Oxford Medical Publications. Oxford: Oxford University Press; 1994.
Cirstea MC, Levin MF: Compensatory strategies for reaching in stroke. Brain 2000, 123(pt 5):940–953.
Reinkensmeyer DJ, McKenna CA, Kahn LE, Kamper DG: Directional control of reaching is preserved following mild/ moderate stroke and stochastically constrained following severe stroke. Exp Brain Res 2002, 143:525–530.
Jezzard P, Matthews PM, Smith SM (eds): Functional MRI: An Introduction to Methods, edn 1. London: International Institute for Strategic Studies; 2001.
Seto E, Sela G, McIlroy WE, et al.: Quantifying head motion associated with motor tasks used in fMRI. Neuroimage 2001, 14:284–297. Important study of the effects of stroke on head motion during motor tasks in the MRI scanner.
Nelles G, Cramer SC, Schaechter JD, et al.: Quantitative assessment of mirror movements after stroke. Stroke 1998, 29:1182–1187.
Kim YH, Jang SH, Chang Y, et al.: Bilateral primary sensorimotor cortex activation of post-stroke mirror movements: an fMRI study. Neuroreport 2003, 14:1329–1332.
Wittenberg GF, Bastian AJ, Dromerick AW, et al.: Mirror movements complicate interpretation of cerebral activation changes during recovery from subcortical infarction. Neurorehabil Neural Repair 2000, 14:213–221.
Weiller C, Ramsay SC, Wise RJ, et al.: Individual patterns of functional reorganization in the human cerebral cortex after capsular infarction. Ann Neurol 1993, 33:181–189.
Weiller C, Juptner M, Fellows S, et al.: Brain representation of active and passive movements. Neuroimage 1996, 4:105–110.
Nelles G, Spiekermann G, Jueptner M, et al.: Reorganization of sensory and motor systems in hemiplegic stroke patients. A positron emission tomography study. Stroke 1999, 30:1510–1516.
Weiller C, Chollet F, Friston KJ, et al.: Functional reorganization of the brain in recovery from striatocapsular infarction in man. Ann Neurol 1992, 31:463–472.
Cramer SC, Nelles G, Benson RR, et al.: A functional MRI study of subjects recovered from hemiparetic stroke. Stroke 1997, 28:2518–2527.
Gerardin E, Sirigu A, Lehericy S, et al.: Partially overlapping neural networks for real and imagined hand movements. Cereb Cortex 2000, 10:1093–1104.
Johnson SH: Imagining the impossible: intact motor representations in hemiplegics. Neuroreport 2000, 11:729–732.
Johnson SH, Sprehn G, Saykin AJ: Intact motor imagery in chronic upper limb hemiplegics: evidence for activity-independent action representations. J Cogn Neurosci 2002, 14:841–852.
Chollet F, DiPiero V, Wise RJ, et al.: The functional anatomy of motor recovery after stroke in humans: a study with positron emission tomography. Ann Neurol 1991, 29:63–71.
Marshall RS, Perera GM, Lazar RM, et al.: Evolution of cortical activation during recovery from corticospinal tract infarction. Stroke 2000, 31:656–661.
Feydy A, Carlier R, Roby-Brami A, et al.: Longitudinal study of motor recovery after stroke: recruitment and focusing of brain activation. Stroke 2002, 33:1610–1617.
Bullmore E, Suckling J, Zelaya F, et al.: Practice and difficulty evoke anatomically and pharmacologically dissociable brain activation dynamics. Cerebral Cortex 2003, 13:144–154.
Hummel F, Kirsammer R, Gerloff C: Ipsilateral cortical activation during finger sequences of increasing complexity: representation of movement difficulty or memory load? Clin Neurophysiol 2003, 114:605–613.
Loubinoux I, Carel C, Alary F, et al.: Within-session and between-session reproducibility of cerebral sensorimotor activation: a test-retest effect evidenced with functional magnetic resonance imaging. J Cereb Blood Flow Metab 2001, 21:592–607.
Jantzen KJ, Steinberg FL, Kelso JA: Practice-dependent modulation of neural activity during human sensorimotor coordination: a functional magnetic resonance imaging study. Neurosci Lett 2002, 332:205–209.
Henson RN, Rugg MD: Neural response suppression, haemodynamic repetition effects, and behavioural priming. Neuropsychologia 2003, 41:263–270.
Frost SB, Barbay S, Friel KM, et al.: Reorganization of remote cortical regions after ischemic brain injury: a potential substrate for stroke recovery. J Neurophysiol 2003, 89:3205–3214.
Johansen-Berg H, Rushworth MF, Bogdanovic MD, et al.: The role of ipsilateral premotor cortex in hand movement after stroke. Proc Natl Acad Sci U S A 2002, 99:14518–14523. First TMS study to show functional importance of a contralesional area, identified by fMRI, for motor recovery after stroke.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Krakauer, J.W. Functional imaging of motor recovery after stroke: Remaining challenges. Curr Neurol Neurosci Rep 4, 42–46 (2004). https://doi.org/10.1007/s11910-004-0010-z
Issue Date:
DOI: https://doi.org/10.1007/s11910-004-0010-z