Article

Upper-limb (UL) dysfunction is experienced by up to 75% of patients
poststroke. The greatest potential for functional improvement is in the first
month. Following reperfusion, evidence indicates that neuroplasticity is the
mechanism that supports this recovery. OBJECTIVE:
This preliminary study
hypothesized increased activation of putative motor areas in those receiving
intensive, task-specific UL training in the first month poststroke compared with
those receiving standard care. METHODS: This was a single-blinded, longitudinal,
randomized controlled trial in adult patients with an acute, first-ever ischemic
stroke; 23 participants were randomized to standard care (n = 12) or an
additional 30 hours of task-specific UL training in the first month poststroke
beginning week 1. Patients were assessed at 1 week, 1 month, and 3 months
poststroke. The primary outcome was change in brain activation as measured by
functional magnetic resonance imaging. RESULTS: When compared with the
standard-care group, the intensive-training group had increased brain activation
in the anterior cingulate and ipsilesional supplementary motor areas and a
greater reduction in the extent of activation (P = .02) in the contralesional
cerebellum. Intensive training was associated with a smaller deviation from mean
recovery at 1 month (Pr>F0 = 0.017) and 3 months (Pr>F = 0.006), indicating more
consistent and predictable improvement in motor outcomes. CONCLUSION: Early,
more-intensive, UL training was associated with greater changes in activation in
putative motor (supplementary motor area and cerebellum) and attention (anterior
cingulate) regions, providing support for the role of these regions and functions
in early recovery poststroke.
CI - (c) The Author(s) 2014.

Langue : ANGLAIS