Article

Good motor outcome after stroke has been found to correlate with
increased activity in a dorsal premotor (PMd) brain circuit, suggesting that
therapeutic strategies targeting this circuit might have a favorable, causal
influence on motor status.
This study addressed the hypothesis that a
Premotor Therapy that exercises normal PMd functions would provide greater
behavioral gains than would standard Motor Therapy; and that Premotor Therapy
benefits would be greatest in patients with greater preservation of PMd circuit
elements. METHODS: Patients with chronic hemiparetic stroke (n = 15) were
randomized to 2-weeks of Premotor Therapy or Motor Therapy, implemented through a
robotic device. RESULTS: Overall, gains were modest but significant (change in FM
score, 2.1 +/- 2.8 points, p < 0.02) and did not differ by treatment assignment.
However, a difference between Therapies was apparent when injury to the PMd
circuit was considered, as the interaction between treatment assignment and
degree of corticospinal tract injury was significantly related to the change in
FM score (p = 0.018): the more the corticospinal tract was spared, the greater
the gains provided by Premotor Therapy. Similar results were obtained when
looking at the interaction between treatment assignment and PMd function (p =
0.03). CONCLUSIONS: Targeted engagement of a brain circuit is a feasible strategy
for stroke rehabilitation. This approach has maximum impact when there is less
stroke injury to key elements of the targeted circuit.

Langue : ANGLAIS