This proposal is concerned with recovery of motor function following brain damage after a cerebrovascular infarct. Though functional reorganization has been shown within the premotor cortex following recovery after stroke, we still known relative little about whether these changes can be enhanced during the neurorehabilitative period if special designed techniques, that stimulate the premotor cortex, are applied. Basic research studies have suggested an increase activity of the premotor cortex during conditional motor learning and during reaching and grasping an object. Therefore, we designed a conditional reaching and grasping motor training to indirectly stimulate this area of the brain in stroke patients during the recovery process. Moreover, increases of cortical activity and corticospinal excitability have followed trains of repetitive transcranial magnetic stimulation in humans. Thus, we designed a scheme of repetitive transcranial magnetic stimulation to directly stimulate the premotor cortex in stroke patients during the neurorehabilitative period.
The aim of this proposal is to evaluate the efficacy of these two novel stimulation techniques, supported by neural basis, to enhance motor recovery after stroke. We designed two parallel independent prospective, single-blind, randomize, controlled trials in which we will objectively evaluate behavioral and kinematics changes during motor performance and correlate them with neurophysiological analysis. A voluntary reach-retrieval- delivery task that is an important component of the daily life will be used for the assessment. The proposed work promises to contribute important new insight into the field of therapeutic modalities that can be used to increase motor recovery after stroke. In addition, it will provide some insight into mechanisms underlying such recovery. Since stroke is the leading cause of motor disabilities this work has a clear clinical relevance.
| Fridman, Esteban A; Crespo, Marcos; Gomez Argüello, Santiago et al. (2010) Kinematic improvement following Botulinum Toxin-A injection in upper-limb spasticity due to stroke. J Neurol Neurosurg Psychiatry 81:423-7 |
