Abstract
This study examined whether ankle-movement tracking training could improve ankle function and brain reorganization, evidenced with functional magnetic resonance imagery (fMRI), in a single subject with stroke. Test measurements included self-ratings of functional activities, 15.24 m (50 feet) walk time, ankle range of motion, ankle tracking accuracy, and peak dorsiflexion movement during dorsiflexion phases of tracking. Cortical activation in the frontal and parietal lobes was measured during fMRI with an active voxel count. Additionally, a signal intensity index was determined for the gyrus precentralis (GPrC). Training consisted of 16 sessions of tracking waveforms on a computer screen with ankle motion. Four pretest, four posttest and two follow-up measurements occurred. Data were analyzed by visual inspection and by statistical analysis that examined whether posttest measurements exceeded the pretest mean by at least two standard deviations on at least two consecutive posttest measurements. Posttest results showed that the subject’s self report of paretic ankle “catches” (failure of toes to clear floor during swing phase) during gait were eliminated and that peak dorsiflexion movement improved visually but not statistically. Multiple cortical areas showed increased voxel count statistically, as did the intensity index for GPrC. Follow-up results showed that the ankle “catches”, peak dorsiflexion movement, and the intensity index remained at the same levels as posttest. Voxel counts returned toward pretest values. We concluded that tracking training produced training effects in both ankle function and brain reorganization.
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Ashe J, Ugurbil K (1994) Functional imaging of the motor system. Curr Opin Neurobiol 4:832–839
Bandettini PA, Jesmanowicz A, Wong EC, Hyde JS (1993) Processing strategies for time course data sets in functional MRI of the human brain. Magn Reson Med 30:161–173
Blanke DJ, Hageman PA (1989) Comparison of gait of young men and elderly men. Phys Ther 69:144–148
Butefisch CM, Davis BC, Wise SP, Sawaki L, Koplylev L, Classen J, Cohen LG (2000) Mechanisms of use-dependent plasticity in the human motor cortex. Proc Natl Acad Sci U S A 97:3661–3665
Carey JR (1990) Manual stretch: effect on finger movement control and force control in subjects with stroke with spastic extrinsic finger flexor muscles. Arch Phys Med Rehabil 71:888–894
Carey JR, Kimberley TJ, Lewis SM, Auerbach EJ, Dorsey L, Rundquist P, Ugurbil K (2002) Analysis of fMRI and finger tracking training in subjects with chronic stroke. Brain 125:773–788
Cohen MS, DuBois RM (1999) Stability, repeatability, and the expression of signal magnitude in functional magnetic resonance imaging. J Magn Reson Imaging 10:33–40
Coren S (1993) The lateral preference inventory for measurement of handedness, footedness, eyedness, and earedness: norms for young adults. Bull Psychonom Soc 31:1–3
Cramer SC, Nelles G, Benson RR, Kaplan JD, Parker RA, Kwong KK, Kennedy DN, Finklestein SP, Rosen BR (1997) A functional MRI study of subjects recovered from hemiparetic stroke. Stroke 28:2518–2527
Cramer SC, Finklestein SP, Schaechter JD, Bush G, Rosen BR (1999) Activation of distinct motor cortex regions during ipsilateral and contralateral finger movements. J Neurophysiol 8:383–387
Folstein MF, Folstein SE, McHugh PR (1975) “Mini-mental state:” a practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 12:189–198
Greenough WT, Larson JR, Withers GS (1985) Effects of unilateral and bilateral training in a reaching task on dendritic branching of neurons in the rat motor-sensory forelimb cortex. Behav Neural Biol 44:301–314
Hesse S, Bertelt C, Schaffrin A, Malezic M, Mauritz KH (1994) Restoration of gait in non-ambulatory hemiparetic patients by treadmill training with partial body weight support. Arch Phys Med Rehabil 75:1087–1093
Hesse S, Werner C, Matthias K, Stephen K, Berteanu M (1999) Non-velocity-related effects of a rigid double-stopped ankle-foot orthosis on gait and lower limb muscle activity of hemiparetic subjects with an equinovarus deformity. Stroke 30:1855–1861
Imamizu H, Uno Y, Kawato M (1998) Adaptive internal model of intrinsic kinematics involved in learning an aiming task. J Exp Psychol Hum Percept Perform 24:812–829
Jorgenson H, Nakayama H, Raaschou H, Olsen T (1995) Recovery of walking function in stroke patients: The Copenhagen Stroke Study. Arch Phys Med Rehabil 76:27–32
Kerrigan DC, Frates EP, Rogan S, Riley PO, (2000) Hip hiking and circumduction: quantitative definitions. Am J Phys Med Rehabil 79:247–252
Kim S-G, Hendrick K, Hu X, Merkle H, Ugurbil K (1994) Potential pitfalls of functional MRI using conventional gradient-recalled echo techniques. NMR Biomed 7:69–74
Kleim JA, Barbay S, Cooper NR, Hogg TM, Reidel CN, Remple MS, Nudo RJ (2002) Motor learning-dependent synaptogenesis is localized to functionally reorganized motor cortex. Neurobiol Learn Mem 77:63–77
Lehmann JF, Condon SM, de Lateur BJ, Price R (1986) Gait abnormalities in peroneal nerve paralysis and their corrections by orthoses: a biomechanical study. Arch Phys Med Rehabil 67:380–386
Miltner WHR, Bauder HB, Sommer M, Dettmers C, Taub E (1999) Effects of constraint-induced movement therapy on patients with chronic motor deficits after stroke: a replication. Stroke 30:586–592
Muellbacher W, Ziemann U, Boroojerdi B, Cohen L, Hallett M (2001) Role of the human motor cortex in rapid motor learning. Exp Brain Res 136:431–438
Muellbacher W, Richards C, Ziemann U, Wittenberg G, Weltz D, Boroojerdi B, Cohen L, Hallett M (2002) Improving hand function in chronic stroke. Arch Neurol 59:1278–1282
Nudo RJ, Milliken GW, Jenkins WM, Merzenich MM (1996) Use-dependent alterations of movement representations in primary motor cortex of adult squirrel monkeys. J Neurosci 16:785–807
Oldfield RC (1971) The assessment and analysis of handedness: the Edinburgh inventory. Neuropsychologia 9:97–113
Pascual-Leone A, Grafman J, Hallett M (1994) Modulation of cortical motor output maps during development of implicit and explicit knowledge. Science 263:1287–1289
Perry J, Garrett M, Gronley JK, Mulroy SJ (1995) Classification of walking handicap in the stroke population. Stroke 26:982–989
Plautz EJ, Milliken GW, Nudo RJ (2000) Effects of repetitive motor training on movement representations in adult squirrel monkeys: role of use versus learning. Neurobiol Learn Mem 74:27–55
Portney LG, Watkins MP (2000) Foundations of clinical research: applications to practice. Appleton & Lange, East Norwalk, CT
Remple MS, Bruneau RM, VandenBerg PM, Goertzen C, Kleim JA (2001) Sensitivity of cortical movement representations to motor experience: evidence that skill learning but not strength training induces cortical reorganization. Behav Brain Res 123:133–141
Richards C, Malouin F, Dumas F, Tardif D (1995) Gait velocity as an outcome measure of locomotor recovery after stroke. Mosby, St. Louis, MO
Shields RK, Leo KC, Messaros AJ, Somers VK (1999) Effects of repetitive handgrip training on endurance, specificity, and cross-education. Phys Ther 79:467–475
Smith GV, Silver KHC, Goldberg AP, Macko RF (1999) “Task-oriented” exercise improves hamstring strength and spastic reflexes in chronic stroke patients. Stroke 30:2112–2118
Strupp JP (1996) Stimulate: a GUI based, fMRI analysis software package. Neuroimage 3:S607
Talairach J, Tournoux P (1988) Co-planar stereotaxic atlas of the human brain. Thieme, New York
Taub E, Miller NE, Novack TA, Cook EW III, Fleming WD, Nepomuceno CS, Connell JS, Crago JE (1993) Technique to improve chronic motor deficit after stroke. Arch Phys Med Rehabil 74:347–354
Taub E, Crago JE, Burgio LD, Groomes TE, Cook EW, DeLuca SC, Miller NE (1994) An operant approach to rehabilitation medicine: overcoming learned nonuse by shaping. J Exp Anal Behav 61:281–293
Taub E, Crago JE, Uswatte G (1998) Constraint-induced movement therapy: a new approach to treatment in physical rehabilitation. Rehabil Psychol 43:152–170
Vaughan JT, Adriany G, Garwood M, Andersen P, Ugurbil K (2001) The head cradle: an open faced, high performance TEM coil. Proc Intl Soc Mag Reson Med 9:15
Waldvogel D, van Gelderen P, Immisch I, Pfeiffer C, Hallett M (2000) The variability of serial fMRI data: correlation between a visual and a motor task. Neuroreport 11:3843–3847
Xiong J, Gao JH, Lancaster JL, Fox PT (1995) Clustered pixels analysis for functional MRI activation studies of the human brain. Hum Brain Mapp 3:287–301
Ziemann U, Corwell B, Cohen LG (1998) Modulation of plasticity in human motor cortex after forearm ischemic nerve block. J Neurosci 18:1115–1123
Acknowledgements
The work was supported by the National Institute for Disability and Rehabilitation Research (US Department of Education #H133G010077-02) and the National Institutes of Health (National Centers for Research Resources #P41RR08079). We thank Gregor Adriany, PhD, and J. Thomas Vaughan, PhD, for their valuable contributions.
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This work was completed at the University of Minnesota, Minneapolis, MN 55455
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Carey, J.R., Anderson, K.M., Kimberley, T.J. et al. fMRI analysis of ankle movement tracking training in subject with stroke. Exp Brain Res 154, 281–290 (2004). https://doi.org/10.1007/s00221-003-1662-7
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DOI: https://doi.org/10.1007/s00221-003-1662-7