Functional versus Nonfunctional Rehabilitation in Chronic Ischemic Stroke: Evidences from a Randomized Functional MRI Study

• Published in: Journal of neural transplantation & plasticity Vol. 2016; no. 2016; pp. 1 - 10
• Main Authors: de Araujo, Draulio B., dos Santos, Antonio C., Fabio, Soraia R. C., Minelli, Cesar, Lino de Souza, Altay A., Peres, Andre S. C., Novaes, Morgana M., Pelicioni, Maristela C. X., Pontes-Neto, Octavio M.
• Format: Journal Article
• Language: English
• Published: Cairo, Egypt Hindawi Publishing Corporation 01.01.2016; John Wiley & Sons, Inc; Hindawi Limited; Wiley
• Subjects: Adult; Aged; Brain - physiopathology; Brain Ischemia - physiopathology; Brain Ischemia - rehabilitation; Female; Functional Laterality - physiology; Humans; Ischemia; Magnetic Resonance Imaging; Male; Middle Aged; Paresis; Patients; Physical therapy; Recovery of Function - physiology; Rehabilitation; Stroke; Stroke (Disease); Stroke - physiopathology; Stroke Rehabilitation; Treatment Outcome
• ISSN: 2090-5904; 0792-8483; 1687-5443
• DOI: 10.1155/2016/6353218

Motor rehabilitation of stroke survivors may include functional and/or nonfunctional strategy. The present study aimed to compare the effect of these two rehabilitation strategies by means of clinical scales and functional Magnetic Resonance Imaging (fMRI). Twelve hemiparetic chronic stroke patients were selected. Patients were randomly assigned a nonfunctional (NFS) or functional (FS) rehabilitation scheme. Clinical scales (Fugl-Meyer, ARA test, and modified Barthel) and fMRI were applied at four moments: before rehabilitation (P1) and immediately after (P2), 1 month after (P3), and three months after (P4) the end of rehabilitation. The NFS group improved significantly and exclusively their Fugl-Meyer scores at P2, P3, and P4, when compared to P1. On the other hand, the FS group increased significantly in Fugl-Meyer at P2, when compared to P1, and also in their ARA and Barthel scores. fMRI inspection at the individual level revealed that both rehabilitation schemes most often led to decreased activation sparseness, decreased activity of contralesional M1, increased asymmetry of M1 activity to the ipsilesional side, decreased perilesional activity, and decreased SMA activity. Increased M1 asymmetry with rehabilitation was also confirmed by Lateralization Indexes. Our clinical analysis revealed subtle differences between FS and NFS.