Evaluation of motor recovery with stroke in chronic state demostrated electromyography, fMRI, and DTI

The aim of this study was to evaluate the motor recoveries in 3 chronic hemiparetic patients with Fugl-Meyer assessment (FMA), modified Ashworh scale (MAS), manual muscle test (MMT) scores, EMG characteristics, cortical activation and white matter changes before and after the training program with a symmetrical upper-limb motion trainer training. The training was performed at 1 hr/day, 5 days/week during 6 weeks. Electromyographic activities of the affected hand were recorded during isometric wrist flexion/extension movements. In all patients, FMA and MMT scores except MAS were significantly improved after the 6-week training. Delay in onset/offset of muscle contraction significantly decreased in the affected wrist during the training. The cocontraction ratio of flexor/extensor muscles decreased significantly after the training. We compared cortical activations in two different tasks before and after the training program. Functional magnetic resonance imaging (fMRI) studies in unilateral wrist movement showed that cortical activations decreased in ipsilateral SMC but increased in contralateral SMC and ipsilateral cerebellum. In bilateral wrist movements, bilateral SMC, PMA, SMA and cerebellum showed cortical reorganizations. Diffusion tensor imaging (DTI) results also showed that fractional anisotropy (FA) significantly increased after the training. It seemed that the cortical reorganization was induced by the 6-week training using the symmetrical upper limb motion trainer.