Clinical Research
The effects of motor imagery training and conventional therapy on the functioning of stroke survivors: A resting-state fMRI study
Limin Sun, Hewei Wang, Guojun Xu, Changhui Sun, Bing Zhu, Yiming Xu, Mingxia Fan, Yi Wu
Published 2019-02-25
Cite as Chin J Phys Med Rehabil, 2019, 41(2): 84-90. DOI: 10.3760/cma.j.issn.0254-1424.2019.02.002
Abstract
ObjectiveTo measure the efficacy of combining motor imagery training (MIT) with conventional therapy in improving stroke patients′ upper-extremity function. And to seek a cortical reorganization mechanism associated with the improvement using resting-state functional magnetic resonance imaging (rs-fMRI).
MethodsTen stroke survivors were selected as an experimental group. They were given motor imagery training for four weeks (30 minutes a day, 5 days a week) and conventional rehabilitation therapy (40 minutes a day, 5 days a week). Another 10 healthy counterparts were the control group. Before and after the four weeks of treatment, both groups were assessed using the upper extremity Fugl-Meyer assessment (FMA-UE) and the modified Barthel index (MBI). Moreover, rs-fMRI was conducted to assess functional connectivity between cortical regions and the ipsilesional primary motor cortex (M1) before and after the intervention. The laterality index (LI) of the primary motor or sensory cortex was also calculated.
ResultsAfter the intervention, the average FMA-UE and MBI scores of the experimental group had increased significantly. After MIT and conventional therapy there was increased functional connectivity between the ipsilesional and contralesional M1 areas, and between the ipsilesional M1 and contralesional primary sensory cortex (S1) and frontal lobe, the functional connection between the ipsilesional M1 and the ipsilesional paracentral lobule and the anterior cingutate was also increased. More specifically, the LI relating M1 and S1 decreased after the intervention, tending toward the normal level. LIMI decreased significantly.
ConclusionThe 4-week regimen of motor imagery training and conventional therapy resulted in functional improvement in the upper limbs and greater ability in the activities of daily living. The observed improvements may be due to cortical reorganization, including better functional connectivity between the bilateral M1 areas and increased connectivity between the ipsilesional M1 area and some non-motor areas. There is some recovery of symmetry in the bilateral primary motor cortex.
Key words:
Resting-state functional magnetic resonance imaging; Functional magnetic resonance imaging; Motor imagery training; Stroke; Cortical reorganization
Contributor Information
Limin Sun
Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai 200040, China
Hewei Wang
Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai 200040, China
Guojun Xu
Department of Physics, Shanghai Key Laboratory of Magnetic Resonance, East China Normal University, Shanghai 200062, China
Changhui Sun
Department of Rehabilitation Medicine, Huashan North Hospital, Fudan University, Shanghai 201907, China
Bing Zhu
Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai 200040, China
Yiming Xu
Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai 200040, China
Mingxia Fan
Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai 200040, China
Yi Wu
Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai 200040, China
