FMRI evidence for Intensive Stroke Rehabilitation Improving stroke movement

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Functional MRI and motor behavioral changes obtained with constraint-induced movement therapy in chronic stroke; Könönen M, Tarkka IM, Niskanen E, Pihlajamäki M, Mervaala E, Pitkänen K, Vanninen R; write in the European Journal of Neurology (Oct 2011)
Background:  In an attempt to understand why the clinical benefits of intensive stroke rehabilitation vary between patients the group looked at multimodal functional imaging to assess the relationship of clinical gain and imaging. The group looked at patients with chronic stroke whose voluntary motor control improved after constraint-induced movement therapy (CIMT).
The group showed that increases in fMRI activation in the sensorimotor areas is greater amongst those subjects who had either poor hand motor behavior before therapy and/or whose functional ability outcome  improved during therapy
The group concluded that alterations in sensorimotor cortical activations represented by (fMRI) and corticospinal conductivity (TMS) were observed after intensive rehabilitation in patients with chronic stroke. This activation and functional changes in fMRI and TMS were seen to correlatewith the degree of clinical improvement in hand motor behavior.
The Tutor system, which includes the HandTutor, ArmTutor, LegTutor and 3DTutor, are used extensively for stroke rehabilitation therapy.
The newly developed HandTutor is a glove used successfully in hand therapy. Its sister devices the ArmTutor and LegTutor are arm and leg braces respectively that are successful in improving functional movement outcome and neuromuscular rehabilitation following physical and occupational therapy. These innovative devices implement an impairment based program with augmented feedback and encourage motor learning through intensive active exercises. These exercises are challenging and motivating and allow for repetitive training tailored to the patient’s performance as prescribed by physiotherapist and occupational therapists world wide. The Tutor system also includes objective quantitative evaluations that provide the therapist information to customize the most suitable rehabilitation program to the patient’s ability. Currently part of the rehabilitation program of leading U.S. and foreign hospitals the Tutors are also used in clinics and at home through the use of telerehabilitation. See http://www.handtutor.com
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