%0 Journal Article
%T Functional Brain Correlates of Upper Limb Spasticity and Its Mitigation following Rehabilitation in Chronic Stroke Survivors
%A Svetlana Pundik
%A Adam D. Falchook
%A Jessica McCabe
%A Krisanne Litinas
%A Janis J. Daly
%J Stroke Research and Treatment
%D 2014
%I Hindawi Publishing Corporation
%R 10.1155/2014/306325
%X Background. Arm spasticity is a challenge in the care of chronic stroke survivors with motor deficits. In order to advance spasticity treatments, a better understanding of the mechanism of spasticity-related neuroplasticity is needed. Objective. To investigate brain function correlates of spasticity in chronic stroke and to identify specific regional functional brain changes related to rehabilitation-induced mitigation of spasticity. Methods. 23 stroke survivors (>6 months) were treated with an arm motor learning and spasticity therapy (5£¿d/wk for 12 weeks). Outcome measures included Modified Ashworth scale, sensory tests, and functional magnetic resonance imaging (fMRI) for wrist and hand movement. Results. First, at baseline, greater spasticity correlated with poorer motor function ( ) and greater sensory deficits ( ). Second, rehabilitation produced improvement in upper limb spasticity and motor function ( ). Third, at baseline, greater spasticity correlated with higher fMRI activation in the ipsilesional thalamus ( , ). Fourth, following rehabilitation, greater mitigation of spasticity correlated with enhanced fMRI activation in the contralesional primary motor ( , ), premotor ( , ), primary sensory ( , ), and associative sensory ( , ) regions while controlling for changes in motor function. Conclusions. Contralesional motor regions may contribute to restoring control of muscle tone in chronic stroke. 1. Introduction Motor rehabilitation is a challenging task especially for individuals who exhibit spasticity along with motor impairment. Spasticity can limit effective practice of coordinated movement and hinder functional recovery and rehabilitation [1¨C3]. In fact, a more complete restoration of motor function is achieved when spasticity is absent [4]. The obstacle that spasticity creates for upper limb rehabilitation is due to restriction of movement, in opposition to the spastic muscle activity, as in practice of wrist and finger extension when wrist and finger flexors exhibit spasticity. Spasticity burdens a significant portion of patients with chronic motor deficits, secondary to stroke and other types of brain injury. Up to 42% of stroke survivors exhibit abnormal hypertonia [4¨C8]. This abnormally elevated muscle tone is likely to impact quality of life because it affects many aspects of everyday function, produces pain and discomfort, and prevents normal movements [3, 9]. Spasticity can be improved to some degree. Currently available treatment modalities for spasticity include pharmacological agents (oral preparations, neuromuscular blockade
%U http://www.hindawi.com/journals/srt/2014/306325/