Evaluating the Abnormality of Bilateral Motor Cortex Activity in Subacute Stroke Patients Executing a Unimanual Motor Task With Increasing Demand on Precision

• Type of Material: Article
• Authors: Kate Pirog Revill, Emory University; Deborah A Barany, Emory University; Isabelle Vernon, Emory University; Stephanie Rellick, West Virginia University; Alexandra Caliban, Emory University; Julie Tran, Emory University; Samir Belagaje, Emory University; Fadi Nahab, Emory University; Marc W Haut, West Virginia University; Cathrin Buetefisch, Emory University
• Language: English
• Date: 2022-05-25
• Publisher: FRONTIERS MEDIA SA
• Publication Version: Final Published Version
• Copyright Statement: © 2022 Revill, Barany, Vernon, Rellick, Caliban, Tran, Belagaje, Nahab, Haut and Buetefisch.
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.3389/fneur.2022.836716
• Title of Journal or Parent Work: FRONTIERS IN NEUROLOGY
• Volume: 13
• Start Page: 836716
• End Page: 836716
• Grant/Funding Information: DB received support from the Emory University NIH/NINDST32 training and translational research in neurology program (T32NS007480), Georgia StrokeNet, and the American Heart Association (18POST34060183). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.; This work was supported by the National Institutes of Neurological Diseases and Stroke and the National Institutes of Child Development and Health at the National Institutes of Health, Bethesda, MD, USA (R01NS090677).
• Keywords: CORTICAL ACTIVATION; stroke; Science & Technology; fMRI; FUNCTIONAL MRI; CONTROLLED TRIAL; motor cortex; CONTRALESIONAL HEMISPHERE; motor recovery-cerebral infarct; PREMOTOR CORTEX; RECOVERY; MIRROR MOVEMENTS; Life Sciences & Biomedicine; INFORMATION CAPACITY; hand function; TRANSCRANIAL MAGNETIC STIMULATION; Clinical Neurology; Neurosciences & Neurology; Neurosciences; INTERHEMISPHERIC INHIBITION
• Research Categories: Health Sciences, Medicine and Surgery

Abstract

Abnormal contralesional M1 activity is consistently reported in patients with compromised upper limb and hand function after stroke. The underlying mechanisms and functional implications of this activity are not clear, which hampers the development of treatment strategies targeting this brain area. The goal of the present study was to determine the extent to which contralesional M1 activity can be explained by the demand of a motor task, given recent evidence for increasing ipsilateral M1 activity with increasing demand in healthy age-matched controls. We hypothesized that higher activity in contralesional M1 is related to greater demand on precision in a hand motor task. fMRI data were collected from 19 patients with ischemic stroke affecting hand function in the subacute recovery phase and 31 healthy, right-handed, age-matched controls. The hand motor task was designed to parametrically modulate the demand on movement precision. Electromyography data confirmed strictly unilateral task performance by all participants. Patients showed significant impairment relative to controls in their ability to perform the task in the fMRI scanner. However, patients and controls responded similarly to an increase in demand for precision, with better performance for larger targets and poorer performance for smaller targets. Patients did not show evidence of elevated ipsilesional or contralesional M1 blood oxygenation level-dependent (BOLD) activation relative to healthy controls and mean BOLD activation levels were not elevated for patients with poorer performance relative to patients with better task performance. While both patients and healthy controls showed demand-dependent increases in BOLD activation in both ipsilesional/contralateral and contralesional/ipsilateral hemispheres, patients with stroke were less likely to show evidence of a linear relationship between the demand on precision and BOLD activation in contralesional M1 than healthy controls. Taken together, the findings suggest that task demand affects the BOLD response in contralesional M1 in patients with stroke, though perhaps less strongly than in healthy controls. This has implications for the interpretation of reported abnormal bilateral M1 activation in patients with stroke because in addition to contralesional M1 reorganization processes it could be partially related to a response to the relatively higher demand of a motor task when completed by patients rather than by healthy controls.