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Reorganization of Brain Function During Force Production After Stroke: A Systematic Review of the Literature

Kokotilo, Kristen J. BSc; Eng, Janice J. PT, MSc, PhD; Boyd, Lara A. MPT, PhD

Journal of Neurologic Physical Therapy: March 2009 - Volume 33 - Issue 1 - pp 45-54
doi: 10.1097/NPT.0b013e31819824f0

Background and Purpose: Damage to motor areas of the brain caused by stroke can produce devastating motor deficits, including aberrant control of force. Reorganization of brain function is a fundamental mechanism involved in recovery of motor control after stroke, and recent advances in neuroimaging have enabled study of this reorganization. This review focuses on neuroimaging studies that have examined reorganization of brain function during force production and force modulation after stroke.

Methods: The type and extent of reorganization after stroke were characterized by three factors: severity of injury, time after stroke, and impact of therapeutic interventions on brain activation during force production. Twenty-six studies meeting the inclusion criteria could be identified in MEDLINE (1980–2007).

Results: Relevant characteristics of studies (lesion location, chronicity of stroke, and motor task) and mapping techniques varied. During force production, increased activation in secondary motor areas occurred in persons with more severe strokes. Reduced recruitment of secondary motor areas during force production was found as a function of increased time since stroke. During force modulation, increased activation in motor areas occurred with greater force generation. Persons with more severe stroke showed greater activation with increasing force compared with persons with less severe stroke. Alteration of brain activation during and after rehabilitative interventions was identified in some studies.

Discussion and Conclusion: This systematic review establishes that reorganization of brain function during force production and force modulation can occur after stroke. These findings imply that therapeutic strategies may target brain reorganization to improve force control and functional recovery after stroke.

Graduate Program in Neuroscience (K.J.K., J.J.E., and L.A.B.), University of British Columbia. Vancouver, BC, Canada; Rehabilitation Research Lab (K.J.K. and J.J.E.), GF Strong Rehab Centre, Vancouver, BC, Canada; and Department of Physical Therapy (J.J.E., and L.A.B.), Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.

Supported by Canadian Institute for Health Research and the Michael Smith Foundation for Health Research (to J.J.E.); The North Growth Fund, Vancouver Coastal Health Research Institute and Foundation, and Heart and Stroke Foundation of British Columbia (to L.A.B.); and Natural Sciences and Engineering Research Council (trainee award to K.J.K.).

Address correspondence to: Janice J Eng, E-mail:

© 2009 Neurology Section, APTA