Rehabilitation

doi:10.1017/CBO9780511544903.012

11 - Rehabilitation

Published online by Cambridge University Press: 12 August 2009

David Gow ,

Chris Fraser and

Shaheen Hamdy

Edited by

Simon Boniface and

Ulf Ziemann

Show author details

David Gow: Affiliation:
Department of GI Sciences and Medicine, University of Manchester, Hope Hospital, Eccles Old Road, Salford M6 8HD, UK
Chris Fraser: Affiliation:
Department of Medicine, Royal Bolton Hospital Farnworth, Bolton BL 4 OJR, UK
Shaheen Hamdy: Affiliation:
Department of GI Sciences and Medicine, University of Manchester, Hope Hospital, Eccles Old Road, Salford M6 8HD, UK
Simon Boniface: Affiliation:
Addenbrooke's Hospital, Cambridge
Ulf Ziemann: Affiliation:
Johann Wolfgang Goethe-Universität Frankfurt

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Summary

Introduction

Neurological rehabilitation can be defined as the institution of therapy to maximize the degree of recovery within a given individual following a neurological insult. It has been suggested that neurological rehabilitation is based around the phenomenon of neuronal plasticity which is thought to play a crucial role in recovery from neurological injury and in particular stroke. For the design and implementation of effective rehabilitative strategies it is essential to consider three components: (i) an understanding of the nature of the initial insult, (ii) an understanding of the manner in which recovery may occur and (iii) an objective measure of the result of therapeutic interventions employed.

Each of these components can be addressed in part with transcranial magnetic stimulation and the area of recovery from disability following stroke has received most attention. In particular, TMS has been used to investigate motor reorganization following stroke, which has led to a greater understanding of the potential recovery patterns that occur. TMS may also have a role in the induction of plasticity itself and has potential to become a rehabilitative tool in recovery from neurological injury.

In this chapter we will review how TMS has been utilized in the study of spontaneous recovery, explore the role of TMS in quantifying rehabilitation and examine how TMS has been applied to studies aimed at influencing the recovery process with therapeutic intervention.

Mechanisms of recovery from unilateral hemispheric stroke

Unilateral hemispheric stroke (UHS) has many advantages as a model for investigating recovery from neurological injury.

Information

Type: Chapter
Information: Plasticity in the Human Nervous System
Investigations with Transcranial Magnetic Stimulation
, pp. 264 - 287

DOI: https://doi.org/10.1017/CBO9780511544903.012 [Opens in a new window]

Publisher: Cambridge University Press

Print publication year: 2003

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References

Barer, D. H. (1989). The natural history and functional consequences of dysphagia after hemispheric stroke. J. Neurol. Neurosurg. Psychiatry, 52: 236–241CrossRef Google Scholar PubMed

Ben-Shachar, D., Belmaker, R. H., Grisaru, N. & Klein, E. (1997). Transcranial magnetic stimulation induces alterations in brain monoamines. J. Neural. Transm., 104: 191–197CrossRef Google Scholar PubMed

Ben-Shachar, D., Gazawi, H., Riboyad-Levin, J. & Klein, E. (1999). Chronic repetitive transcranial magnetic stimulation alters beta-adrenergic and 5-HT 2 receptor characteristics in rat brain. Brain Res., 816: 78–83CrossRef Google Scholar

Berardelli, A., Inghilleri, M., Rothwell, J. C.. (1998). Facilitation of muscle evoked responses after repetitive cortical stimulation in man. Exp. Brain Res., 122: 79–84CrossRef Google Scholar PubMed

Berardelli, A., Inghilleri, M., Gilio, F.. (1999). Effects of repetitive cortical stimulation on the silent period evoked by magnetic stimulation. Exp. Brain Res., 125: 82–86CrossRef Google Scholar PubMed

Bobath, B. (1970). Adult Hemiplegia: Evaluation and Treatment. London: William Heinemann Medical Books Ltd.

Brasil-Neto, J. P., Valls-Sole, J., Pascual-Leone, A.. (1993). Rapid modulation of human cortical motor outputs following ischaemic nerve block. Brain, 116: 511–525CrossRef Google Scholar PubMed

Buckner, R. L., Corbetta, M., Schatz, J., Raichle, M. E. & Petersen, S. E. (1996). Preserved speech abilities and compensation following prefrontal damage. Proc. Natl Acad. Sci., USA, 93: 1249–1253CrossRef Google Scholar PubMed

Cao, Y., D'Olhaberriague, L., Vikingstad, E. M., Levine, S. R. & Welch, K. M. (1998). Pilot study of functional MRI to assess cerebral activation of motor function after poststroke hemiparesis. Stroke, 29: 112–122CrossRef Google Scholar PubMed

Caramia, M. D., Palmieri, M. G., Giacomini, P., Iani, C., Dally, L. & Silvestrini, M. (2000). Ipsilateral activation of the unaffected motor cortex in patients with hemiparetic stroke. Clin. Neurophysiol., 111: 1990–1996CrossRef Google Scholar PubMed

Carr, L. J., Harrison, L. M., Evans, A. L. & Stephens, J. A. (1993). Patterns of central motor reorganization in hemiplegic cerebral palsy. Brain, 116: 1223–1247CrossRef Google Scholar PubMed

Carr, L. J., Harrison, L. M. & Stephens, J. A. (1994). Evidence for bilateral innervation of certain homologous motoneurone pools in man. J. Physiol., 475: 217–227CrossRef Google Scholar PubMed

Chen, R., Classen, J., Gerloff, C.. (1997). Depression of motor cortex excitability by low-frequency transcranial magnetic stimulation. Neurology, 48: 1398–1403CrossRef Google Scholar PubMed

Chollet, F., DiPiero, V., Wise, R. J., Brooks, D. J., Dolan, R. J. & Frackowiak, R. S. (1991). The functional anatomy of motor recovery after stroke in humans: a study with positron emission tomography. Ann. Neurol., 29: 63–71CrossRef Google Scholar PubMed

Cohen, L. G., Brasil-Neto, J. P., Pascual-Leone, A. & Hallett, M. (1993). Plasticity of cortical motor output organization following deafferentation, cerebral lesions, and skill acquisition. Adv. Neurol., 63: 187–200Google Scholar PubMed

Cote, R., Hachinski, V. C., Shurvell, B. L., Norris, J. W. & Wolfson, C. (1986). The Canadian Neurological Scale: a preliminary study in acute stroke. Stroke, 17: 731–737CrossRef Google Scholar PubMed

Cramer, S. C., Nelles, G., Benson, R. R.. (1997). A functional MRI study of subjects recovered from hemiparetic stroke. Stroke, 28: 2518–2527CrossRef Google Scholar PubMed

D'Olhaberriague, L., Gamissans, Espadaler J. M., Marrugat, J.Valls, A., Ley, Oliveras C. & Seoane, J. L. (1997). Transcranial magnetic stimulation as a prognostic tool in stroke. J. Neurol. Sci., 147: 73–80CrossRef Google Scholar PubMed

Donoghue, J. P., Suner, S. & Sanes, J. N. (1990). Dynamic organization of primary motor cortex output to target muscles in adult rats. II. Rapid reorganization following motor nerve lesions. Exp. Brain Res., 79: 492–503CrossRef Google Scholar PubMed

Fisher, C. M. (1992). Concerning the mechanism of recovery in stroke hemiplegia. Can. J. Neurol. Sci., 19: 57–63Google Scholar PubMed

Fraser, C., Hamdy, S., Rothwell, J. C. & Thompson, D. G. (1999). Sensory-induced reorganisation of human swallowing motor cortex displays differential frequency dependent patterms. NeuroImage, 9: A507Google Scholar

Fraser, C., Hobday, D., Power, M.. (2001a). A functional study of sensory dependent brain reorganisation during swallowing. Gastroenterology, 120: A713CrossRef Google Scholar

Fraser, C., Power, M., Hamdy, S.. (2001b). Driving plasticity in adult human motor cortex improves functional performance after cerebral injury. Clin. Neurophysiol., 112: S86Google Scholar

Hamdy, S., Aziz, Q., Rothwell, J. C.. (1996). The cortical topography of human swallowing musculature in health and disease. Nat. Med., 2: 1217–1224CrossRef Google Scholar PubMed

Hamdy, S., Aziz, Q., Rothwell, J. C.. (1997). Explaining oropharyngeal dysphagia after unilateral hemispheric stroke. Lancet, 350: 686–692CrossRef Google Scholar PubMed

Hamdy, S., Aziz, Q., Rothwell, J. C.. (1998a). Recovery of swallowing after dysphagic stroke relates to functional reorganization in the intact motor cortex. Gastroenterology, 115: 1104–1112CrossRef Google Scholar

Hamdy, S., Rothwell, J. C., Aziz, Q., Singh, K. D. & Thompson, D. G. (1998b). Long-term reorganization of human motor cortex driven by short-term sensory stimulation. Nat. Neurosci., 1: 64–68CrossRef Google Scholar

Hausmann, A., Weis, C., Marksteiner, J., Hinterhuber, H. & Humpel, C. (2000). Chronic repetitive transcranial magnetic stimulation enhances c-fos in the parietal cortex and hippocampus. Brain Res. Mol. Brain Res., 76: 355–362CrossRef Google Scholar PubMed

Heald, A., Bates, D., Cartlidge, N. E., French, J. M. & Miller, S. (1993). Longitudinal study of central motor conduction time following stroke. 2. Central motor conduction measured within 72 h after stroke as a predictor of functional outcome at 12 months. Brain, 116: 1371–1385CrossRef Google Scholar PubMed

Heiss, W. D., Kessler, J., Thiel, A., Ghaemi, M. & Karbe, H. (1999). Differential capacity of left and right hemispheric areas for compensation of poststroke aphasia. Ann. Neurol., 45: 430–4383.0.CO;2-P>CrossRef Google Scholar PubMed

Keck, M. E., Sillaber, I., Ebner, K.. (2000). Acute transcranial magnetic stimulation of frontal brain regions selectively modulates the release of vasopressin, biogenic amines and amino acids in the rat brain. Eur. J. Neurosci., 12: 3713–3720CrossRef Google Scholar PubMed

Liepert, J., Bauder, H., Wolfgang, H. R., Miltner, W. H., Taub, E. & Weiller, C. (2000). Treatment-induced cortical reorganization after stroke in humans. Stroke, 31: 1210–1216CrossRef Google Scholar PubMed

Mahoney, F. & Barthel, D. (1965). Functional evaluation: the Barthel index. MD State Med. J., 14: 61–85Google Scholar PubMed

Muellbacher, W., Artner, C. & Mamoli, B. (1998). Motor evoked potentials in unilateral lingual paralysis after monohemispheric ischaemia. J. Neurol. Neurosurg. Psychiatry, 65: 755–761CrossRef Google Scholar PubMed

Muellbacher, W., Artner, C. & Mamoli, B. (1999). The role of the intact hemisphere in recovery of midline muscles after recent monohemispheric stroke. J. Neurol., 246: 250–256CrossRef Google Scholar PubMed

Muller, K., Iliyya, Kass F. & Reitz, M. (1997). Ontogeny of ipsilateral corticospinal projections: a developmental study with transcranial magnetic stimulation. Ann. Neurol., 42: 705–711CrossRef Google Scholar PubMed

Muller, M. B., Toschi, N., Kresse, A. E., Post, A. & Keck, M. E. (2000). Long-term repetitive transcranial magnetic stimulation increases expression of brain derived neurotrophic factor and cholecystokinin mRNA, but not neuropeptide tyrosine mRNA in specific areas of rat brain. Neuropsychopharmacology, 23: 205–215CrossRef Google Scholar

Nelles, G., Spiekermann, G., Jueptner, M.. (1999). Reorganization of sensory and motor systems in hemiplegic stroke patients. A positron emission tomography study. Stroke, 30: 1510–1516CrossRef Google Scholar PubMed

Netz, J., Lammers, T. & Homberg, V. (1997). Reorganization of motor output in the non-affected hemisphere after stroke. Brain, 120: 1579–1586CrossRef Google Scholar PubMed

Nudo, R. J. (1997). Remodeling of cortical motor representations after stroke: implications for recovery from brain damage. Mol. Psychiatry, 2: 188–191CrossRef Google Scholar PubMed

Nudo, R. J. & Milliken, G. W. (1996). Reorganization of movement representations in primary motor cortex following focal ischemic infarcts in adult squirrel monkeys. J. Neurophysiol., 75: 2144–2149CrossRef Google Scholar PubMed

Nudo, R. J., Wise, B. M., SiFuentes, F. & Milliken, G. W. (1996). Neural substrates for the effects of rehabilitative training on motor recovery after ischemic infarct. Science, 272: 1791–1794CrossRef Google Scholar PubMed

Nudo, R. J., Plautz, E. J. & Frost, S. B. (2001). Role of adaptive plasticity in recovery of function after damage to motor cortex. Muscle Nerve, 24: 1000–1019CrossRef Google Scholar PubMed

Leone, Pascual A., Houser, C. M., Reese, K.. (1993). Safety of rapid-rate transcranial magnetic stimulation in normal volunteers. Electroencephalogr. Clin. Neurophysiol., 89: 120–130CrossRef Google Scholar

Leone, Pascual A., Sole, Valls J., Wassermann, E. M. & Hallett, M. (1994). Responses to rapid-rate transcranial magnetic stimulation of the human motor cortex. Brain, 117: 847–858CrossRef Google Scholar

Penfield, W. B. E. (1937). Somatic motor and sensory representation in the cerebral cortex in man as studied by electrical stimulation. Brain, 60: 389–443CrossRef Google Scholar

Rapisarda, G., Bastings, E., Noordhout, A. M., Pennisi, G. & Delwaide, P. J. (1996). Can motor recovery in stroke patients be predicted by early transcranial magnetic stimulation?Stroke, 27: 2191–2196CrossRef Google Scholar PubMed

Ridding, M. C. & Rothwell, J. C. (1997). Stimulus/response curves as a method of measuring motor cortical excitability in man. Electroencephalogr. Clin. Neurophysiol., 105: 340–344CrossRef Google Scholar PubMed

Ridding, M. C., McKay, D. R., Thompson, P. D. & Miles, T. S. (2001). Changes in corticomotor representations induced by prolonged peripheral nerve stimulation in humans. Clin. Neurophysiol., 112: 1461–1469CrossRef Google Scholar PubMed

Rosen, H. J., Petersen, S. E., Linenweber, M. R.. (2000). Neural correlates of recovery from aphasia after damage to left inferior frontal cortex. Neurology, 55: 1883–1894CrossRef Google Scholar PubMed

Sanes, J. N., Wang, J. & Donoghue, J. P. (1992). Immediate and delayed changes of rat motor cortical output representation with new forelimb configurations. Cereb. Cortex, 2: 141–152CrossRef Google Scholar PubMed

Seitz, R. J., Hoflich, P., Binkofski, F., Tellmann, L., Herzog, H. & Freund, H. J. (1998). Role of the premotor cortex in recovery from middle cerebral artery infarction. Arch. Neurol., 55: 1081–1088CrossRef Google Scholar PubMed

Taub, E., Uswatte, G. & Pidikiti, R. (1999). Constraint-induced movement therapy: a new family of techniques with broad application to physical rehabilitation – a clinical review. J. Rehabil. Res. Dev., 36: 237–251Google Scholar PubMed

Traversa, R., Cicinelli, P., Bassi, A., Rossini, P. M. & Bernardi, G. (1997). Mapping of motor cortical reorganization after stroke. A brain stimulation study with focal magnetic pulses. Stroke, 28: 110–117CrossRef Google Scholar PubMed

Trompetto, C., Assini, A., Buccolieri, A., Marchese, R. & Abbruzzese, G. (2000). Motor recovery following stroke: a transcranial magnetic stimulation study. Clin. Neurophysiol., 111: 1860–1867CrossRef Google Scholar PubMed

Turton, A., Wroe, S., Trepte, N., Fraser, C. & Lemon, R. N. (1996). Contralateral and ipsilateral EMG responses to transcranial magnetic stimulation during recovery of arm and hand function after stroke. Electroencephalogr. Clin. Neurophysiol., 101: 316–328CrossRef Google Scholar PubMed

Urban, P. P., Hopf, H. C., Fleischer, S., Zorowka, P. G. & Forell, Muller W. (1997). Impaired cortico-bulbar tract function in dysarthria due to hemispheric stroke. Functional testing using transcranial magnetic stimulation. Brain, 120: 1077–1084CrossRef Google Scholar PubMed

Wassermann, E. M. & Lisanby, S. H. (2001). Therapeutic application of repetitive transcranial magnetic stimulation: a review. Clin. Neurophysiol., 112: 1367–1377CrossRef Google Scholar PubMed

Wassermann, E. M., Fuhr, P., Cohen, L. G. & Hallett, M. (1991). Effects of transcranial magnetic stimulation on ipsilateral muscles. Neurology, 41: 1795–1799CrossRef Google Scholar PubMed

Wassermann, E. M., Leone, Pascual A. & Hallett, M. (1994). Cortical motor representation of the ipsilateral hand and arm. Exp. Brain Res., 100: 121–132CrossRef Google Scholar

Wassermann, E. M., Grafman, J., Berry, C.. (1996). Use and safety of a new repetitive transcranial magnetic stimulator. Electroencephalogr. Clin. Neurophysiol., 101: 412–417CrossRef Google Scholar PubMed

Weiller, C., Chollet, F., Friston, K. J., Wise, R. J. & Frackowiak, R. S. (1992). Functional reorganization of the brain in recovery from striatocapsular infarction in man. Ann. Neurol., 31: 463–472CrossRef Google Scholar PubMed

Weiller, C., Ramsay, S. C., Wise, R. J., Friston, K. J. & Frackowiak, R. S. (1993). Individual patterns of functional reorganization in the human cerebral cortex after capsular infarction. Ann. Neurol., 33: 181–189CrossRef Google Scholar PubMed

Weiller, C., Isensee, C., Rijntjes, M.. (1995). Recovery from Wernicke's aphasia: a positron emission tomographic study. Ann. Neurol., 37: 723–732CrossRef Google Scholar PubMed

Woolsey, C. N., Erickson, T. C. & Gilson, W. E. (1979). Localization in somatic sensory and motor areas of human cerebral cortex as determined by direct recording of evoked potentials and electrical stimulation. J. Neurosurg., 51: 476–506CrossRef Google Scholar PubMed

Wu, T., Sommer, M., Tergau, F. & Paulus, W. (2000). Lasting influence of repetitive transcranial magnetic stimulation on intracortical excitability in human subjects. Neurosci. Lett., 287: 37–40CrossRef Google Scholar PubMed

Ziemann, U., Corwell, B. & Cohen, L. G. (1998a). Modulation of plasticity in human motor cortex after forearm ischemic nerve block. J. Neurosci., 18: 1115–1123CrossRef Google Scholar

Ziemann, U., Hallett, M. & Cohen, L. G. (1998b). Mechanisms of deafferentation-induced plasticity in human motor cortex. J. Neurosci., 18: 7000–7007CrossRef Google Scholar

Ziemann, U., Ishii, K., Borgheresi, A.. (1999). Dissociation of the pathways mediating ipsilateral and contralateral motor-evoked potentials in human hand and arm muscles. J. Physiol., 518: 895–906CrossRef Google Scholar PubMed

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