Targeted engagement of a dorsal premotor circuit in the treatment of post-stroke paresis

Lucy Dodakian, Kelli G. Sharp, Jill See, Neil S. Abidi, Khoa Mai, Brett Fling, Vu H. Le, Steven C. Cramer

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

BACKGROUND: Good motor outcome after stroke has been found to correlate with increased activity in a dorsal premotor (PMd) brain circuit, suggesting that therapeutic strategies targeting this circuit might have a favorable, causal influence on motor status. OBJECTIVE: This study addressed the hypothesis that a Premotor Therapy that exercises normal PMd functions would provide greater behavioral gains than would standard Motor Therapy; and that Premotor Therapy benefits would be greatest in patients with greater preservation of PMd circuit elements. METHODS: Patients with chronic hemiparetic stroke (n = 15) were randomized to 2-weeks of Premotor Therapy or Motor Therapy, implemented through a robotic device. RESULTS: Overall, gains were modest but significant (change in FM score, 2.1 ± 2.8 points, p <0.02) and did not differ by treatment assignment. However, a difference between Therapies was apparent when injury to the PMd circuit was considered, as the interaction between treatment assignment and degree of corticospinal tract injury was significantly related to the change in FM score (p = 0.018): the more the corticospinal tract was spared, the greater the gains provided by Premotor Therapy. Similar results were obtained when looking at the interaction between treatment assignment and PMd function (p = 0.03). CONCLUSIONS: Targeted engagement of a brain circuit is a feasible strategy for stroke rehabilitation. This approach has maximum impact when there is less stroke injury to key elements of the targeted circuit.

Original languageEnglish (US)
Pages (from-to)13-24
Number of pages12
JournalNeuroRehabilitation
Volume33
Issue number1
DOIs
StatePublished - 2013
Externally publishedYes

Fingerprint

Paresis
Stroke
Therapeutics
Pyramidal Tracts
Wounds and Injuries
Exercise Therapy
Brain
Robotics
Equipment and Supplies

Keywords

  • corticospinal tract
  • motor recovery
  • premotor cortex
  • robot
  • Stroke

ASJC Scopus subject areas

  • Clinical Neurology
  • Rehabilitation
  • Physical Therapy, Sports Therapy and Rehabilitation

Cite this

Dodakian, L., Sharp, K. G., See, J., Abidi, N. S., Mai, K., Fling, B., ... Cramer, S. C. (2013). Targeted engagement of a dorsal premotor circuit in the treatment of post-stroke paresis. NeuroRehabilitation, 33(1), 13-24. https://doi.org/10.3233/NRE-130923

Targeted engagement of a dorsal premotor circuit in the treatment of post-stroke paresis. / Dodakian, Lucy; Sharp, Kelli G.; See, Jill; Abidi, Neil S.; Mai, Khoa; Fling, Brett; Le, Vu H.; Cramer, Steven C.

In: NeuroRehabilitation, Vol. 33, No. 1, 2013, p. 13-24.

Research output: Contribution to journalArticle

Dodakian, L, Sharp, KG, See, J, Abidi, NS, Mai, K, Fling, B, Le, VH & Cramer, SC 2013, 'Targeted engagement of a dorsal premotor circuit in the treatment of post-stroke paresis', NeuroRehabilitation, vol. 33, no. 1, pp. 13-24. https://doi.org/10.3233/NRE-130923
Dodakian, Lucy ; Sharp, Kelli G. ; See, Jill ; Abidi, Neil S. ; Mai, Khoa ; Fling, Brett ; Le, Vu H. ; Cramer, Steven C. / Targeted engagement of a dorsal premotor circuit in the treatment of post-stroke paresis. In: NeuroRehabilitation. 2013 ; Vol. 33, No. 1. pp. 13-24.
@article{2c3d4517495246cb900ea5afde96d9ca,
title = "Targeted engagement of a dorsal premotor circuit in the treatment of post-stroke paresis",
abstract = "BACKGROUND: Good motor outcome after stroke has been found to correlate with increased activity in a dorsal premotor (PMd) brain circuit, suggesting that therapeutic strategies targeting this circuit might have a favorable, causal influence on motor status. OBJECTIVE: This study addressed the hypothesis that a Premotor Therapy that exercises normal PMd functions would provide greater behavioral gains than would standard Motor Therapy; and that Premotor Therapy benefits would be greatest in patients with greater preservation of PMd circuit elements. METHODS: Patients with chronic hemiparetic stroke (n = 15) were randomized to 2-weeks of Premotor Therapy or Motor Therapy, implemented through a robotic device. RESULTS: Overall, gains were modest but significant (change in FM score, 2.1 ± 2.8 points, p <0.02) and did not differ by treatment assignment. However, a difference between Therapies was apparent when injury to the PMd circuit was considered, as the interaction between treatment assignment and degree of corticospinal tract injury was significantly related to the change in FM score (p = 0.018): the more the corticospinal tract was spared, the greater the gains provided by Premotor Therapy. Similar results were obtained when looking at the interaction between treatment assignment and PMd function (p = 0.03). CONCLUSIONS: Targeted engagement of a brain circuit is a feasible strategy for stroke rehabilitation. This approach has maximum impact when there is less stroke injury to key elements of the targeted circuit.",
keywords = "corticospinal tract, motor recovery, premotor cortex, robot, Stroke",
author = "Lucy Dodakian and Sharp, {Kelli G.} and Jill See and Abidi, {Neil S.} and Khoa Mai and Brett Fling and Le, {Vu H.} and Cramer, {Steven C.}",
year = "2013",
doi = "10.3233/NRE-130923",
language = "English (US)",
volume = "33",
pages = "13--24",
journal = "NeuroRehabilitation",
issn = "1053-8135",
publisher = "IOS Press",
number = "1",

}

TY - JOUR

T1 - Targeted engagement of a dorsal premotor circuit in the treatment of post-stroke paresis

AU - Dodakian, Lucy

AU - Sharp, Kelli G.

AU - See, Jill

AU - Abidi, Neil S.

AU - Mai, Khoa

AU - Fling, Brett

AU - Le, Vu H.

AU - Cramer, Steven C.

PY - 2013

Y1 - 2013

N2 - BACKGROUND: Good motor outcome after stroke has been found to correlate with increased activity in a dorsal premotor (PMd) brain circuit, suggesting that therapeutic strategies targeting this circuit might have a favorable, causal influence on motor status. OBJECTIVE: This study addressed the hypothesis that a Premotor Therapy that exercises normal PMd functions would provide greater behavioral gains than would standard Motor Therapy; and that Premotor Therapy benefits would be greatest in patients with greater preservation of PMd circuit elements. METHODS: Patients with chronic hemiparetic stroke (n = 15) were randomized to 2-weeks of Premotor Therapy or Motor Therapy, implemented through a robotic device. RESULTS: Overall, gains were modest but significant (change in FM score, 2.1 ± 2.8 points, p <0.02) and did not differ by treatment assignment. However, a difference between Therapies was apparent when injury to the PMd circuit was considered, as the interaction between treatment assignment and degree of corticospinal tract injury was significantly related to the change in FM score (p = 0.018): the more the corticospinal tract was spared, the greater the gains provided by Premotor Therapy. Similar results were obtained when looking at the interaction between treatment assignment and PMd function (p = 0.03). CONCLUSIONS: Targeted engagement of a brain circuit is a feasible strategy for stroke rehabilitation. This approach has maximum impact when there is less stroke injury to key elements of the targeted circuit.

AB - BACKGROUND: Good motor outcome after stroke has been found to correlate with increased activity in a dorsal premotor (PMd) brain circuit, suggesting that therapeutic strategies targeting this circuit might have a favorable, causal influence on motor status. OBJECTIVE: This study addressed the hypothesis that a Premotor Therapy that exercises normal PMd functions would provide greater behavioral gains than would standard Motor Therapy; and that Premotor Therapy benefits would be greatest in patients with greater preservation of PMd circuit elements. METHODS: Patients with chronic hemiparetic stroke (n = 15) were randomized to 2-weeks of Premotor Therapy or Motor Therapy, implemented through a robotic device. RESULTS: Overall, gains were modest but significant (change in FM score, 2.1 ± 2.8 points, p <0.02) and did not differ by treatment assignment. However, a difference between Therapies was apparent when injury to the PMd circuit was considered, as the interaction between treatment assignment and degree of corticospinal tract injury was significantly related to the change in FM score (p = 0.018): the more the corticospinal tract was spared, the greater the gains provided by Premotor Therapy. Similar results were obtained when looking at the interaction between treatment assignment and PMd function (p = 0.03). CONCLUSIONS: Targeted engagement of a brain circuit is a feasible strategy for stroke rehabilitation. This approach has maximum impact when there is less stroke injury to key elements of the targeted circuit.

KW - corticospinal tract

KW - motor recovery

KW - premotor cortex

KW - robot

KW - Stroke

UR - http://www.scopus.com/inward/record.url?scp=84883890726&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84883890726&partnerID=8YFLogxK

U2 - 10.3233/NRE-130923

DO - 10.3233/NRE-130923

M3 - Article

VL - 33

SP - 13

EP - 24

JO - NeuroRehabilitation

JF - NeuroRehabilitation

SN - 1053-8135

IS - 1

ER -