Assessing recovery in middle cerebral artery stroke using functional MRI.

PRIMARY OBJECTIVE: To understand the temporal evolution of brain reorganization during recovery from stroke. RESEARCH DESIGN: A patient who suffered left middle cerebral artery stroke 9 months earlier was studied on three occasions, approximately 1 month apart. METHODS AND PROCEDURES: Brain activation was studied using functional Magnetic Resonance Imaging (fMRI). During each session, the patient performed a finger-to-thumb opposition task, which involved one bimanual and two unimanual conditions. Each condition consisted of overt movement of fingers and imagery of the same task. RESULTS: With recovery, greater recruitment was observed of the affected primary motor cortex (M1) and a decrease in activation of the unaffected M1 and supplementary motor area. In addition, the widespread activation of brain areas seen during the initial session changed to a more focused pattern of activation as the patient recovered. Imagery tasks resulted in similar brain activity as overt execution pointing to imagery as a potential tool for rehabilitation.

Functional MRI reveals the existence of modality and coordination-dependent timing networks.

Growing evidence suggests that interval timing in humans is supported by distributed brain networks. Recently, we demonstrated that the specific network recruited for the performance of rhythmic timing is not static but is influenced by the coordination pattern employed during interval acquisition. Here we expand on this previous work to investigate the role of stimulus modality and coordination pattern in determining the brain areas recruited for performance of a self-paced rhythmic timing task. Subjects were paced with either a visual or an auditory metronome in either a synchronized (on the beat) or syncopated (off the beat) coordination pattern. The pacing stimulus was then removed and subjects continued to move based on the required interval. When compared with networks recruited for auditory pacing and continuation, the visual-specific activity was observed in the classic dorsal visual stream that included bilateral MT/V5, bilateral superior parietal lobe, and right ventral premotor cortex. Activity in these regions was present not only during pacing, when visual information is used to guide motor behavior, but also during continuation, when visual information specifying the temporal interval was no longer present. These results suggest a role for modality-specific areas in processing and representing temporal information. The cognitive demands imposed by syncopated coordination resulted in increased activity in a broad network that included supplementary motor area, lateral pre-motor cortex, bilateral insula, and cerebellum. This coordination-dependent activity persisted during the subsequent continuation period, when stimuli were removed and no coordination constraints were imposed. Taken together, the present results provide additional evidence that time and timing are served by a context-dependent distributed network rooted in basic sensorimotor processes.

Neural substrates of real and imagined sensorimotor coordination.

Much debate in the behavioral literature focuses on the relative contribution of motor and perceptual processes in mediating coordinative stability. To a large degree, such debate has proceeded independently of what is going on in the brain. Here, using blood oxygen level-dependent measures of neural activation, we compare physically executed and imagined rhythmic coordination in order to better assess the relative contribution of hypothesized neuromusculoskeletal mechanisms in modulating behavioral stability. The executed tasks were to coordinate index finger to thumb opposition movements of the right hand with an auditory metronome in either a synchronized (on the beat) or syncopated (off the beat) pattern. Imagination involved the same tasks, except without physical movement. Thus, the sensory stimulus and coordination constraints were the same in both physical and imagination tasks, but the motoric requirements were not. Results showed that neural differences between executed synchronization and syncopation found in premotor cortex, supplementary motor area, basal ganglia and lateral cerebellum persist even when the coordinative patterns were only imagined. Neural indices reflecting behavioral stability were not abolished by the absence of overt movement suggesting that coordination phenomena are not exclusively rooted in purely motoric constraints. On the other hand, activity in the superior temporal gyrus was modulated by both the presence of movement and the nature of the coordination, attesting to the intimacy between perceptual and motoric processes in coordination dynamics.