Cambios en resonancia magnética funcional de la corteza sensitivomotora en pacientes con traumatismo craneoencefálico tras un programa intensivo de rehabilitación / Changes in the functional magnetic resonance imaging of the sensorimotor cortex in traumatic brain injury after intensive rehabilitation

Objetivo. Evaluar el potencial de reorganización de la corteza sensitivomotora en pacientes con traumatismo craneoencefálico (TCE) después de un programa intensivo de rehabilitación. Pacientes y métodos. Se valoraron los cambios en la resonancia magnética funcional (RMf) motora en un paciente de 17 años afecto de TCE grave antes y después de un programa de rehabilitación motora. Las tareas realizadas durante el análisis con RMf fueron: oposición sucesiva del pulgar a los demás dedos de la mano (RMf motora de la mano) y flexión plantar del tobillo y de los dedos (RMf motora del pie), en ambos casos bilateral con períodos de reposo intercalados. Resultados. Previamente al tratamiento, las áreas cerebrales activadas durante la RMf motora de la mano derecha fueron el área motora primaria (M1), el área motora suplementaria (AMS), el área parietal superior y la región poscentral. Para la mano izquierda, las áreas de mayor actividad fueron M1 y cerebelo. Posteriormente al tratamiento, las áreas activadas fueron la región pre y poscentral para la mano derecha y la región precentral para la mano izquierda. Para la función motora del pie, las áreas activadas antes del tratamiento fueron el área paracentral para el pie derecho, y el AMS y el área poscentral para el pie izquierdo. Después del tratamiento, la activación para el pie derecho se vio en el área paracentral, y la activación para el pie izquierdo en el área paracentral y en el AMS. Conclusiones. La disminución de la actividad cortical posterior al tratamiento puede explicarse como una reorganización cortical, que en el presente estudio se correlaciona con los automatismos y habilidades motoras adquiridas por el paciente durante el proceso de rehabilitación (AU)

Aim. To evaluate the potential reorganization of the sensorimotor cortex in a patient with traumatic brain injury after an intensive motor rehabilitation. Patients and methods. A 17-year-old male with severe traumatic brain injury was submitted to functional magnetic resonance imaging (fMRI) analyses of motor control before and after motor rehabilitation. The motor tasks performed during fMRI were finger tapping, ankle plantar flexion, and toe flexion. Results. Prior to treatment, the cerebrally activated areas for the right hand during finger tapping were the primary motor (M1), supplementary motor area (SMA), superior parietal and postcentral areas. For the left hand, the areas were the M1 and the cerebellum. After treatment, the activated areas were the pre and postcentral areas for the right hand and the precentral area for the left hand. For the foot motor-task, the activated areas prior to treatment were the paracentral area for the right foot, and the SMA, paracentral and poscentral areas for the left. After treatment, activation for the right foot was seen in the paracentral area, and activation for the left foot was seen in the paracentral area and SMA. Conclusions. The decrease in the post-treatment activation pattern could be explained as a cortical reorganization, which in the current study was related to motor skill and motor automatism acquired by the patient (AU)

[Changes in the functional magnetic resonance imaging of the sensorimotor cortex in traumatic brain injury after intensive rehabilitation]. / Cambios en resonancia magnética funcional de la corteza sensitivomotora en pacientes con traumatismo craneoencefalico tras un programa intensivo de rehabilitación.

AIM: To evaluate the potential reorganization of the sensorimotor cortex in a patient with traumatic brain injury after an intensive motor rehabilitation. PATIENTS AND METHODS: A 17-year-old male with severe traumatic brain injury was submitted to functional magnetic resonance imaging (fMRI) analyses of motor control before and after motor rehabilitation. The motor tasks performed during fMRI were finger tapping, ankle plantar flexion, and toe flexion. RESULTS: Prior to treatment, the cerebrally activated areas for the right hand during finger tapping were the primary motor (M1), supplementary motor area (SMA), superior parietal and postcentral areas. For the left hand, the areas were the M1 and the cerebellum. After treatment, the activated areas were the pre and postcentral areas for the right hand and the precentral area for the left hand. For the foot motor-task, the activated areas prior to treatment were the paracentral area for the right foot, and the SMA, paracentral and poscentral areas for the left. After treatment, activation for the right foot was seen in the paracentral area, and activation for the left foot was seen in the paracentral area and SMA. CONCLUSIONS: The decrease in the post-treatment activation pattern could be explained as a cortical reorganization, which in the current study was related to motor skill and motor automatism acquired by the patient.