11 - Human brain mapping of the motor system after stroke  pp. 113-124

Human brain mapping of the motor system after stroke

By Nick S. Ward

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Introduction

After stroke, recovery of useful upper-limb function occurs in only 50% of those with significant early paresis, leading to dramatically impaired quality of life and sense of well-being. For most patients, the term “rehabilitation” refers to approaches designed to improve societal participation and quality of life. In this sense, rehabilitation is often successful, but on its own may not take full advantage of the enormous potential for plastic change in the adult human brain, even after focal injury. We have learned much from studying animal models of focal brain injury, but the tools available for studying the working human brain are different to those used in animal models. In human subjects, experiments are performed at the level of neural systems rather than single cells or molecules. Both approaches have something to learn from the other, and it is likely that for a complete understanding of the way the brain responds to injury, both will be helpful. This chapter will concentrate on the ways that functional brain imaging has contributed to our understanding of how the brain responds to injury, and how it might be used in the future to help improve therapeutic approaches to stroke patients with persistent impairment.

BOLD signal in cerebrovascular disease

Most functional imaging studies performed in stroke patients have used functional magnetic resonance imaging (fMRI), which relies on the blood oxygen level-dependent (BOLD) signal. The BOLD signal relies on the close coupling between blood flow and metabolism.

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