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Abstract
Objective To determine the effects of a 12-week home-based motor training telerehabilitation program in patients with subcortical stroke by combining motor function assessments and multimodality MRI analysis methods.
Methods Fifty-two patients with stroke and hemiplegia were randomly assigned to either a home-based motor training telerehabilitation (TR) group or a conventional rehabilitation (CR) group for 12 weeks. The Fugl-Meyer assessment (FMA) for upper and lower extremities and the modified Barthel Index were used as primary outcomes. The secondary outcomes included resting-state functional connectivity (rsFC) between the bilateral M1 areas, gray matter volumes of the primary motor cortex (M1) areas, and white matter integrity of the corticospinal tract. Analysis of covariance was applied to examine the effects of the home-based motor training TR program on neural function recovery and brain plasticity.
Results Compared with the CR group, the TR group showed significant improvement in the FMA (p = 0.011) and significantly increased M1-M1 rsFC (p = 0.031) at the end of the rehabilitation. The M1-M1 rsFC change was significantly positively correlated with the FMA change in the TR group (p = 0.018).
Conclusion This study showed a beneficial effect of the home-based motor training telerehabilitation program on motor function in patients with stroke, which was accompanied by enhanced interhemispheric functional connectivity of the M1 areas. We inferred that it is feasible, safe, and efficacious for patients with stroke to receive professional rehabilitation training at home. The combined use of imaging biomarkers should be encouraged in motor training clinical studies in patients with stroke.
Classification of evidence This study provides Class II evidence that for patients with stroke with hemiplegia, home-based telerehabilitation compared to conventional rehabilitation significantly improves some motor function tests.
Glossary
- ADL=
- activities of daily living;
- AFQ=
- automated fiber quantification;
- CI=
- confidence interval;
- CONSORT=
- Consolidated Standards of Reporting Trials;
- CR=
- conventional rehabilitation;
- CST=
- corticospinal tract;
- CSTL=
- left corticospinal tract;
- CSTR=
- right corticospinal tract;
- DTI=
- diffusion tensor imaging;
- EPI=
- echoplanar imaging;
- ETNS=
- EMG-triggered neuromuscular stimulation;
- FA=
- fractional anisotropy;
- FMA=
- Fugl-Meyer assessment;
- FOV=
- field of view;
- GMV=
- gray matter volume;
- M1=
- primary motor cortex;
- MBI=
- modified Barthel index;
- MD=
- mean diffusivity;
- NIHSS=
- NIH Stroke Scale;
- OT=
- occupational therapy;
- PT=
- physical therapy;
- RCT=
- randomized controlled trial;
- RD=
- radial diffusivity;
- rsFC=
- resting-state functional connectivity;
- sMRI=
- structural MRI;
- SPM=
- statistical parametric mapping;
- TE=
- echo time;
- TR=
- telerehabilitation;
- TRS=
- Telemedicine Rehabilitation System;
- VBM=
- voxel-based morphometry;
- WM=
- white matter
Footnotes
Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
↵* These authors contributed equally to this work.
Editorial, page 761
Class of Evidence: NPub.org/coe
Patient Page e2462
CME Course: NPub.org/cmelist
- Received August 2, 2019.
- Accepted in final form May 8, 2020.
- © 2020 American Academy of Neurology
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