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Stroke Research and Treatment
Volume 2014, Article ID 306325, 8 pages
Clinical Study

Functional Brain Correlates of Upper Limb Spasticity and Its Mitigation following Rehabilitation in Chronic Stroke Survivors

1Neurology and Research Service, Cleveland VA Medical Center, 10701 East Boulevard, Cleveland, OH 44106, USA
2Department of Neurology, Case Western Reserve University School of Medicine, 11100 Euclid Avenue, Cleveland, OH 44106, USA
3Department of Neurology and McKnight Brain Institute, Brain Rehabilitation Research Center of Excellence, Malcom Randall VA Medical Center, University of Florida, 1601 SW Archer Road, Gainesville, FL 32608, USA

Received 31 March 2014; Revised 23 May 2014; Accepted 11 June 2014; Published 3 July 2014

Academic Editor: Steve Kautz

Copyright © 2014 Svetlana Pundik et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Background. Arm spasticity is a challenge in the care of chronic stroke survivors with motor deficits. In order to advance spasticity treatments, a better understanding of the mechanism of spasticity-related neuroplasticity is needed. Objective. To investigate brain function correlates of spasticity in chronic stroke and to identify specific regional functional brain changes related to rehabilitation-induced mitigation of spasticity. Methods. 23 stroke survivors (>6 months) were treated with an arm motor learning and spasticity therapy (5 d/wk for 12 weeks). Outcome measures included Modified Ashworth scale, sensory tests, and functional magnetic resonance imaging (fMRI) for wrist and hand movement. Results. First, at baseline, greater spasticity correlated with poorer motor function ( ) and greater sensory deficits ( ). Second, rehabilitation produced improvement in upper limb spasticity and motor function ( ). Third, at baseline, greater spasticity correlated with higher fMRI activation in the ipsilesional thalamus ( , ). Fourth, following rehabilitation, greater mitigation of spasticity correlated with enhanced fMRI activation in the contralesional primary motor ( , ), premotor ( , ), primary sensory ( , ), and associative sensory ( , ) regions while controlling for changes in motor function. Conclusions. Contralesional motor regions may contribute to restoring control of muscle tone in chronic stroke.