The influence of coupled rtms and prism illusion on motor cortical activity and motor function recovery in stroke: A case study Seung-Min Lee* 1 & Jon

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1 The influence of coupled rtms and prism illusion on motor cortical activity and motor function recovery in stroke: A case study Seung-Min Lee* 1 & Jong-Seong An 2 1 Chungnam National University & 2 Seoul National University [Purpose] [Methods] [Results] [Conclusion] Key words:

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4 Table 1. Participants subject age sex affected type affected side 1 60 male Lt. MCA inf right 2 66 male Lt. MCA inf right 3 55 male Lt. MCA inf right 4 61 male Lt. MCA inf right Fig. 1. Measurement of resting motion threshold and MEP (motor evoked potential) through TMS(transcranial magnetic stimulator)

5 Ⅳ Fig. 2. bilateral training equipment

6 Fig. 3. Placement and situation of experimental equipment for kinematic evaluation (reaching motion)

7 Table 2. Mean of Jebsen Taylor hand functional assessment Unit: sec subjects subject 1 subject 2 subject 3 subject 4 TEST card turning picking up small objects Jebsen-Taylor Hand Function Test (affected hand) simulated feeding stacking checkers lifting large, light object lifting large, heavy object PRE 22.29± ± ± ± ± ± ±15 POST 17.61± ± ± ± ± ± ±10.45 PRE 21.33± ± ± ± ± ± ±15.65 POST 17.30± ± ± ± ± ± ±11.97 PRE 23.45± ± ± ± ± ± ±12.36 POST 16.43± ± ± ± ± ± ±9.99 PRE 24.10± ± ± ± ± ± ±12.91 POST 18.54± ± ± ± ± ± ±11.03 Total

8 Fig. 4. The velocity profile in the reaching motion of normal elderly subjects(subjects 1, 2) Fig. 5. Pre & post-training velocity profile of stroke patient 1 Fig. 6. Pre & post-training velocity profile of stroke patient 2 Fig. 7. Pre & post-training velocity profile of stroke patient 3 Fig. 8. Pre & post-training velocity profile of stroke patient 4

9 Table 3. Mean of neuro-physiological assessment Subject MEP(%) Map Volume(uV) pre post pre post

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11 Kim, S. B., Lee, S. M., & Park, S. H. (2011). Is There a Difference between Symmetric and Asymmetric Bilateral Training on Motor Function Recovery for Stroke Patient? Korean Journal of Sport Psychology, 22(4), Park, S. H., Lee, S. M., & Kim, S. B.(2009). The Influence of Motor Cortical Excitability on Visual Illusion Using Mirror, Motor Imagery and Action Observation. Korean Journal of Sport Psychology, 20(4), Lee, S. M. (2008). The Effects of Bilateral Coordination Training on Cortical Reorganization and Upper-limb Motor Function Recovery of Choronic Stroke Patients. Doctoral dissertation, Department of Physical Education Graduate School Seoul National University. Lee, S. M. (2015). The effect of motor function recovery by bilateral coordination training with rtms for chronic stroke patients. Korean Journal of Sport Psychology, 26, 3, Lee, S. M., Kim, S. J., & Kim, S. B. (2009). The Effects of Motor Cortical Excitability and Upper-limb Recovery of Chronic Stroke Older on Bilateral Single Movement Training. Korean Journal of Sport Psychology, 20(1), Tae, K. S., Choi, H. S., Song, S. J., & Kim, Y. H. (2005). Effects of the Symmetric Upper Extremity Motion Trainer on the Motor Function Recovery after Brain Injury: An fmri Study. Korean Journal of Medical Physics, 16(1), 1-9. Abbott, A. (2004). Striking back. Nature, 429, Bultitude, J. H., & Rafal, R. D. (2010). Derangement of body representation in complex regional pain syndrome: report of a case treated with mirror and prisms. Experimental Brain Research, 204, Cauraugh, J. H., & Kim, S. (2002). Two coupled motor recovery protocols are better than one electromyogram-triggered neuromuscular stimulation and bilateral movements. Stroke, 33(6), Cauraugh, J. H., & Summers, J. J. (2005). Neural plasticity and bilateral movements: a rehabilitation approach for chronic stroke. Progress in neurobiology, 75(5), Cauraugh, J. H., Coombes, S. A., & Summers, J. J. (2007). Stroke motor recovery evidence: bilateral coordination training with an extra load on the unimpaired hand. NASPSPA Conference, s60. Crosbie, J. H., McDonough, S. M., Gilmore, D. H., & Wiggam, M. I. (2004). The adjunctive role of mental practice in the rehabilitation of the upper limb after hemiplegic stroke: a pilot study. Clinical Rehabilitation, 18, Dechent, P., Merboldt, K. D., & Frahm. J. (2004). Is the human primary motor cortex involved in motor imagery? Brain research: Cognitive Brain Research, 19, Ehrsson, H. H., Spence, C., Passingham, R. E. (2004). That's my hand! activity in premotor cortex reflects feeling of ownership of a limb. Science, 305, Grezes, J., & Decety, J. (2001). Functional anatomy of execution, mental simulation, observation, and verb generation of action: a meta-analysis. Human Brain Mapping, 12, Kagerer, F. A., Summers, J. J., & Semjen, A. (2003). Instabilities during antiphase bimanual movements: are ipsilateral pathways involved?. Experimental Brain Research, 151(4), Kim, Y. H., Park, J. W., Ko, M. H., Jang, S. H., & Lee, P. K. (2004) Facilitative effect of high frequency subthreshold repetitive transcranial magnetic stimulation on complex sequential motor learning in humans. Neuroscience Letter 367, Kolb, B., & Gibb, R. (2007). Brain plasticity and recovery from early cortical injury. Developmental Psychology, 49,

12 Lamont, K., Chin, M., &Kogan, M. (2011). Mirror box therapy seeing is believing. Explore: The Journal of Science and Healing, 7(6), Leonard, G., & Tremblay, F. (2007). Corticomotor facilitation associated with observation, imagery and imitation of hand actions: a comparatioe studassocyoung and old adults. Experimental Brain Research, 177, Lin, K., Chen, Y., Chen, C., & Wu, C. (2010). The effects of bilateral arm training on motor control and functional performance in chronic stroke: a randomized controlled study. Neurorehabilitation & Neural Repair, Mudie, M, H. & Matyas, T. A. (2000). Can simultaneous bilateral movement involve the undamaged hemisphere in reconstruction of neural networks damaged by stroke? Disability rehabilitation, 22, Malouin, F., Richards, C. L., Jackson, P. L., Lafleur, M. F., Durand, A., &Doyon, J. (2007). The Kinesthetic and Visual Imagery Questionnaire (KVIQ) for assessing motor imagery in persons with physical disabilities: a reliability and construct validity study. Journal of Neurologic Physical Therapy, 31(1), Michielsen, M. E., Selles, R. W., van der Geest, J. N., Eckhardt, M., Yavuzer, G., Stam, H. J., Smits, M., Ribbers, G. M., Bussmann, J. B. (2011). Motor recovery and cortical reorganization after mirror therapy in chronic stroke patients: a phase Ⅱrandomized controlled trial. Neurorehabilitation Nueral Repair Oh, Y., Song, Y, W., & Lee, J. S. (2015). The effect of driving simulator training to visual and physical response speed in patients of strokes: a single case study. Journal of Korean Society of Occupational Therapy, 23, 4, Page, S. J., Levine, P., & Leonard, A. C. (2005). Effects of mental practice on affected limb use and function in chronic stroke. Archives of physical Medicine and Rehabilitation, 86, Ridding, M. C., & Rothwell, J. C. (1999). Afferent input and cortical organisation: a study with magnetic stimulation. Experimental brain research, 126(4), Shumway-Cook, A., & Wollacott, M. H. (2007). Motor control: translating research into clinical practice. 3th (Eds.), Philadelphia: Lippincott Williams & Wilkins. Shimizu, T., Hosaki, A., Hino, T., Sato, M., Komori, T., Hiraiand, S., & Rossini, P. G. (2002). Motor cortical disinhibition in the unaffected hemisphere after unilateral cortical stroke. Brain, 125, Stevens, J. A., & Stoykov, M. E. (2003). Using motor imagery in the rehabilitation of hemiparesis. Archives of Physical Medicine and Rehabilitation, 7, Summers, J. J., Kagerer, F. A., Garry, M. I., Hiraga, C. Y., Loftus, A., & Cauraugh, J. H. (2007b). Bilateral and unilateral movement training on upper limb function in chronic stroke patients: a TMS study. Journal of the neurological sciences, 252(1), Summers, J. J., Garry, M. I., Dicker, W., & Cauraugh, J. H. (2007a). Effects of EMG-triggered neuromuscular stimulation on motor function and cortical excitability in chronic stroke. Journal of Sport & Exercise Psychology, 29. Teasell, R. W., & Kalra, L. (2004). What's new in stroke rehabilitation. Stroke, Takeuchi, N., Chuma, T., Matsuo, Y., Watanabe, I., & Ikoma, K. (2005). Repetitive transcranial magnetic stimulation of contralesional primary motor cortex. Stroke, Uy, J., Ridding, M. C., Hillier, S., Thompson, P. D., & Miles, T. S. (2003) Does induction of plastic change in motor cortex improve leg function after stroke? Neurology 61, Volman, M. C. J., Wijnroks, A. L., & Vermeer, A. (2002). Effect of task context on reaching performance in children with spastic hemiparesis. Clinical Rehabilitation, 16(6), Vries, S., & Mulder, T. (2007). Motor imagery and stroke rehabilitation: a critical discussion. Journal of Rehabilitation, 39, Statistics korea (2006) Life Tables for Korea Ziemann, U. L. F., Rothwell, J. C., & Ridding, M. C. (1996). Interaction between intracortical inhibition and facilitation in human motor cortex. The Journal of physiology, 496(Pt 3), 873. Ziemann, U., Muellbacher, W., Hallett, M., & Cohen, L. G. (2001). Modulation of practice-dependent plasticity in human motor cortex. Brain, 124(6),

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