Modulation of cortical and spinal inhibition with functional recovery of upper extremity motor function among patients with chronic stroke

Purpose:We hypothesized that recovery of upper extremity motor function is associated with reduction of intracortical inhibition and improved reciprocal inhibition. This study examines the relationships of functional recovery in chronic stroke with the intracortical inhibition and spinal reciprocal inhibition. Methods: Participants were 61 patients with chronic hemiparetic stroke. The participants were applied hybrid assistive neuromuscular dynamic stimulation (HANDS) therapy for 3 weeks. The Fugl-Meyer test upper extremity motor score (FM) and modified Ashworth scale (MAS) were assessed before (T0), immediately after (T1) and 3 months after (T2) the end of HANDS therapy. A paired pulse TMS paradigm was applied to assess short intracortical inhibition (SICI). Reciprocal inhibition (RI) was assessed with H reflex conditioning-test paradigm. Results: FM and MAS were improved until T₂. The change of FM from T₀ to T₂ was positively correlated with the change in affected SICI from T₀ toT₁. The change of wrist MAS from T₀ to T₁ was positively correlated with the change of RI. Conclusions: In chronic stroke patients with moderate or severe hemiparesis, well-recovered patients showed disinhibition of ipsilesional hemisphere and increased resiprocal inhibition of forearm.