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Objective: To determine how age, time since injury, motor status,nd gait velocity are each related to brain function after SCI. Design:rospective, blinded, two-center study. Setting: Outpatient rehabilita-

tion clinic; institute for clinical translational science. Participants: 20subjects with chronic, incomplete SCI (age � 52.6 �/� 12.1 yearsold; months post injury � 85.8�/� 84.0 months). Most exhibitedASIA D motor incomplete SCI (N�17), or ASIA C (N�3). Inter-vention: Not applicable. Main Outcome Measures: Functional mag-netic resonance imaging (fMRI) was administered. Subjects alternatedrest with active right lower extremity dorsiflexion/plantarflexion at 0.3Hz frequency. Results: Older age correlated significantly with largerctivation in left lateral postcentral gyrus, bilateral anterior cingu-ate, and bilateral medial pre-frontal cortex. Longer time sincenjury correlated significantly with larger activation in left lateralostcentral gyrus/inferior parietal lobule and left lateral frontalobe. Total ASIA motor score and gait velocity did not correlateignificantly with any features of brain function. Conclusions: Timeas significant effects on the brain after SCI, as both increased agend increased time post SCI were associated with increased corticalctivity. The locations of these changes are of interest and mightndicate altered sensory processing (post-central gyrus) and in-reased error detection (anterior cingulate). Key Words: Spinalord injury; Motor function; Neuroscience; Rehabilitation.

oster 17ortical Activity During Imagined Wrist Actions Mirrors Plastichanges Due to Motor Rehabilitation After SCI. Mateoébastien (Lyon Neuroscience Research Center, University ofyon 1, Villeurbanne, France), Christian Collet, Sébastien Dali-ault, Claude Delpuech, Aymeric Guillot, Gilles Rode, Franck Diienzo.

isclosure: None disclosed.Background: Movement Imagery (MI) is the mental representation

f an action without any overt movement. Recent findings promote theenefits of mental training to stimulate sensorimotor cortical networksfter SCI, with the aim to improve upper limb motor functions. Usingagentoencephalography (MEG), we addressed whether cortical ac-

ivations during MI mirrored plastic changes due to motorehabilitation. Methods: Three C6/C7 SCI patients (six months postnjury) took part in rehabilitation sessions combining both physicalractice and MI during five weeks, to improve grasp function. Move-ent time and MEG recordings were collected before (pre-test) and

fter (post-test) the course of rehabilitation. Participants performedhree blocks of 10 imagined wrist extensions, and remained motionlessuring a rest condition. Three age-matched healthy participants under-ent a similar procedure. Results: Similar pre- and post-test move-ent times were recorded in healthy participants while MEG b-signals

15-35 Hz) yielded comparable primary sensorimotor cortical activa-ions during MI. Conversely, movement time was shorter and MEGctivity was significantly reduced in primary sensorimotor cortexuring the post-test in SCI participants. Discussion: Shortened move-ent times in SCI participants witness motor program automation.hile wrist extension alone does not serve specific functions in

ealthy participants, this movement is a key component of the teno-esis grasp after SCI. After automation, wrist extension may beontrolled at a subcortical level, hence explaining reduced corticalctivity during the post-test. Present data therefore support the hypoth-sis of plastic changes due to motor rehabilitation associated withental training, resulting in improved motor functions. Key Words:pinal cord injury; Neuroplasticity; Motor function; Neuroscience;ehabilitation.

oster 18herapeutic Gains after Utilization of a Foot Drop Stimulator introke Extend Beyond the Ankle Joint: A Case Report. Mathewarossi (Kessler Foundation Research Center, West Orange, NJ),rvind Ramanujam, Rakesh Pilkar, Karen J. Nolan.

isclosure: None disclosed. D

Objective: To evaluate the therapeutic effect of a functional elec-rical stimulation device in individuals with hemiplegia secondary totroke. Design: Single subject design. Setting: Rehabilitation Re-earch Center. Participants: A 55-year-old male with right-sidedemiplegia�six months post-stroke. Interventions: Surface FES ap-lied to the peroneal nerve through a commercially available foot droptimulator during walking for a period of four weeks. Main Outcome

easurements: Kinematics and EMG of the lower limb at baselinend four weeks post-intervention including: lower limb EMG activa-ion timing and intensity, and joint angles at the hip, knee and ankleuring self-selected walking speed. To examine the therapeutic effectll data were collected without the use of the FES device. Results:eak ankle dorsiflexion during swing increased (�3.7°�0.89 to.82°�4.81) and peak tibialis anterior activation increased duringerminal double support in preparation for swing following use of theES device. Post-intervention mean hip flexion angle during swing

ncreased (9.99°�1.28 to 17.30°�1.04), while range of motion re-ained the same. Hip angular velocity also increased during early

wing following intervention. Knee hyperextension during initial dou-le stance decreased (�10.44°�3.77 to 0.75°�1.79), facilitated byncreased biceps femoris and gastrocnemius activity during this phase.onclusions: Increased muscle activation during gait when the deviceas not used indicated a therapeutic effect. Increased muscle activationas accompanied by increased ankle dorsiflexion and hip flexion during

wing, and knee flexion during stance. These changes represent an overallmproved gait pattern demonstrating that the therapeutic gains made using

foot drop stimulator extend beyond the ankle joint. Key Words:troke; Motor function; Neuroscience; Rehabilitation.

oster 19n Vivo Characterization of White Matter Myelin Content After Strokesing Multicomponent T2 Relaxation Imaging. Michael Robertorich (University of British Columbia, Vancouver, BC, Canada).

isclosure: None disclosed.Objectives: To characterize the impact of stroke on myelin content

ithin brain white matter. Current knowledge of the impact of stroke onyelin in the brain is limited. White matter imaging, employing multi-

omponent T2 relaxation imaging (MCRI), represents a significant ad-ance in the ability to quantify myelin status in vivo in humans. Design:ingle blind controlled survey study. Setting: University of British Co-

umbia Brain Behaviour Laboratory and 3T MRI Research Centre. Par-icipants: 12 individuals with subcortical stroke in the chronic phase ofecovery with mild-moderate impairment of arm function (Fugl-Meyerpper extremity mean score: 54.6, range: 23-62) and nine age/genderatched healthy controls. Interventions: Not applicable. Main Out-

ome Measures: All participants underwent a whole-brain 3D T2-eighted MCRI scan. Myelin water fraction (%MWF) was determined

or whole-brain white matter and the posterior limb of the internal capsulePLIC) bilaterally. Results: Preliminary results from independent sam-les t-test analyses demonstrate significant differences between groupsstroke vs. controls) in MWF in whole-brain white matter (p�0.004,I95%: 0.5-2.3%) and in the ipsilesional PLIC (p�0.036, CI95%: 0.6-.9%). Further, we show trends for differences between ipsilesional andontralesional PLIC in the stroke brain (p�0.136, CI95%: �1.2-8.2%).onclusion: This is the first report of in vivo changes in myelin status

ollowing stroke in humans using MCRI. These preliminary results dem-nstrate that after stroke myelin is reduced across the whole brain. Theseata inform future work investigating the capacity for remyelination inonjunction with post-stroke rehabilitation interventions. Key Words:troke; Motor function; Neuroscience; Rehabilitation.

oster 20on-Invasive Brain Stimulation Paired With a Novel Locomotorraining in Chronic Stroke: A Feasibility Study. Megan M.anzl (University of Kentucky and Cardinal Hill Rehabilitationospital, Lexington, KY), Kenneth Chelette, Kara Lee, Danaykins, Lumy Sawaki.

isclosure: None disclosed.

Arch Phys Med Rehabil Vol 93, October 2012

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Objective: To determine the feasibility of combining transcranialirect current stimulation (tDCS) of the lower extremity (LE) motorortex with novel locomotor training to facilitate gait and neuroplastichange in subjects with chronic stroke. Methodology: Double-blind,andomized controlled study. We enrolled 10 subjects with chronic stroke;utpatient rehabilitation setting. Subjects were stratified according toaseline LE motor function then randomized to either active tDCS (20in; 2mA) or sham tDCS for 12 sessions over one month. Both groups

articipated in identical locomotor training following each tDCS session.raining protocol (robot-assisted treadmill (Lokomat)) was designed toarness corticospinal neuroplasticity. Primary Outcome Measure: 10-eter Walk Test (10MWT). Other Outcome Measures: Functionalmbulation Category (FAC), Timed Up and Go (TUG), Berg Balancecale (BBS), Stroke Impact Scale-16 (SIS); cortical excitability (transcra-ial magnetic stimulation (TMS)). Results: Eight subjects completed the

study (four men; mean age 67.8 years; mean years post-stroke: four).ANOVA trended towards improvement for both groups. Active tDCSgroup showed more marked improvement than sham in all measures(FAC p�0.028; 10 MWT p�0.19; TUG p�0.066; SIS p�0.062) exceptBBS (p�0.919). TMS recruitment curves demonstrated increased corticalexcitability at completion and one-month follow-up. ImportantFindings: It is feasible to combine tDCS targeting the LE motor cortexwith novel locomotor training. It appears that tDCS has the potential toimprove gait in chronic stroke. Our novel locomotor training also appearsto enhance corticospinal excitability. Results warrant larger studies apply-ing tDCS and locomotor training, particularly regarding stroke survivorswith low ambulation. Key Words: Stroke; Motor function; Neurosci-ence; Rehabilitation.

Poster 21Callosal Sensory Fibre Integrity is Reduced in the Chronic Phaseof Stroke. Cameron Scott Mang (Brain Behaviour Laboratory,Department of Rehabilitation Sciences, Faculty of Medicine, Uni-versity of British Columbia, Vancouver, BC, Canada).

Disclosure: None disclosed.Objectives: To characterize microstructural fiber integrity of sen-

sorimotor regions of the corpus callosum (CC) in individuals withchronic stroke. The secondary objective was to evaluate relationshipsbetween CC integrity and upper extremity motor performance. Wehypothesized that the integrity of CC sensorimotor regions would bereduced in individuals with chronic stroke compared to age-matchedcontrols and that CC integrity would relate to upper extremity motorperformance. Design: Single-blinded survey controlled study. Setting:

niversity of British Columbia Brain Behaviour Laboratory and 3TRI Research Centre. Participants: Thirteen individuals with middle

erebral artery chronic stroke and thirteen age- and gender-matchedealthy controls. Participants were recruited through volunteerampling. Interventions: Not applicable. Main Outcome Measures:he primary outcome measure was fractional anisotropy (FA) of aross-section of the sensorimotor regions of the CC obtained fromiffusion tensor imaging. The secondary outcome measure was boxnd block test (BBT) score to evaluate upper extremity motor perfor-ance. Multivariate analysis of variance evaluated differences in FA

etween stroke and healthy groups. Correlational analyses were con-ucted for upper extremity motor performance and FA. Results: In thetroke group FA was reduced in the sensory (CI95%: 0.044–0.141,�0.001), but not motor (CI95%: �0.015–0.057, p�0.236), region ofhe CC. A significant correlation between CC sensory region FA andBT performance was observed across all participants (R2�0.222,�0.023). Conclusions: Reduced integrity of callosal sensory fibersay contribute to motor deficits in chronic stroke. Future research is

eeded to determine how CC sensory region integrity influencesnterhemispheric interactions post-stroke. Key Words: Stroke; Motorunction; Neuroscience; Rehabilitation.

oster 22ptimizing Transcranial Direct Current Stimulation for Motor Recov-

ry From Severe Post-Stroke Hemiparesis: Early Results From an On-

rch Phys Med Rehabil Vol 93, October 2012

oing Clinical Trial. Kenneth Chelette, Cheryl Carrico, Laurieichols, Lumy Sawaki (University of Kentucky, Lexington, KY).

isclosure: Transcranial Direct Current Stimulation.Objective: To determine the best electrode configuration for trans-

cranial direct current stimulation (tDCS), a non-invasive brain stimu-lation technique, to enhance upper extremity (UE) motor function insubjects with severe post-stroke hemiparesis. Design: Randomized,double-blind, placebo-controlled clinical trial. Setting: Outpatientrehabilitation. Participants: Here, we present data from 26 of (pro-jected) 44 chronic stroke subjects with severe UE motor deficit (i. e,virtually no wrist and hand movement). Interventions: Subjects wereassigned to one of four groups: (1) anodal tDCS to excite ipsilesionalhemisphere, (2) cathodal tDCS to inhibit contralesional hemisphere,(3) dual: a simultaneous combination of anodal and cathodal tDCS,(4) sham tDCS. All subjects participated in 10 treatment sessionsconsisting of tDCS followed by three hours of occupational therapy.Main Outcome Measures: Primary outcome measure: Fugl-MeyerAssessment. Secondary Outcome Measures: Action Research ArmTest and Stroke Impact Scale. Evaluations were performed at baselineand post-intervention. Results: Preliminary results indicate substan-tially greater improvement in the cathodal group than in other groups.Conclusions: Our results differ from findings in subjects with mildhemiparesis. This disparity may be due to the larger lesions of subjectswith severe hemiparesis which may change tDCS current flow comparedto subjects with mild hemiparesis. Furthermore, in subjects with severehemiparesis, comparatively less ipsilesional neuronal substrate may beavailable for stimulation. Therefore, the anodal and the dual configura-tions, which rely on ipsilesional stimulation, may not prove optimal. KeyWords: Stroke; Motor function; Neuroscience; Rehabilitation.

Poster 23Correlating Electrophysiology and Metabolic Profiles to AssessMotor Impairment After Stroke. Paul W. Jones (University ofKentucky, Lexington, KY).

Disclosure: None disclosed.Objective: To correlate metabolic, anatomical, and electrophysiolog-

ical measurements of the primary motor (M1) and somatosensory (S1)cortices to identify potential mechanisms underlying motor deficits afterstroke. Design: Single time-point case series study. Setting: Laboratorybased study in the Brain Behaviour Lab and MRI Research Centre at theUniversity of British Columbia. Participants: Population-based sampleof 15 individuals (aged 50-75) with chronic stroke affecting unilateralmotor or sensorimotor systems. Interventions: Single and paired-pulsetranscranial magnetic stimulation (TMS) to assess primary motor corticalexcitability in both cerebral hemispheres. Single voxel magnetic reso-nance spectroscopy (MRS) positioned over M1 and S1 in both theipsilesional and contralesional hemispheres to characterize metabolicchanges after stroke. Main Outcome Measures: For metabolic mea-sures, absolute concentration (mmol/kg) of glutamate, creatine, N-acety-laspartate, choline and myo-inositol were quantified in both affected andunaffected hemispheres. Electrophysiology measurements of motorevoked potentials (MEPs) were collected using surface electromyographyplaced over the flexor carpi radialis of both arms. Results: Preliminarydata shows a significant decrease in glutamate concentration (affected,6.91(�/� 0.17) mmol/kg; unaffected, 7.47(�/�0.17) mmol/kg) coupled

ith altered cortical excitability in the stroke affected hemisphere. Con-lusions: Initial findings indicate altered cortical excitability may beelated to a decrease in the facilitatory neurotransmitter glutamate in thetroke affected hemisphere. Further study will provide a more compre-ensive understanding of the metabolic consequences of stroke and howhey relate to motor deficits. In turn this knowledge may be used toenerate novel therapeutic approaches. Key Words: Stroke; Motor

function; Neuroscience; Rehabilitation.

Poster 24Ipsilesional White Matter Integrity Predicts Implicit MotorLearning. Katlyn Brown (University of British Columbia, Van-

couver, BC, Canada).