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Improving Hand Function in Chronic Stroke
Wolf Muellbacher, MD;
Coletta Richards, MD;
Ulf Ziemann, MD;
George Wittenberg, MD;
Deborah Weltz, MD;
Babak Boroojerdi, MD;
Leonardo Cohen, MD;
Mark Hallett, MD
Arch Neurol. 2002;59:1278-1282.
Background Recovery of function following stroke plateaus in about 1 year, typically
leaving upper arm function better than that in the hand. Since there is competition
among body parts for territory in the sensorimotor cortex, even limited activity
of the upper arm might prevent the hand from gaining more control, particularly
when the territory is reduced in size because of the stroke. Deafferentation
of a body part in a healthy brain enhances cortical representations of adjacent
body parts, and this effect is markedly increased by voluntary activity of
the adjacent part.
Objective To explore whether deafferentation of the upper arm, produced by a new
technique of regional anesthesia during hand motor practice, helps recovery
of hand function in patients with long-term stable weakness of their hand
following stroke.
Methods and Results Deafferentation, produced by a new technique of regional anesthesia
of the upper arm during hand motor practice, dramatically improved hand motor
function including some activities of daily living. The improvement was associated
with an increase in transcranial magnetic stimulation–evoked motor output
to the practice hand muscles.
Conclusion This is a novel therapeutic strategy that may help improve hand function
in patients with long-term weakness after stroke.
From the Human Motor Control Section (Drs Muellbacher, Ziemann, and
Hallett), and the Human Cortical Physiology Section (Drs Ziemann, Wittenberg,
Boroojerdi, and Cohen), National Institute of Neurological Disorders and Stroke,
and the Department of Anesthesia (Drs Richards and Weltz), National Institutes
of Health, Bethesda, Md; Department of Neurology, Ludwig Boltzmann Institute,
Neurological Hospital of Vienna, Vienna, Austria (Dr Muellbacher); and the
Clinic of Neurology, J. W. Goethe–University Frankfurt, Frankfurt am
Main, Germany (Dr Ziemann).
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