Modificaciones en las proyecciones córtico-motoneuronales que van a la mano en pacientes que reciben rehabilitación intensiva

Introduction. Cerebrovascular disease is one of the main causes of motor deficits. We evaluated the effect of an intensive rehabilitation program over the reorganization of cortico-motoneuronal projections to the affected hand in patients after stroke from the mean cerebral artery territory. Material and methods. We carried out a cohort study, selecting a group of 20 hospitalized patients (group 1:G1) who were admitted to receive intensive rehabilitation treatment and another group of 10 ambulatory patients (group 2: G2) was selected as control group, they were not receiving at this moment any physical rehabilitation treatment. All the patients fulfilled the following criteria: ≥ 6 months post-stroke, ≥ 75 points in the Barthel index, and ≥ 2 in Medical Research Council in the affected hand. We excluded patients with ≥ 2 strokes, or who were carriers of electromagnetic devices. Both groups were evaluated before and after 28 days of treatment (only G1); applying the same clinical scales and electrophysiologically with motor mapping using transcranial magnetic stimulation, defining map area and location. Test for dependent (Wilcoxon) and for independent samples (Mann-Whitney U) were performed, with α = 0.05. Results. Before treatment both groups were clinically and electrophysiologically similar without any significant statistical difference (Mann Whitney U; p < 0,05). Contralateral responses were obtained in all patients after stimulating the affected hemisphere. Significant differences between groups were demonstrated after treatment; higher values in clinical scales were observed in G1 in comparison to initial values (Wilcoxon: Barthel index, Z = 3.4793, p = 0.000; MRC: Z = 3.8230, p = 0.000) and in the motor map area of both hemispheres (Wilcoxon: Z = 3.9199, p = 0.00). Conclusion. Intensive rehabilitation induced changes in cortico-motoneuronal projections to the hand in patients with stroke.