Read Full Text: Cortical changes underlying balance recovery in patients with hemiplegic stroke (Must purchase to read in full)
Journal: NeuroImage (Impact Factor 5.42)
Year Published: 2014
Ranked 29th on our 2014-2019 list of the 50 most influential articles
Big-picture article breakdown for OTs
I’m going to be honest, I’m a little surprised by how little we know about the brain.
But, at the same time, I’m impressed by how quickly our knowledge base is growing.
Take this week’s article, for example. It seeks to understand which parts of the brain are responsible for balance control (as well as its post-stroke recovery mechanisms).
Now, we already know that the spinal cord, brainstem, cerebellum, basal ganglia, and cerebral cortex each play a role in balance, but that is basically like saying the central nervous system controls balance—it would be helpful to be more specific.
A previous study found a correlation between the supplementary motor area (SMA) and prefrontal cortex (both specific parts of the cerebral cortex) in balance control.
However, the exact roles these two areas would play in balance recovery following stroke remained unclear.
Thus, a longitudinal study was conducted to gather more information. This study monitored the aforementioned areas of the brain before and after intensive rehabilitation following a hemipalegic stroke.
The authors found a significant correlation between activity in the SMA and balance function improvement, as measured by the Berg Balance Scale.
The implication of this is that cortical activation changes could be used as biomarkers for balance recovery after stroke. And, they might also be useful in evaluating whether rehab interventions are working.
What OTs need know about the details
This study was conducted in Osaka, Japan. It involved twenty patients: 20 male, and three female. All of these patients were admitted to multidisciplinary inpatient rehab to address impairments from subcortical strokes. The average length of rehab was 41 days.
Assessments utilized:
The use of fNIRS
To measure cortical activation, a Functional Near Infrared Spectroscopy (fNIRS) was used. Here’s an example of one, to give you an idea:
Because, the details about the imaging are so dense and outside of our expertise, I’ll direct you to the article to learn more about exact fNIRS utilized, and for details about the data they gathered.
How was OT involved?
Rehabilitation was provided seven days a week, with 60 minutes of PT, 60 minutes of OT, and SLP as needed.
Here’s what occupational therapy included:
- Relaxation
- Training for hygiene
- Dressing
- Writing
- Eating
- Toileting and bathing
- Balance exercises
- Reaching
- Coordinative taks of the upper limb and trunk and
- Dual motor tasks, such as handling objects while standing and walking
It is fun to see that even though this study took place across the globe from where I sit, the OT interventions sound very familiar 
Takeaways for OT
(These are my personal takeaways, and were not mentioned in the article.)
Biomarkers could quickly become an important objective measure for OT.
If you’ve been following the Club each week, you know that we’ve talked about biomarkers before. We’ve already reviewed one other article related to cortical changes and biomarkers for stroke.
There is an interesting combination of things going on right now: we are learning more and more about which areas of the brain are involved in functional recovery. And the technology to measure these changes is rapidly becoming less expensive.
I couldn’t easily find information on how much a fNIRS costs, but the general trend we are seeing in technologies like this is that they are becoming more and more affordable.
Which, I’m guessing, means that within a decade, even an average OT clinic may be using some sort of brainwave tracker—and using it to measure progress.
Function is still important.
I, for one, don’t see these objective measures as precluding the need for functional measures. Instead, I see them as a complement to them.
Our hope, of course, is that the cortical changes will substantiate the efficacy of our treatments—and give us better information than we currently have for adjusting treatments as needed.
We know that many of biomechanical measures we currently use don’t necessarily translate to functional improvements. (For example, if your ROM improves by a couple degrees, that doesn’t necessarily mean your functional outcomes improve.) However, cortical changes will hopefully have a closer correlation to functional improvements.
This is not just for stroke patients.
Both of the articles we’ve looked at about biomarkers have been related to stroke. But, this technology is just not important for stroke patients. If it ends up working, I think it will quickly expand to other diagnoses.
The other diagnosis I’ve heard most frequently associated with biomarkers is autism. For past discussion on autism and biomarkers, please see the discussion on this biomarker article and this one on autism.
Listen to a summary in podcast form:
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