Affiliations: Centre for Functional Magnetic Resonance Imaging of
the Brain, Department of Clinical Neurology, University of Oxford, UK | Montreal Neurological Institute, McGill University,
Canada
Note: [] Corresponding author: Professor P.M. Matthews, John Radcliffe
Hospital, Headley Way, Headington, Oxford, UK OX3 9DU. Tel.: +44 1865 222729;
Fax: +44 1865 222717; E-mail: [email protected]
Abstract: Modern cognitive neuroscience provides a powerful framework in which
biological models of recovery and neurorehabilitation can be constructed and
tested. The widespread availability, relatively low cost and informativeness of
functional magnetic resonance imaging (fMRI) has made it the most popular of
the techniques available to help with this task. Here, on the basis of
functional imaging studies of stroke, diffuse microvascular disease and
multiple sclerosis, we argue that processes of motor control and learning in
the healthy brain share common mechanisms with those for adaptive functional
reorganisation during spontaneous recovery after brain injury or with
neurorehabilitation. Relatively stringent criteria can be met to confirm that
adaptive functional reorganisation limits disability even in the adult brain:
functional brain changes are related to disease burden, can be found in
patients with demonstrable pathology but no clinical deficits and can be
defined (in motor cortex) even in the absence of volitional recruitment.
Initial studies of neurorehabilitation responses using fMRI and transcranial
magnetic stimulation demonstrate that adaptive reorganisation can be
manipulated directly with both pharmacological and behavioural interventions.
The combination of strategies based on a strong biological rational with
monitoring their effects using highly informative functional brain imaging
methods heralds a new era of scientifically-founded neurorehabilitation.
Keywords: FMRI, neurorehabilitation, learning, transcranial magnetic stimulation, motor control
