Bimanu al Tandem Motor Task with Multiple Sclerosis in Functi onal Magnetic Resonance Imaging: Effect of Physi otherape utic Techniques –  a Pilot Study

Authors: K. Řasová 1,3;  P. Brandejský 2;  J. Tintěra 4;  J. Krásenský 7;  D. Zimová 6;  E. Medová 6;  A. Herbe­nová 1;  H. Kalistová 3;  R. Jech 3;  M. Řasová 3;  P. Zemanová 7;  J. Zeman 8;  I. Ibrahim 4;  P. Mar­tin­­ková 9;  D. Doležil 6;  D. Jandová 1
Authors‘ workplace: Klinika rehabilitačního lékařství 3. LF UK a FN Královské Vinohrady, Praha, 2Ústav tělovýchovného lékařství 1. LF UK a VFN v Praze, 3Ne urologická klinika 1. LF UK a VFNv Praze, 4Klinika radi odi agnostiky a intervenční radi ologi e, odd. magnetické rezon 1
Published in: Cesk Slov Neurol N 2009; 72/105(4): 350-358
Category: Original Paper


The aim of the study was to find out whether there is a difference in the pattern of brain activation (PBA) examined by means of functional magnetic resonance (fMRI) during a motor task in patients with multiple sclerosis (MS) and healthy probands (HP); and if it is possible to influence

clinical functions and PBA by means of neurorehabilitation (NRHB) and aerobic training (AT).

Twelve MS patients and five HP were examined twice – at the beginning and at the end of the two-month experiment. In its course, one half of the patients underwent NRHB and one half AT. We examined chosen clinical parameters and fMRI (motor task: a simple movement of each hand separately and a tandem movement of both hands).

There was an improvement in postural functions (p = 0.008) in MS patients after the NRHB. The number of changes after NRHB was significantly higher (p = 0.009) in comparison to the group which underwent AT. The fMRI examination at the beginning of the experiment shows a statistically significant difference (p = 0.01) between MS and HP in the extent of the activated area in the collateral primary motor cortex hand, which carried out the movement as the second of the pair. This difference in the extent of activation between HP and MS reduced after both therapeutic programs and it was not significant after the therapy. If we understand this activation pattern as a manifestation of normal interhemispheric cooperation, then in this sense we can think of “recovery to normal”.

This pilot study signals that the by us considered PBA during the movement carried out by both hands differs in MS and HP. Further, it turned out that NRHB and AT influence the clinical manifestation of the disease as well as the pattern of brain activity. The results need further verification.

Key words:
multiple sclerosis –  rehabilitati on –  aerobic exercise –  functi onal magnetic resonance imaging –  rehabilitati on –  plasticity –  central nervo us system


1. Lassonde M, Sa uerwein HC, Lepore F. Extent and limits of callosal plasticity: presence of disconnecti on symptoms in callosal agenesis. Ne uropsychologi a 1995; 33(8): 989– 1007.

2. Stanćák A, Cohen ER, Seidler RD, Duong TQ, Kim S. The Size of Corpus Callosum Correlates with Functi onal Activati on of Medi al Motor Cortical Are as in Bimanu al and Unimanu al Movements. Cerebral Cortex 2003; 13(5): 475– 485.

3. Manson SC, Palace J, Frank JA, Matthews PM. Loss of interhemispheric inhibiti on in pati ents with multiple sclerosis is related to corpus callosum atrophy. Exp Brain Res 2006; 174(4): 728– 733.

4. Cader S, Cifelli A, Abu- Omar Y, Palace J, Matthews PM. Reduced brain functi onal reserve and altered functi onal connectivity in pati ents with multiple sclerosis. Brain 2006; 129(2): 527– 537.

5. Pelleti er J, Habib M, Lyon- Caen O, Salamon G, Poncet M, Khalil R. Functi onal and magnetic resonance imaging correlates of callosal involvement in multiple sclerosis. Arch Ne urol 1993; 50(10): 1077– 1082.

6. Pelleti er J, Suchet L, Witjas T, Habib M, Guttmann CR, Salamon G et al. A longitudinal study of callosal atrophy and interhemispheric dysfuncti on in relapsing- remitting multiple sclerosis. Arch Ne urol 2001; 58(1): 105– 111.

7. Simon JH, Holtås SL, Schiffer RB, Rudick RA, Herndon RM, Kido DK et al. Corpus callosum and subcallosal- periventricular lesi ons in multiple sclerosis: detecti on with MR. Radi ology 1986; 160(2): 363– 367.

8. Rasova K, Krasensky J, Havrdova E, Obenberger J, Seidel Z, Dolezal O et al. Is it possible to actively and purposely make use of plasticity and adaptability in the ne urorehabilitati on tre atment of Multiple Sclerosis pati ents? A Pilot Project. Clin Rehabil 2005; 19(2): 170– 181.

9. Řasová K et al. Principy řízení pohybu a jejich aplikace v ne urorehabilitaci nemocných s roztro ušeno u sklerózo u mozkomíšní. Instruktážní film s facilitačními (terape utickými) prvky. Uni e ROSKA, Česká MS společnost 2007.

10. Řasová K. Fyzi oterapi e u ne urologicky nemocných (se zaměřením na roztro ušeno u sklerózu mozkomíšní). Praha: Ceros o.p.s. 2007.

11. Bai er ML, Cutter GR, Rudick RA, Miller D, Cohen JA, Weinstock- Guttman B et al. Low- contrast letter acuity testing captures visu al dysfuncti on in pati ents with multiple sclerosis. Ne urology 2005, 64(6), 992– 995.

12. Deme urisse G, Demol O, Robaye E. Motor evalu ati on in vascular hemiplegi a. Eur Ne urol 1980; 19(6): 382– 389.

13. Bohannon RW, Smith MB. Interrater reli ability of a modifi ed Ashworth scale of Muscle spasticity. Phys Ther 1987; 67(2): 206– 207.

14. Berg K, Wo od- Da uphinee S, Willi ams JI. The Balance Scale: Reli ability assessment for elderly residents and pati ents with an acute stroke. Scand J Rehab Med 1995; 27(1): 27– 36.

15. Fahn S, Tolosa E, Marín C. Clinical rating scale for tremor. In: Jankovic J, Tolosa E (eds). Parkinson’s Dise ase and Movement Disorders. Baltimore‑Munich: Urban & Schwarzenberg 1993: 271– 280.

16. Alusi SH, Worthington J, Glickman S, Findley LJ, Bain PG. Evalu ati on of three different ways of assessing tremor in multiple sclerosis. J Ne urol Ne urosurg Psychi atry 2000; 68(6): 756– 760.

17. Corrive a u H, Gu arna F, Dutil E, Riley E, Arsena ult AB, Dro uin G. An evalu ati on of the hemiplegic subject based on the Bobath appro ach. Scand J Rehab Med 1988; 20(1): 5– 11.

18. Davi es PM. Steps to Follow. A guide to the Tre atment of Adult Hemiplegi a. Based on the Concept of K. and B. Bobath. Berlin: Springer- Verlag 1993: 15– 16.

19. Morris LC. Clinical and Rehabilitati on Outcome Me asures. In: Burks JS, Johnson KP (eds). Multiple Sclerosis –  Di agnosis, Medical Management and Rehabilitati on. New York: Demos 2000: 236– 290.

20. Carey RG, Seibert JH, Posavac EJ. Who makes the most progress in inpati ent rehabilitati on? An analysis of functi onal gain. Arch Phys Med Rehabil 1988; 69(5): 337– 343.

21. Freeman JA, Langdon DW, Hobart JC, Thompson AJ. The impact of inpati ent rehabilitati on on progressive multiple sclerosis. Ann Ne urol 1997; 42(2): 236– 244.

22. Freeman JA, Langdon DW, Hobart JC, Thompson AJ. Inpati ent rehabilitati on in multiple sclerosis: do the benefits carry over into the community? Ne urology 1999; 52(1): 50– 56.

23. Solari A, Filippini G, Gasco P, Colla L, Salmaggi A, La Manti a L et al. Physical rehabilitati on has a positive effect on disability in multiple sclerosis pati ents. Ne urology 1999; 52(1): 57– 62.

24. Rasova K, Havrdova E, Brandejsky P, Zálisová M, Fo ubikova B, Martinkova P. Comparison of the influence of different rehabilitati on programs on clinical spirometric and spiroergometric parameters in pati ents with multiple sclerosis. Mult Scler 2006; 12(2): 227– 234.

25. Di Fabi o RP, Soderberg J, Cho i T, Hansen CR, Schapiro RT. Extended o utpati ent rehabilitati on: its influence on symptom frequency, fatigue, and functi onal status for persons with progressive multiple sclerosis. Arch Phys Med Rehabil 1998; 79(2): 141– 146.

26. Wiles CM, Newcombe RG, Fuller KJ, Shaw S, Furnival- Doran J, Pickersgill TP et al. Controlled randomised crossover tri al of the effects of physi otherapy on mobility in chronic multiple sclerosis. J Ne urol Ne urosurg Psychi atry 2001; 70(2): 174– 179.

27. Patti F, Ci anci o MR, Cacopardo M, Reggi o E, Fi orilla T, Palermo F et al. Effects of a short o utpati ent rehabilitati on tre atment on disability of multiple sclerosis pati ents –  a randomised controlled tri al. J Ne urol 2003; 250(7): 861– 866.

28. Khan F, Pallant JF, Brand C, Kilpatrick TJ. Effectiveness of Rehabilitati on Interventi on in persons with Multiple sclerosis: A Randomized Controlled Tri al. J Ne urol Ne urosurg Psychi atry 2008; 79(11): 1230– 1235.

29. Romberg A, Virtanen A, Ruuti ainen J. Long‑term exercise improves functi onal impairment but not qu ality of life in multiple sclerosis. J Ne urol 2005; 252(7): 839– 845.

30. Lord SE, Wade DT, Halligan PW. A comparison of two physi otherapy tre atment appro aches to improve walking in multiple sclerosis: a pilot randomized controlled study. Clin Rehabil 1998; 12(6): 477– 486.

31. Cattane o D, Jonsdottir J, Zocchi M, Regola A. Effects of balance exercises on pe ople with multiple sclerosis: a pilot study. Clin Rehabil 2007; 21(9): 771– 781.

32. Shepherd RB, Carr JH. Ne urological rehabilitati on. Disabil Rehabil 2006; 28(13– 14): 811– 812.

33. Schapiro RT, Petajan JH, Kosich D, Molk B, Feeney J. Role of cardi ovascular fitness in multiple sclerosis: a Pilot Study. Ne urorehabil Ne ural Repair 1988; 2: 43– 49.

34. Ponichtera- Mulcare JA. Exercise and multiple sclerosis. Med Sci Sports Exerc 1993; 25(4): 451– 65.

35. Petajan JH, Gappmai er E, White AT, Spencer MK, Mino L, Hicks RW. Impact of aerobic training on fitness and qu ality of life in multiple sclerosis. Ann Ne urology 1996; 39(4): 432– 441.

36. Mostert S, Kesselring J. Effects of a short‑term exercise training program on aerobic fitness, fatigue, he alth percepti on and activity level of subjects with multiple sclerosis. Mult Scler 2002; 8(2): 161– 168.

37. Kileff J, Ashburn A. A pilot study of the effect of aerobic exercise on pe ople with moderate disability multiple sclerosis. Clin Rehabil 2005; 19(2): 165– 169.

38. Schulz KH, Gold SM, Witte J, Bartsch K, Lang UE, Hellweg R et al. Impact of aerobic training on immune- endocrine parameters, ne urotrophic factors, qu ality of life and co ordinative functi on in multiple sclerosis. J Ne urol Sci 2004; 225(1– 2): 11– 18.

38. Newman MA, Dawes H, van den Berg M, Wade DT, Burridge J, Izadi H. Can aerobic tre admill training reduce the effort of walking and fatigue in pe ople with multiple sclerosis: a pilot study. Mult Scler 2007; 13(1): 113– 119.

40. Rampello A, Franceschini M, Pi epoli M, Antenucci R, Lenti G, Olivi eri D et al. Effect of aerobic training on walking capacity and maximal exercise tolerance in pati ents with multiple sclerosis: a randomized crossover controlled study. Phys Ther 2007; 87(5): 545– 559.

41. Netz Y, Tomer R, Axelrad S, Argov E, Inbar O. The effect of a single aerobic training sessi on on cognitive flexibility in late middle- aged adults. Int J Sports Med 2007;28(1): 82– 87.

42. Verschuren O, Ketelaar M, Gorter JW, Helders PJ, Uiterwaal CS, Takken T. Exercise training program in children and adolescents with cerebral palsy: a randomized controlled tri al. Arch Pedi atr Adolesc Med 2007; 161(11): 1075– 1081.

43. Colcombe SJ, Erickson KI, Scalf PE, Kim JS, Prakash R, McAuley E et al. Aerobic exercise training incre ases brain volume in aging humans. J Gerontol A Bi ol Sci Med Sci 2006; 61(11): 1166– 1170.

44. Colcombe SJ, Erickson KI, Raz N, Webb AG, Cohen NJ, McAuley E, Kramer AF. Aerobic fitness reduces brain tissue loss in aging humans. J Gerontol A Bi ol Sci Med Sci. 2003; 58(2): 176– 180.

45. Prakash RS, Sno ok EM, Erickson KI, Colcombe SJ, Voss MW, Motl RW et al. Cardi orespiratory fitness: A predictor of cortical plasticity in multiple sclerosis. Ne uro image 2007; 34(3): 1238– 1244.

46. Lee M, Reddy H, Johansen- Berg H, Pendlebury S, Jenkinson M, Smith S et al. The motor cortex shows adaptive functi onal changes to brain injury from multiple sclerosis. Ann Ne urol 2000; 47(5): 606– 613.

47. Reddy H, Narayanan S, Arno utelis R, Jenkinson M, Antel J, Matthews PM et al. Evidence for adaptive functi onal changes to brain injury from multiple sclerosis. Brain 2000; 123(11): 2314– 2320.

48. Pantano P, Mainero C, Iannetti GD, Carami a F, Di Legge S, Pi attella MC et al. Contributi on of corticospinal tract damage to cortical motor re organizati on after a single clinical attack of multiple sclerosis. Ne uro image 2002; 17(4): 1837– 1843.

49. Pantano P, Mainero C, Lenzi D, Carami a F, Iannetti GD, Pi attella MC et al. A longitudinal fMRI study on motor activity in pati ents with multiple sclerosis. Brain 2005; 128(9): 2146– 2153.

50. Rocca MA, Gavazzi C, Mezzapesa DM, Falini A, Colombo B, Mascalchi M et al. A functi onal magnetic resonance imaging study of pati ents with secondary progressive multiple sclerosis. Ne uro image 2003; 19(4): 1770– 1777.

51. Filippi M, Rocca MA, Falini A, Caputo D, Ghezzi A, Colombo B et al. Correlati ons between structural CNS damage and functi onal MRI changes in primary progressive MS. Ne uro image 2002; 15(3): 537– 346.

52. Morgen K, Kadom N, Sawaki L, Tessitore A, Ohayon J, McFarland H et al. Training- dependent plasticity in pati ents with multiple sclerosis. Brain 127(11): 2506– 2517.

53. Lotze M, Bra un C, Birba umer N, Anders S, Cohen LG. Motor le arning elicited by voluntary drive. Brain 2003; 126(4): 866– 872.

54. Classen J, Li epert J, Wise SP, Hallett M, Cohen LG. Rapid plasticity of human cortical movement representati on induced by practice. J Ne urophysi ol 1998; 79(2): 1117– 1123.

55. Morgen K, Kadom N, Sawaki L, Tessitore A, Ohayon J, Frank J et al. Kinematic specificity of cortical re organizati on associ ated with motor training. Ne uro image 2004; 21(3): 1182– 1187.

56. Schaechter JD, Kraft E, Hilli ard TS, Dijkhuizen RM, Benner T, Finklestein SP et al. Motor recovery and cortical re organizati on after constraint‑induced movement therapy in stroke pati ents: a preliminary study. Ne urorehabil Ne ural Repair 2002; 16(4): 326– 338.

57. Li epert J, Ba uder H, Wolfgang HR, Miltner WH, Ta ub E, Weiller C. Tre atment‑induced cortical re organizati on after stroke in humans. Stroke 2000; 31(6): 1210– 1216.

58. Li epert J, Uhde I, Gräf S, Leidner O, Weiller C. Motor cortex plasticity during forced- use therapy in stroke pati ents: a preliminary study. J Ne urol 2001; 248(4): 315– 321.

59. Nelles G, Jentzen W, Jueptner M, Muller S, Di ener HC. Arm training induced brain plasticity in stroke studi ed with seri al positron emissi on tomography. Ne uro image 2001; 13(1): 1146– 1154.

60. Le onard CT. The Ne urosci ence of Motor Le arning. In: Le onard CT (ed). The Ne urosci ence of Human Movement. St. Lo uis: Mosby 1998: 203– 229.

61. Verstynen T, Di edrichsen J, Albert N, Aparici o P, Ivry RB. Ipsilateral motor cortex activity during unimanu al hand movements relates to task complexity. J Ne urophysi ol 2005; 93(3): 1209– 1222.

62. Roland PE, Skinhøj E, Lassen NA, Larsen B. Different cortical are as in man in organizati on of voluntary movements in extrapersonal space. J Ne urophysi ol 1980; 43(1): 137– 150.

63. Kim SG, Ashe J, Hendrich K, Ellermann JM, Merkle H,Uğurbil K et al. Functi onal magnetic resonance imaging of motor cortex: hemispheric asymmetry and handedness. Sci ence 1993; 261(5121): 615– 617.

64. Kawashima R, Matsumura M, Sadato N, Naito E, Waki A, Nakamura S et al. Regi onal cerebral blo od flow changes in human brain related to ipsilateral and contralateral complex hand movements –  a PET study. Eur J Ne urosci 1998; 10(7): 2254– 2260.

65. Kawashima R, Roland PE, O‘Sullivan BT. Activity in the human primary motor cortex related to ipsilateral hand movements. Brain Res 1994; 663(2): 251– 256.

66. Beltramello A, Cerini R, Puppini G, El- Dalati G, Vi ola S, Martone E et al. Motor representati on of the hand in the human cortex: an f- MRI study with a conventi onal 1.5 T clinical unit. Ital J Ne urol Sci 1998; 19(5): 277– 284.

67. Aramaki Y, Honda M, Sadato N. Suppressi on of the non‑dominant motor cortex during bimanu al symmetric finger movement: a functi onal magnetic resonance imaging study. Ne urosci ence 2006; 141(4): 2147– 2153.

68. Kobayashi M, Hutchinson S, Schla ug G, Pas­cu al- Le one A. Ipsilateral motor cortex activati on on functi onal magnetic resonance imaging during unilateral hand movements is related to interhemispheric interacti ons. Ne uro image 2003; 20(4): 2259– 2270.

69. Aramaki Y, Honda M, Okada T, Sadato N. Ne ural correlates of the spontane o us phase transiti on during bimanu al co ordinati on. Cereb Cortex 2006; 16(9): 1338– 1348.

70. Gu H, Stein EA, Yang Y. Nonline ar responses of cerebral blo od volume, blo od flow and blo od oxygenati on signals during visu al stimulati on. Magn Reson Imaging 2005; 23(9): 921– 928.

71. Weiller C, Chollet F, Friston KJ, Wise RJ, Frackowi ak RS. Functi onal re organizati on of the brain in recovery from stri atocapsular infarcti on in man. Ann Ne urol 1992; 31(5): 463– 472.

72. Marshall RS, Perera GM, Lazar RM, Kraka uer JW, Constantine RC, DeLaPaz RL. Evoluti on of cortical activati on during recovery from corticospinal tract infarcti on. Stroke 2000; 31(3): 656– 661.

73. Small SL, Hlustik P, Noll DC, Genovese C, Solodkin A.Cerebellar hemispheric activati on ipsilateral to the paretic hand correlates with functi onal recovery after stroke. Brain 2002; 125(7): 1544– 1557.

74. Manson SC, Wegner C, Filippi M, Barkhof F, Beckmann C, Ciccarelli O et al. Impairment of movement‑associ ated brain de activati on in multiple sclerosis: further evidence for a functi onal pathology of interhemispheric ne uronal inhibiti on. Exp Brain Res 2008; 187(1): 25– 31.

75. Cader S, Palace J, Matthews PM. Cholinergic agonism alters cognitive processing and enhances brain functi onal connectivity in pati ents with multiple sclerosis. J Psychopharmacol. 2008 Jul 17. [Epub ahead of print].

76. Erickson KI, Colcombe SJ, Wadhwa R, Bherer L, Peterson MS, Scalf PE et al. Training‑induced plasticity in older adults: effects of training on hemispheric asymmetry. Ne urobi ol Aging 2007; 28(2): 272– 283.

77. Aramaki Y, Honda M, Sadato N. Suppressi on of the non‑dominant motor cortex during bimanu al symmetric finger movement: a functi onal magnetic resonance imaging study. Ne urosci ence 2006; 141(4): 2147– 2153.

Paediatric neurology Neurosurgery Neurology

Article was published in

Czech and Slovak Neurology and Neurosurgery

Issue 4

2009 Issue 4

Most read in this issue

This topic is also in:

Forgotten password

Don‘t have an account?  Create new account

Forgotten password

Enter the email address that you registered with. We will send you instructions on how to set a new password.


Don‘t have an account?  Create new account