Neurorehabilitation-induced cortical reorganization in brain injury: A 14-month longitudinal follow-up study

Purpose: This study highlights the effects of a comprehensive neurorehabilitation (CN) on neuroplasticity and motor recovery in a 25 years old adult with right hippocampal sclerosis and the temporal lobectomy and amygdalotomy. Methods: The patient received 8-month course of comprehensive neurorehabilitation, comprised of five times/week. Motor behavioral and 1.5 T functional magnetic resonance imaging (fMRI) tests were implemented to determine the restoration of motor function and neuroplasitic changes, respectively. In fMRI measure, a laterality index (LI) was used to determine any shift in the symmetry of cortical activation between the hemispheres. Additionally, motor behavioral changes were measured to probe long-term retention of learned motor skills at the 6-month post-treatment follow-up test. Results: Motor behavioral tests showed that comprehensive neurorehabilitation enhanced functional reaching, grasping, and hand manipulation skills, which were well retained even at the 6-month post-treatment. Baseline fMRI showed asymmetry of the contralesional sensori-motor cortex (SMC) activation (Laterality index score: 0.54), but was restored to normal symmetry (Lateral index: 1.0) during affected hand movement after comprehensive neurorehabilitation. Conclusions: Our novel findings suggest that comprehensive neurorehabilitation may facilitate restitution of normal symmetry of cortical activation, thereby enhancing motor function. This case provides the first neuroimaging evidence about a long-term comprehensive neurorehabilitation -induced neuroplasticity of the individual with a complex brain injury in the literature.