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22. European Stroke Conference 7 Rehabilitation and reorganisation after stroke A 9:30 - 9:40 The signature of structural cortical plasticity in central post-stroke pain: Gray matter decreases in prefrontal, secondary somatosensory and temporal cortex T. Krause1, S. Frank2, B. Taskin3, L. Harnisch4, A. Flöel5, V. Witte6, K. Villringer7, A. Villrin-ger8, G.J. Jungehülsing9 Klinik für Neurologie und Centrum für Schlaganfallforschung, Charité, Universitätsme-dizin Berlin, Campus Benjamin Franklin, Berlin, GERMANY1,Klinik für Neurologie und Centrum für Schlaganfallforschung, Charité, Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, GERMANY2, Klinik für Neurologie und Centrum für Schlaganfallforschung, Charité, Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, GERMANY3, Klinik für Neurologie und Centrum für Schlaganfallforschung, Charité, Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, GERMANY4, Klinik für Neurologie und Centrum für Schlaganfallforschung, Charité, Universitätsmedizin Berlin, Campus Charité Mitte, Berlin, GERMANY5, Klinik für Neurologie und Centrum für Schlaganfallforschung, Charité, Univer-sitätsmedizin Berlin, Campus Charité Mitte, Berlin, GERMANY6, Centrum für Schlaganfall-forschung, Charité, Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, GERMA-NY7, Max-Planck-Institut für Kognitions- und Neurowissenschaften, Leipzig, GERMANY8, Klinik für Neurologie und Centrum für Schlaganfallforschung, Charité, Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, GERMANY9 Background: The role of structural cortical plasticity in various chronic pain conditions has recently been emphasized, and distinct pain syndromes have been linked to unique patterns of cortical reorganization. It has been proposed that decreases in gray matter density might play a crucial role in the emergence and maintenance of chronic pain. Although central post-stroke pain (CPSP) is assumed to result from lesions of the spinothalamic tract and/or its target re-gions, little is known about potentially resulting cortical reorganization. Methods: Using high-resolution T1-weighted MRI at 3T, we examined 55 patients with chronic (>6 months) subcortical sensory strokes and a residual somatosensory syndrome. Out of these, 23 patients had CPSP. We compared CPSP patients to non-pain patients as well as to 30 healthy matched controls employing voxel-based morphometry. Results: As compared to non-pain patients, CPSP patients showed significant decreases in gray matter density (p<0.05, Familiy-wise error corrected) in ipsilesional ventrolateral prefrontal cortex, in contralesional secondary somatosensory cortex as well as superior/middle temporal gyrus. When comparing CPSP patients to healthy controls, additional decreases were found in bilateral S2, in bilateral anterior insular cortex, in ipsilesional posterior insular cortex, in con-tralesional medial orbitofrontal cortex, and in contralesional nucleus accumbens. In CPSP pa-tients, gray matter density in ventromedial prefrontal cortex was negatively correlated to pain intensity (p<0.05, Familiy-wise error corrected). Conclusion: Our study shows for the first time that CPSP leads to a unique pattern of extensive cortical reorganization expanding beyond sensory cortex to frontal areas, which are well known to be involved in the processing of the emotional and aversive aspects of pain. 6 Rehabilitation and reorganisation after stroke A 9:20 - 9:30 Functional Strength Training may enhance upper limb but not walking function of people at least 6 months post-stroke: The FeSTivaLS Trial K. Mares1, J. Cross2, A. Clark3, S. Vaughan4, G.R. Barton5, F. Poland6, K. McGlashan7, M. Watson8, P.K. Myint9, V.M. Pomeroy10 University of East Anglia, Norwich, UNITED KINGDOM1,University of East Anglia, Nor-wich, UNITED KINGDOM2, University of East Anglia, Norwich, UNITED KINGDOM3, Uni-versity of East Anglia, Norwich, UNITED KINGDOM4, University of East Anglia, Norwich, UNITED KINGDOM5, University of East Anglia, Norwich, UNITED KINGDOM6, Coleman Centre for Specialist Rehabilitation, Norwich, UNITED KINGDOM7, University of East An-glia, Norwich, UNITED KINGDOM8, University of East Anglia, Norwich, UNITED KING-DOM9, University of East Anglia, Norwich, UNITED KINGDOM10 Background: Functional Strength Training (FST) potentially could enhance motor function of people who are more than six months after stroke. The aim of this trial is to evaluate the clini-cal efficacy of enhancing upper and lower limb motor function with FST. Methods: Randomised, observer-blind trial. Participants (n = 52), six months to five years after stroke with difficulty using their paretic upper (UL) and lower limbs (LL) for everyday func-tional activity. All were randomised to either FST-UL or FST-LL. An independent randomisa-tion service used baseline Functional Ambulation Categories (FAC) and Action Research Arm Test (ARAT) scores to minimise any imbalance and concealed from the research team until after baseline assessment was completed. Interventions were delivered in participants’ own homes for up to fours days each week for six weeks. Measures were undertaken before ran-domisation (baseline), after six-weeks of intervention (outcome) and six weeks thereafter (fol-low- up). Primary outcomes for clinical efficacy were ARAT and FAC scores. ARAT was ana-lysed by ranking each individual and comparing mean rank, based on a regression model with minimisation variables included, between the two groups using the non-parametric bootstrap. FAC categories were compared using the proportional odds model with group and minimisation variables included. Results: There was a significant difference in ARAT scores between the groups with the FST-LL group having a smaller score at both outcome (14.2, 22.9, p=0.042) and follow-up (15.6, 20.3, p=0.19). There was no difference in FAC scores between groups at either outcome (p=0.654) or follow-up (p=0.925). The proportional odds assumption for FAC was tested and no reason to reject the fit of the model (outcome: p=0.964); follow-up: p=0.821). Conclusion: FST provided to people who were between 6 months and 5 years after stroke may improve motor function of the upper but not the lower limb. 98 © 2013 S. Karger AG, Basel Scientific Programme


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