The role of neuroimaging in understanding the impact of neuroplasticity after CNS damage
After stroke, there is little restitution of neural tissue, but reorganization of surviving neural networks appears to be important for recovery of function. Non-invasive techniques such as functional magnetic resonance imaging and magnetoencephalography allow some aspects of this brain reorganization to be studied in humans. For example, early after stroke there appears to be an upregulation in task-related activity which diminishes with time, but more particularly with recovery. Those with the most complete recovery tend to have the most ‘normal’ activation patter, and those with less complete recovery tend to rely on additional brain regions. Disruption of activity in these additional regions can impair performance in stroke patients suggesting that these new patterns of brain activity can support what recovered function there is. In other words, this reorganization is functionally relevant. Advances in functional neuroimaging now allow the study of alterations in connections between brain regions. Understanding how brain organization is related to anatomical damage, as well as impairment and recovery that can take place over weeks and months following stroke opens the way for functional brain imaging to become a clinically useful tool in rehabilitation, particularly in our ability to predict outcomes and response to novel therapies. Understanding the dynamic process of systems level reorganization will allow greater understanding of the mechanisms of recovery and potentially improve our ability to deliver effective restorative therapy.