Effective interventions have demonstrated the ability to improve motor function by reengaging ipsilesional resources, which has been shown to be critical and feasible for hand function recovery even in individuals with severe chronic stroke. However, previous studies focus on changes in brain activity related to motor execution. How changes in motor preparation may facilitate these changes at motor execution is still unclear. In order to address this question, we had 8 individuals with severe chronic hemiparetic stroke participate in a device-assisted intervention. We then quantified changes in both coupling between regions during motor preparation and changes in topographical cortical activity at motor execution for both the hand in isolation and together with the shoulder using high density EEG. We hypothesized that intervention-induced changes in cortico-cortico interactions during motor preparation would lead to changes in activity at motor execution specifically towards an increased reliance on the ipsilesional hemisphere. We found that, following the intervention, individuals displayed a reduction in coupling from ipsilesional M1 to contralesional M1 within gamma frequencies during motor preparation for hand opening. This was followed by a reduction in activity in the contralesional primary sensorimotor cortex during motor execution. Meanwhile, during lifting and opening, a shift to inhibitory coupling within ipsilesional M1 from gamma to beta frequencies was accompanied by an increase in ipsilesional primary sensorimotor cortex activity following the intervention. Together, these results show that intervention-induced changes in coupling within or between motor regions during motor preparation lead to corresponding changes in focal cortical activity at execution.
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