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Michel Rijntjes

Publications and source records attributed to Michel Rijntjes.

11 recordsLinked to original sources
PubMed2006

Dynamics of language reorganization after stroke.

Previous functional imaging studies of chronic stroke patients with aphasia suggest that recovery of language occurs in a pre-existing, bilateral network with an upregulation of undamaged areas and a recruitment of perilesional tissue and homologue right language areas. The present study aimed at identifying the dynamics of reorganization in the language system by repeated functional MRI (fMRI) examinations with parallel language testing from the acute to the chronic stage. We examined 14 patients with aphasia due to an infarction of the left middle cerebral artery territory and an age-matched control group with an auditory comprehension task in an event-related design. Control subjects were scanned once, whereas patients were scanned repeatedly at three consecutive dates. All patients recovered clinically as shown by a set of aphasia tests. In the acute phase [mean: 1.8 days post-stroke (dps)], patients' group analysis showed little early activation of non-infarcted left-hemispheric language structures, while in the subacute phase (mean: 12.1 dps) a large increase of activation in the bilateral language network with peak activation in the right Broca-homologue (BHo) was observed. A direct comparison of both examinations revealed the strongest increase of activation in the right BHo and supplementary motor area (SMA). These upregulated areas also showed the strongest correlation between improved language function and increased activation (r(BHo) = 0.88, r(SMA) = 0.92). In the chronic phase (mean: 321 dps), a normalization of activation with a re-shift of peak activation to left-hemispheric language areas was observed, associated with further language improvement. The data suggest that brain reorganization during language recovery proceeds in three phases: a strongly reduced activation of remaining left language areas in the acute phase is followed by an upregulation with recruitment of homologue language zones, which correlates with language improvement. Thereafter, a normalization of activation is observed, possibly reflecting consolidation in the language system.

Acute Disease↗
PubMed2006

Two different reorganization patterns after rehabilitative therapy: an exploratory study with fMRI and TMS.

We used two complementary methods to investigate cortical reorganization in chronic stroke patients during treatment with a defined motor rehabilitation program. BOLD ("blood oxygenation level dependent") sensitive functional magnetic resonance imaging (fMRI) and intracortical inhibition (ICI) and facilitation (ICF) measured with transcranial magnetic stimulation (TMS) via paired pulse stimulation were used to investigate cortical reorganization before and after "constraint-induced movement therapy" (CI). The motor hand function improved in all subjects after CI. BOLD signal intensity changes within affected primary sensorimotor cortex (SMC) before and after CI showed a close correlation with ICI (r = 0.93) and ICF (r = 0.76) difference before and after therapy. Difference in number of voxels and ICI difference before and after CI also showed a close correlation (r = 0.92) in the affected SMC over the time period of training. A single subject analysis revealed that patients with intact hand area of M1 ("the hand knob") and its descending motor fibers (these patients revealed normal motor evoked potentials [MEP] from the affected hand) showed decreasing ipsilesional SMC activation which was paralleled by an increase in intracortical excitability. This pattern putatively reflects increasing synaptic efficiency. When M1 or its descending pyramidal tract was lesioned (MEP from the affected hand was pathologic) ipsilesional SMC activation increased, accompanied by decreased intracortical excitability. We suggest that an increase in synaptic efficiency is not possible here, which leads to reorganization with extension, shift and recruitment of additional cortical areas of the sensorimotor network. The inverse dynamic process between both complementary methods (activation in fMRI and intracortical excitability determined by TMS) over the time period of CI illustrates the value of combining methods for understanding brain reorganization.

Aged↗
PubMed2006

Role of functional imaging in neurological disorders.

Neuroimaging in recent years has greatly contributed to our understanding of a wide range of aspects related to central neurological diseases. These include the classification and localization of disease, such as in headache; the understanding of pathology, such as in Parkinson's disease (PD); the mechanisms of reorganization, such as in stroke and multiple sclerosis (MS); and the subclinical progress of disease, such as in amyotrophic lateral sclerosis (ALS). Apart from presurgical mapping, however, the clinical applications so far are limited. Nevertheless, functional imaging does enable the formulation of neurobiological hypotheses that can be tested clinically, and thus is well suited for testing classic clinical hypotheses about how the brain works. Understanding the mechanisms and sites of pathology, such as has been achieved in cluster headaches, facilitates the development of new therapeutic strategies.

Animals↗
PubMed2006

Mechanisms of recovery in stroke patients with hemiparesis or aphasia: new insights, old questions and the meaning of therapies.

PURPOSE OF REVIEW: The mechanisms responsible for recovery after stroke in patients with hemiparesis or aphasia are under intense study, since knowledge of these mechanisms is a prerequisite for choosing which therapy a patient receives and when to apply it. RECENT FINDINGS: Most of the recent insights are obtained with longitudinal studies using functional imaging and direct cortical stimulation during the process of recovery. They reveal that reorganization is a highly dynamic process, involving the establishment of new communications in the remaining system and showing similarities to learning processes in healthy individuals. Lesion localization is a major determinant for recovery and the pattern of reorganization. Neurobiological hypotheses lead to clinical studies, which in turn are now used to confirm or reject these hypotheses. SUMMARY: Although our understanding of the mechanisms responsible for recovery is increasing, the application of this knowledge in daily praxis is still limited. A better understanding of the underlying mechanisms, however, can lead to appropriate therapies for individual patients.

Aphasia↗
PubMed2005

Individual factors in constraint-induced movement therapy after stroke.

OBJECTIVES: Constraint-induced movement therapy (CIMT) has been shown to be effective in chronic stroke patients. It is worthwhile to investigate the influence of individual factors for two reasons: to find out whether they influence outcome and to see whether they support the theory underlying CIMT. METHODS: A group of 26 patients were treated with CIMT and followed over 6 months. In total, 14 individual factors were identified. Patients were assessed with 6 tests, including 2 commonly used after stroke (Frenchay Arm Test, 9 Hole Peg Test). RESULTS: There were individual differences, but as a group, patients improved after therapy. There were no individual factors that influenced improvement in more than one test. CONCLUSIONS: CIMT is an effective therapy in patients with moderate impairment after stroke, also in tests commonly used in stroke rehabilitation. Factors that could have expected to make a difference on the basis of the theory behind CIMT (e.g., time since stroke, previous therapy, sensory deficit) did not influence results. Patients with hemorrhagic lesions and those with a high level of performance (Motor Activity Log > 2.5) profit as well. Pairwise therapy is as effective as individual therapy.

Adolescent↗
PubMed2005

[Is a reformation of the medical training worthwhile? The quality of the Hamburg curriculum under the old and the new board certification law].

This paper presents the results of the evaluation of a new undergraduate curriculum at the Medical Faculty of Hamburg University. This curriculum is based on the new law on medical board certification of 2002, and was tested for the first time in the summer term of 2004. The results were compared with those obtained under the previous law. The data show a substantial increase in student subjective learning effectiveness and satisfaction with the new program. The reasons discerned were the increased practice orientation of the program, the problem-oriented seminars, and the increased motivation of the teaching staff.

Curriculum↗
PubMed2003

The human action recognition system and its relationship to Broca's area: an fMRI study.

Primate studies have identified populations of neurons that are capable of action recognition. These "mirror neurons" show spiking activity both when the monkey executes or observes a grasping movement. These neurons are located in the ventral premotor cortex, possibly the homologue of "Broca's area" in human. This led to the speculation that action recognition and language production share a common system [Trends Neurosci. 21 (1998), 188]. To test this hypothesis, we combined an action recognition with a language production (VERB) and a grasping movement task (MOVE) by using functional magnetic resonance imaging. Action recognition-related activation was observed in the left inferior frontal gyrus and on the border between the inferior frontal gyrus and precentral gyrus (defined as IFG/PG), the ventral occipitotemporal junction, the superior and inferior parietal cortex, and in the intraparietal sulcus in the left hemisphere. An overlap of activations due to the language production, movement execution, and action recognition was found in the parietal cortex, the left inferior frontal gyrus, and the IFG-PG border (IFG/PG). The activation peaks of action recognition and verb generation were always different in single subjects, but no consistent spatial relationship was detected, in accord with the hypothesis that action recognition and language production share a common functional architecture.

Algorithms↗
PubMed2003

Broca's area and the language instinct.

Language acquisition in humans relies on abilities like abstraction and use of syntactic rules, which are absent in other animals. The neural correlate of acquiring new linguistic competence was investigated with two functional magnetic resonance imaging (fMRI) studies. German native speakers learned a sample of 'real' grammatical rules of different languages (Italian or Japanese), which, although parametrically different, follow the universal principles of grammar (UG). Activity during this task was compared with that during a task that involved learning 'unreal' rules of language. 'Unreal' rules were obtained manipulating the original two languages; they used the same lexicon as Italian or Japanese, but were linguistically illegal, as they violated the principles of UG. Increase of activation over time in Broca's area was specific for 'real' language acquisition only, independent of the kind of language. Thus, in Broca's area, biological constraints and language experience interact to enable linguistic competence for a new language.

Adult↗
PubMed2002

Visuomotor control within a distributed parieto-frontal network.

The aim of this functional magnetic resonance imaging study was to investigate differences in visuomotor control with increasing task complexity. Twelve right-handed volunteers were asked to perform their signature under different degrees of visual control: internally generated movement with closed eyes, signing with open eyes, tracking the line of the projected signature forwards, and tracking the line of the projected signature backwards. There was a gradual onset and disappearance of activation within a distributed network. Parietal, lateral and medial frontal brain areas were activated during all conditions, confirming the involvement of a parieto-frontal system. The weight of activation shifted with increasing task complexity. Internally generated movements activated predominantly the inferior parietal lobule and the ventral premotor cortex, as well as the rostral cingulate area, pre-supplementary motor area (pre-SMA) and SMA proper. Opening the eyes reduced SMA and cingulate activation and activated increasingly the occipito-parietal areas with higher task complexity. Visually guided movements produced an activation predominantly in the superior parietal lobule and dorsal premotor cortex. This study bridges human activation studies with the results of neurophysiological studies with monkeys. It confirms a gradual transition of visuomotor control with increasing task complexity within a distributed parieto-frontal network.

Adult↗
PubMed2002

Recovery of motor and language abilities after stroke: the contribution of functional imaging.

In recent years, functional imaging techniques, like functional magnetic resonance imaging (fMRI), positron emission tomography (PET), and transcranial magnetic stimulation (TMS), have shown that the improvement of motor and language function after ischemic stroke is accompanied by extensive reorganizational changes in the human cortex. To better understand these changes and to judge to what extent they could be responsible for clinical improvement, some basic principles of the organization of the motor and language system are discussed.Non-invasive functional imaging can have only a limited contribution in determining which of the possible underlying neural mechanisms, as they are known from animal experiments, play a role in functional recovery. However, they make it possible to define the functional consequences of anatomical lesions in individual patients and to correlate these functional consequences in the motor and language system with the clinical deficit. They can be used to assess the influence on the cortical reorganization of established and newer physiotherapies, logopedics and medical intervention, and they could be a useful tool in determining prognosis.

Animals↗