大多數的中風患者具有因動作控制能力失調造成的功能障礙，進而影響其生活品質。雖然過去的研究證實復健對於恢復中風病人的動作表現有其療效，但少有研究探討復健活動對於中風病患腦部皮質重塑性的影響。由於過去腦功能造影技術的限制，大部分的腦功能研究著重於上肢精細動作之探討，有關於下肢的功能性活動如踩車卻鮮少被探討。踩車活動常被用於當作急性期中風病患的行走前訓練，也亦被證實對於增加肌肉力量、降低痙攣以及改善神經肌肉控制有效果。由於近紅外光光譜儀（near infrared spectroscopy）為近年來發展之新型腦造影技術，且最大優勢為可用來偵測受試者進行動態活動之腦部活化。本研究即利用近紅外光光譜儀偵測因腦神經細胞活化造成的腦組織血氧濃度變化去探測中風病患在進行踩車活動時的腦部活動以及踩車訓練對於中風病患踩車表現、功能性恢復以及腦部重塑性的效果。在偵測腦訊號的同時，踩車時之肌電訊號可以量化踩車的對稱性，以期瞭解中風病患動作恢復之可能的神經機制。
本實驗第一階段徵召健康年輕與健康老人進行功能性近紅外光光譜儀於偵測進行踩車活動的腦部活性變化之適用性探討。其結果發現主動踩車時會活化感覺運動皮質區。而健康老人在進行具有速度回饋的主動性踩車活動時，其踩車表現會改善。其輔助運動區以及運動前區的活化程度也大於健康年輕人。第二階段則徵召中風病患進行相同的踩車任務，量測其大腦活性變化與踩車表現。其結果顯示，在進行主動踩車活動與被動踩車時，感覺運動皮質區的活化程度相對大於其他皮質區域。但相較於主動踩車，在進行被動踩車時其健側的活化程度較小。而速度回饋有助於改善中風病患踩車的對稱性與速度變異性，而健側運動前區的活化程度增加推測為中風病患處理速度回饋訊號之代償機制，而受傷對側為主的活化模式造成了不對稱的腦部活化。
本研究第三階段為探討主動與被動踩車訓練對中風病患踩車表現、功能性表現以及大腦皮質活性之影響。本實驗將十八位皮質下中風患者隨機分配至主動踩車訓練與被動踩車訓練組，分別進行每次三十分鐘、每周兩次，為期八周的踩車訓練。後測結果發現，主動踩車組其日常活動功能、功能性表現與本體感覺較治療前進步，被動踩車組治療前後其功能與踩車表現則無明顯差異。而主動踩車組之後測顯示健側運動輔助區與運動前區的活化程度較前測增加， 而被動踩車訓練組則無明顯差異。
本研究建立了利用近紅外光光譜儀偵測進行動態活動時大腦活性之可行性。其中風病患踩車活動之腦部造影結果可應用於建立復健最佳化選擇之新策略。

Stroke survivors suffering from deficit motor control have limited functional abilities which could result in poor quality of lives. Although there is evidence that the motor rehabilitation can enhance motor recovery, the rehabilitation efficacy related to the brain plasticity has not been well understood. Identifying and validating the therapeutic techniques with scientific evidence for improving motor function in stroke patients remains a high priority. Cycling exercise is a common pre-ambulation training for restoration of locomotion rhythm in early stroke patients contributed to enhancement in muscle strength, neuromuscular coordination and suppression in muscle spasticity. As the mechanism for motor relearning of pedaling motion in stroke patients has been less investigated before, the main purpose of this study is to investigate cortical activation patterns under varied cycling tasks as well as the training effect of cycling exercise in functional performance and cycling performance and brain activation patterns in stroke patients. We also quantitatively measure the symmetrical pattern of electrophysiological activities during cycling. The data can help us understand the possible neural mechanism of motor recovery in stroke patients.
The first part of study is to determine the ability of the NIRS-based technique to measure the changes of cerebral tissue oxygenation under varied cycling tasks by performing preliminary studies in the health young and elderly. From the normal control studies, the elderly exhibited predominant activation of the sensorimotor cortex (SMC) during active cycling similar to young subjects but with poorer cycling performance. The age-related changes in the cortical control in processing external feedback and pedaling movements was found with increased brain activities of the premotor cortex (PMC) and the supplementay motor areas (SMA) and improved cycling performance. The second part is to investigate the effect of speed feedback, a common used strategy in the clinical setting, in cortical activation patterns and cycling performance in stroke patients. The result showed that passive cycling had a similar cortical activation pattern to that observed during active cycling without feedback but with a smaller intensity of the SMC of the unaffected hemisphere. Enhanced PMC activation of the unaffected side with improved cycling performance was observed during active cycling with feedback, with respect to that observed without feedback. It may suggest that the PMC might be involved in controlling cycling performance to adapt to the usage of external feedback in stroke patients.
The third part is to measure cortical activities in both active and passive cycling schemes and examined their training effects from cycling performance, functional performance and cortical reorganization in stroke patients. Eighteen patients were randomly assigned to two training groups (active and passive), using a random number table. The patients would have additional 30 minutes cycling training besides their regular rehabilitation program. There were a total number of 16 sessions, 2 times per week, in 8 weeks. The training effects of active cycling scheme were observed in improving activities of daily living, basic mobility and joint position sense but insignificant improvement in muscle strength and cycling performance. The enhanced activation of the SMA and PMC of the unaffected side were observed during passive cycling, suggesting a compensatory recruitment related to the cortical reorganization in response to aspects of recovery. The passive group showed improved cycling performance as reduced torque variation but insignificant brain activities changes after training.
In summary, this study first demonstrated the possibility of using NIRS system to detect cortical activation patterns during varied cycling exercise paradigms in healthy controls as well as in stroke patients. The stroke patients can also tolerate repeated NIRS measurements well. If NIRS technique can elucidate cerebral activation patterns associated with real-world outcome, the potentiality of brain-based rehabilitation training program is expectable for patients with stroke.

References

Agre J, Magness J, Hull S, Wright K, Baxter T, Patterson R, Stradel L. 1987. Strength testing with a portable dynamometer: reliability for upper and lower extremities. Arch Phys Med Rehabil. 68: 454.
Ambrosini E, Ferrante S, Pedrocchi A, Ferrigno G, Molteni F. 2011. Cycling Induced by Electrical Stimulation Improves Motor Recovery in Postacute Hemiparetic Patients. Stroke. 42: 1068-1073.
Arenth PM, Ricker JH, Schultheis MT. 2007. Applications of functional near-infrared spectroscopy (fNIRS) to Neurorehabilitation of cognitive disabilities. Clin Neuropsychol. 21: 38-57.
Armstrong DM. 1988. The supraspinal control of mammalian locomotion. J Physiol. 405: 1-37.
Boas DA, Chen K, Grebert D, Franceschini MA. 2004. Improving the diffuse optical imaging spatial resolution of the cerebral hemodynamic response to brain activation in humans. Optics letters. 29: 1506-1508.
Brown DA, Kautz SA. 1998. Increased workload enhances force output during pedaling exercise in persons with poststroke hemiplegia. Stroke. 29: 598-606.
Buttelli O, Vandewalle H, Peres G. 1996. The relationship between maximal power and maximal torque-velocity using an electronic ergometer. Eur J Appl Physiol. 73: 479-483.
Calautti C, Baron JC. 2003. Functional neuroimaging studies of motor recovery after stroke in adults: a review. Stroke. 34: 1553-1566.
Carel C, Loubinoux I, Boulanouar K, Manelfe C, Rascol O, Celsis P, Chollet F. 2000. Neural substrate for the effects of passive training on sensorimotor cortical representation: a study with functional magnetic resonance imaging in healthy subjects. J Cereb Blood Flow Metab. 20: 478-484.
Carpenter CM, Srinivasan S, Pogue BW, Paulsen KD. 2008. Methodology development for three-dimensional MR-guided near infrared spectroscopy of breast tumors. Opt Express. 16: 17903-17914.
Catalan MJ, Honda M, Weeks RA, Cohen LG, Hallett M. 1998. The functional neuroanatomy of simple and complex sequential finger movements: a PET study. Brain. 121 253-264.
Chance B, Zhuang Z, UnAh C, Alter C, Lipton L. 1993. Cognition-activated low-frequency modulation of light absorption in human brain. Proc Natl Acad Sci U S A. 90: 3770-3774.
Chen HY, Chen SC, Chen JJ, Fu LL, Wang YL. 2005. Kinesiological and kinematical analysis for stroke subjects with asymmetrical cycling movement patterns. J Electromyogr Kinesiol. 15: 587-595.
Christensen LO, Johannsen P, Sinkjaer T, Petersen N, Pyndt HS, Nielsen JB. 2000. Cerebral activation during bicycle movements in man. Exp Brain Res. 135: 66-72.
Cohen ME, Marino RJ. 2000. The tools of disability outcomes research functional status measures. Arch Phys Med Rehabil. 81: S21-S29.
Colcombe SJ, Kramer AF, Erickson KI, Scalf P, McAuley E, Cohen NJ, Webb A, Jerome GJ, Marquez DX, Elavsky S. 2004. Cardiovascular fitness, cortical plasticity, and aging. Proc Natl Acad Sci U S A. 101: 3316-3321.
Collins DL, Neelin P, Peters TM, Evans AC. 1994. Automatic 3D intersubject registration of MR volumetric data in standardized Talairach space. J Comput Assist Tomogr. 18: 192-205.
Cope M, Delpy DT. 1988. System for long-term measurement of cerebral blood and tissue oxygenation on newborn infants by near infra-red transillumination. Med Biol Eng Comput. 26: 289-294.
Coyle SM, Ward TE, Markham CM. 2007. Brain-computer interface using a simplified functional near-infrared spectroscopy system. Journal of neural engineering. 4: 219-226.
Cramer SC. 2008. Repairing the human brain after stroke: I. Mechanisms of spontaneous recovery. Ann Neurol. 63: 272-287.
Cui X, Bray S, Reiss AL. 2010. Functional near infrared spectroscopy (NIRS) signal improvement based on negative correlation between oxygenated and deoxygenated hemoglobin dynamics. NeuroImage. 49: 3039-3046.
D'Olhaberriague L, Litvan I, Mitsias P, Mansbach HH. 1996. A reappraisal of reliability and validity studies in stroke. Stroke. 27: 2331-2336.
De Blasi RA, Fantini S, Franceschini MA, Ferrari M, Gratton E. 1995. Cerebral and muscle oxygen saturation measurement by frequency-domain near-infra-red spectrometer. Med Biol Eng Comput. 33: 228-230.
Debaere F, Wenderoth N, Sunaert S, Van Hecke P, Swinnen SP. 2003. Internal vs external generation of movements: differential neural pathways involved in bimanual coordination performed in the presence or absence of augmented visual feedback. NeuroImage. 19: 764-776.
Dechaumont-Palacin S, Marque P, De Boissezon X, Castel-Lacanal E, Carel C, Berry I, Pastor J, Albucher JF, Chollet F, Loubinoux I. 2008. Neural correlates of proprioceptive integration in the contralesional hemisphere of very impaired patients shortly after a subcortical stroke: an FMRI study. Neurorehabil Neural Repair. 22: 154-165.
Dietz V, Muller R, Colombo G. 2002. Locomotor activity in spinal man: significance of afferent input from joint and load receptors. Brain. 125: 2626-2634.
Dum RP, Strick PL. 2002. Motor areas in the frontal lobe of the primate. Physiol Behav. 77: 677-682.
Duncan A, Meek JH, Clemence M, Elwell CE, Fallon P, Tyszczuk L, Cope M, Delpy DT. 1996. Measurement of cranial optical path length as a function of age using phase resolved near infrared spectroscopy. Pediatr Res. 39: 889-894.
Duncan PW, Propst M, Nelson SG. 1983. Reliability of the Fugl-Meyer assessment of sensorimotor recovery following cerebrovascular accident. Phys Ther. 63: 1606.
Dunn JC, Iversen MD. 2003. Interrater reliability of knee muscle forces obtained by hand-held dynamometer from elderly subjects with degenerative back pain. J Geriatr Phys Ther. 26: 23.
Durham K, Van Vliet PM, Badger F, Sackley C. 2009. Use of information feedback and attentional focus of feedback in treating the person with a hemiplegic arm. Physiother Res Int. 14: 77-90.
Ehrsson HH, Fagergren A, Jonsson T, Westling G, Johansson RS, Forssberg H. 2000. Cortical activity in precision- versus power-grip tasks: an fMRI study. J Neurophysiol. 83: 528-536.
Fabbri F, Sassaroli A, Henry ME, Fantini S. 2004. Optical measurements of absorption changes in two-layered diffusive media. Phys Med Biol. 49: 1183-1201.
Ferrante S, Pedrocchi A, Ferrigno G, Molteni F. 2008. Cycling induced by functional electrical stimulation improves the muscular strength and the motor control of individuals with post-acute stroke. Europa Medicophysica-SIMFER 2007 Award Winner. Eur J Phys Rehabil Med. 44: 159-167.
Ferrari M, Mottola L, Quaresima V. 2004. Principles, techniques, and limitations of near infrared spectroscopy. Can J Appl Physiol. 29: 463-487.
Folstein MF, Folstein SE, McHugh PR. 1975. Mini-Mental State: a practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res.
Franceschini MA, Boas DA. 2004. Noninvasive measurement of neuronal activity with near-infrared optical imaging. Neuroimage. 21: 372-386.
Franceschini MA, Joseph DK, Huppert TJ, Diamond SG, Boas DA. 2006. Diffuse optical imaging of the whole head. J Biomed Opt. 11: 054007.
Franceschini MA, Nissila I, Wu W, Diamond SG, Bonmassar G, Boas DA. 2008. Coupling between somatosensory evoked potentials and hemodynamic response in the rat. NeuroImage. 41: 189-203.
Franceschini MA, Thaker S, Themelis G, Krishnamoorthy KK, Bortfeld H, Diamond SG, Boas DA, Arvin K, Grant PE. 2007. Assessment of infant brain development with frequency-domain near-infrared spectroscopy. Pediatr Res. 61: 546-551.
Franceschini MA, Toronov V, Filiaci M, Gratton E, Fantini S. 2000. On-line optical imaging of the human brain with 160-ms temporal resolution. Opt Express. 6: 49-57.
Fugl-Meyer A, Jääskö L, Leyman I, Olsson S, Steglind S. 1975. The post-stroke hemiplegic patient. 1. a method for evaluation of physical performance. Scand J Rehabil Med. 7: 13.
Fujiwara T, Liu M, Chino N. 2003. Effect of pedaling exercise on the hemiplegic lower limb. Am J Phys Med Rehabil. 82: 357-363.
Gladstone DJ, Danells CJ, Black SE. 2002. The Fugl-Meyer assessment of motor recovery after stroke: a critical review of its measurement properties. Neurorehabil Neural Repair. 16: 232.
Goldman-Rakic PS, Bates JF, Chafee MV. 1992. The prefrontal cortex and internally generated motor acts. Curr Opin Neurobiol. 2: 830-835.
Grafton ST, Fagg AH, Arbib MA. 1998. Dorsal premotor cortex and conditional movement selection: A PET functional mapping study. J Neurophysiol. 79: 1092-1097.
Gratton G, Sarno A, Maclin E, Corballis PM, Fabiani M. 2000. Toward noninvasive 3-D imaging of the time course of cortical activity: investigation of the depth of the event-related optical signal. Neuroimage. 11: 491-504.
Hachisuka K, Umezu Y, Ogata H. 1997. Disuse muscle atrophy of lower limbs in hemiplegic patients. Arch Phys Med Rehabil. 78: 13-18.
Halsband U, Ito N, Tanji J, Freund HJ. 1993. The role of premotor cortex and the supplementary motor area in the temporal control of movement in man. Brain. 116 243-266.
Halsband U, Lange RK. 2006. Motor learning in man: a review of functional and clinical studies. J Physiol Paris. 99: 414-424.
Hamaoka T, McCully KK, Quaresima V, Yamamoto K, Chance B. 2007. Near-infrared spectroscopy/imaging for monitoring muscle oxygenation and oxidative metabolism in healthy and diseased humans. J Biomed Opt. 12: 062105.
Hara Y. 2008. Neurorehabilitation with new functional electrical stimulation for hemiparetic upper extremity in stroke patients. J Nippon Med Sch. 75: 4-14.
Hara Y, Ogawa S, Tsujiuchi K, Muraoka Y. 2008. A home-based rehabilitation program for the hemiplegic upper extremity by power-assisted functional electrical stimulation. Disabil Rehabil. 30: 296-304.
Harada T, Miyai I, Suzuki M, Kubota K. 2009. Gait capacity affects cortical activation patterns related to speed control in the elderly. Exp Brain Res. 193: 445-454.
Hatakenaka M, Miyai I, Mihara M, Sakoda S, Kubota K. 2007. Frontal regions involved in learning of motor skill--A functional NIRS study. NeuroImage. 34: 109-116.
Heuninckx S, Wenderoth N, Swinnen SP. 2008. Systems neuroplasticity in the aging brain: recruiting additional neural resources for successful motor performance in elderly persons. J Neurosci. 28: 91-99.
Hodics T, Cohen LG, Cramer SC. 2006. Functional imaging of intervention effects in stroke motor rehabilitation. Arch Phys Med Rehabil. 87: S36-42.
Hornby TG, Straube DS, Kinnaird CR, Holleran CL, Echauz AJ, Rodriguez KS, Wagner EJ, Narducci EA. 2011. Importance of Specificity, Amount, and Intensity of Locomotor Training to Improve Ambulatory Function in Patients Poststroke. Topics in Stroke Rehabilitation. 18: 293-307.
Hoshi E, Tanji J. 2004. Differential roles of neuronal activity in the supplementary and presupplementary motor areas: from information retrieval to motor planning and execution. J Neurophysiol. 92: 3482-3499.
Hoshi E, Tanji J. 2007. Distinctions between dorsal and ventral premotor areas: anatomical connectivity and functional properties. Curr Opin Neurobiol. 17: 234-242.
Huppert TJ, Diamond SG, Franceschini MA, Boas DA. 2009. HomER: a review of time-series analysis methods for near-infrared spectroscopy of the brain. Appl Opt. 48: D280-298.
Hwang IS, Lee HM, Cherng RJ, Chen JJ. 2003. Electromyographic analysis of locomotion for healthy and hemiparetic subjects--study of performance variability and rail effect on treadmill. Gait Posture. 18: 1-12.
Jacobs BL, Fornal CA. 1999. Activity of serotonergic neurons in behaving animals. Neuropsychopharmacology. 21: 9S-15S.
Jang SH, You SH, Hallett M, Cho YW, Park CM, Cho SH, Lee HY, Kim TH. 2005. Cortical reorganization and associated functional motor recovery after virtual reality in patients with chronic stroke: an experimenter-blind preliminary study. Arch Phys Med Rehabil. 86: 2218-2223.
Jobsis FF. 1977. Noninvasive, infrared monitoring of cerebral and myocardial oxygen sufficiency and circulatory parameters. Science. 198: 1264-1267.
Katiuscia S, Franco C, Federico D, Davide M, Sergio D, Giuliano G. 2009. Reorganization and enhanced functional connectivity of motor areas in repetitive ankle movements after training in locomotor attention. Brain Res. 1297: 124-134.
Kato H, Izumiyama M, Koizumi H, Takahashi A, Itoyama Y. 2002. Near-infrared spectroscopic topography as a tool to monitor motor reorganization after hemiparetic stroke: a comparison with functional MRI. Stroke. 33: 2032-2036.
Kendall FP, McCreary EK, Kendall HO. 1983. Muscles, testing and function: Williams & Wilkins Baltimore, MD.
Kenney W, Johnson J. 1992. Control of skin blood flow during exercise. Med Sci Sports Exerc. 24: 303.
Kleim JA, Jones TA. 2008. Principles of experience-dependent neural plasticity: implications for rehabilitation after brain damage. J Speech Lang Hear Res. 51: S225.
Kohno S, Miyai I, Seiyama A, Oda I, Ishikawa A, Tsuneishi S, Amita T, Shimizu K. 2007. Removal of the skin blood flow artifact in functional near-infrared spectroscopic imaging data through independent component analysis. J Biomed Opt. 12: 062111.
Langhorne P, Coupar F, Pollock A. 2009. Motor recovery after stroke: a systematic review. The Lancet Neurology. 8: 741-754.
LaPointe KE, Klein JA, Konkol ML, Kveno SM, Bhatt E, DiFabio RP, Carey JR. 2009. Cortical activation during finger tracking vs. ankle tracking in healthy subjects. Restor Neurol Neurosci. 27: 253-264.
Lin PY, Lin SI, Penney T, Chen JJJ. 2009. Review: Applications of Near Infrared Spectroscopy and Imaging for Motor Rehabilitation in Stroke Patients. J Med Bio Eng. 29: 210-221.
Lin SI. 2005. Motor function and joint position sense in relation to gait performance in chronic stroke patients. Arch Phys Med Rehabil. 86: 197-203.
Lindberg P, Schmitz C, Forssberg H, Engardt M, Borg J. 2004. Effects of passive-active movement training on upper limb motor function and cortical activation in chronic patients with stroke: a pilot study. J Rehabil Med. 36: 117-123.
Liu H, Song Y, Worden KL, Jiang X, Constantinescu A, Mason RP. 2000. Noninvasive investigation of blood oxygenation dynamics of tumors by near-infrared spectroscopy. Appl Opt. 39: 5231-5243.
Lotze M, Markert J, Sauseng P, Hoppe J, Plewnia C, Gerloff C. 2006. The role of multiple contralesional motor areas for complex hand movements after internal capsular lesion. The Journal of neuroscience. 26: 6096-6102.
Loubinoux I, Carel C, Pariente J, Dechaumont S, Albucher JF, Marque P, Manelfe C, Chollet F. 2003. Correlation between cerebral reorganization and motor recovery after subcortical infarcts. NeuroImage. 20: 2166-2180.
Macko R, Ivey F, Forrester L. 2005. Task-oriented aerobic exercise in chronic hemiparetic stroke: training protocols and treatment effects. Top Stroke Rehabil. 12: 45-57.
Macko RF, Ivey FM, Forrester LW, Hanley D, Sorkin JD, Katzel LI, Silver KH, Goldberg AP. 2005. Treadmill exercise rehabilitation improves ambulatory function and cardiovascular fitness in patients with chronic stroke. Stroke. 36: 2206-2211.
Mahoney FI. 1965. The Barthel Index. Md State Med J. 14: 61-65.
Maki A, Yamashita Y, Ito Y, Watanabe E, Mayanagi Y, Koizumi H. 1995. Spatial and temporal analysis of human motor activity using noninvasive NIR topography. Med Phys. 22: 1997-2005.
Marx R, Hudak P, Bombardier C, Graham B, Goldsmith C, Wright J. 1998. The reliability of physical examination for carpal tunnel syndrome. The Journal of Hand Surgery: Journal of the British Society for Surgery of the Hand. 23: 499-502.
Mattay VS, Fera F, Tessitore A, Hariri AR, Das S, Callicott JH, Weinberger DR. 2002. Neurophysiological correlates of age-related changes in human motor function. Neurology. 58: 630-635.
Mihara M, Miyai I, Hatakenaka M, Kubota K, Sakoda S. 2007. Sustained prefrontal activation during ataxic gait: a compensatory mechanism for ataxic stroke? NeuroImage. 37: 1338-1345.
Mihara M, Miyai I, Hatakenaka M, Kubota K, Sakoda S. 2008. Role of the prefrontal cortex in human balance control. NeuroImage. 43: 329-336.
Miyai I, Suzuki M, Hatakenaka M, Kubota K. 2006. Effect of body weight support on cortical activation during gait in patients with stroke. Exp Brain Res. 169: 85-91.
Miyai I, Tanabe HC, Sase I, Eda H, Oda I, Konishi I, Tsunazawa Y, Suzuki T, Yanagida T, Kubota K. 2001. Cortical mapping of gait in humans: a near-infrared spectroscopic topography study. NeuroImage. 14: 1186-1192.
Miyai I, Yagura H, Hatakenaka M, Oda I, Konishi I, Kubota K. 2003. Longitudinal optical imaging study for locomotor recovery after stroke. Stroke. 34: 2866-2870.
Miyai I, Yagura H, Oda I, Konishi I, Eda H, Suzuki T, Kubota K. 2002. Premotor cortex is involved in restoration of gait in stroke. Ann Neurol. 52: 188-194.
Molloy DW, Standish TIM. 1997. A guide to the standardized Mini-Mental State Examination. Int Psychogeriatr. 9: 87-94.
Nelles G, Jentzen W, Jueptner M, Müller S, Diener H. 2001. Arm training induced brain plasticity in stroke studied with serial positron emission tomography. NeuroImage. 13: 1146-1154.
Nelles G, Spiekermann G, Jueptner M, Leonhardt G, Muller S, Gerhard H, Diener HC. 1999. Evolution of functional reorganization in hemiplegic stroke: a serial positron emission tomographic activation study. Ann Neurol. 46: 901-909.
O'Shea J, Johansen-Berg H, Trief D, Göbel S, Rushworth MFS. 2007. Functionally specific reorganization in human premotor cortex. Neuron. 54: 479-490.
Okamoto M, Matsunami M, Dan H, Kohata T, Kohyama K, Dan I. 2006. Prefrontal activity during taste encoding: an fNIRS study. NeuroImage. 31: 796-806.
Olaleye D, Perkins BA, Bril V. 2001. Evaluation of three screening tests and a risk assessment model for diagnosing peripheral neuropathy in the diabetes clinic. Diabetes Res Clin Pract. 54: 115-128.
Ou W, Nissila I, Radhakrishnan H, Boas DA, Hamalainen MS, Franceschini MA. 2009. Study of neurovascular coupling in humans via simultaneous magnetoencephalography and diffuse optical imaging acquisition. NeuroImage. 46: 624-632.
Park SW, Butler AJ, Cavalheiro V, Alberts JL, Wolf SL. 2004. Changes in serial optical topography and TMS during task performance after constraint-induced movement therapy in stroke: a case study. Neurorehabil Neural Repair. 18: 95-105.
Patten C, Lexell J, Brown HE. 2004. Weakness and strength training in persons with poststroke hemiplegia: rationale, method, and efficacy. J Rehabil Res Dev. 41: 293-312.
Picard N, Strick PL. 2001. Imaging the premotor areas. Curr Opin Neurobiol. 11: 663-672.
Pifferi A, Torricelli A, Taroni P, Cubeddu R. 2001. Reconstruction of absorber concentrations in a two-layer structure by use of multidistance time-resolved reflectance spectroscopy. Opt Lett. 26: 1963-1965.
Potempa K, Lopez M, Braun LT, Szidon JP, Fogg L, Tincknell T. 1995. Physiological outcomes of aerobic exercise training in hemiparetic stroke patients. Stroke. 26: 101-105.
Raasch CC, Zajac FE. 1999. Locomotor strategy for pedaling: muscle groups and biomechanical functions. J Neurophysiol. 82: 515-525.
Reed R, Den Hartog R, Yochum K, Pearlmutter L, Ruttinger AC, Mooradian A. 1993. A comparison of hand-held isometric strength measurement with isokinetic muscle strength measurement in the elderly. J Am Geriatr Soc. 41: 53.
Rehme AK, Eickhoff SB, Rottschy C, Fink GR, Grefkes C. 2011. Activation likelihood estimation meta-analysis of motor-related neural activity after stroke. NeuroImage.
Rinne T, Gratton G, Fabiani M, Cowan N, Maclin E, Stinard A, Sinkkonen J, Alho K, Naatanen R. 1999. Scalp-recorded optical signals make sound processing in the auditory cortex visible? Neuroimage. 10: 620-624.
Rockwood K, Awalt E, Carver D, MacKnight C. 2000. Feasibility and measurement properties of the functional reach and the timed up and go tests in the Canadian study of health and aging. The journals of gerontology Series A, Biological sciences and medical sciences. 55: M70.
Rosano C, Aizenstein H, Brach J, Longenberger A, Studenski S, Newman AB. 2008. Special article: gait measures indicate underlying focal gray matter atrophy in the brain of older adults. J Gerontol A Bio Sci Med Sci. 63: 1380-1388.
Saitou H, Yanagi H, Hara S, Tsuchiya S, Tomura S. 2000. Cerebral blood volume and oxygenation among poststroke hemiplegic patients: effects of 13 rehabilitation tasks measured by near-infrared spectroscopy. Arch Phys Med Rehabil. 81: 1348-1356.
Sanford J, Moreland J, Swanson LR, Stratford PW, Gowland C. 1993. Reliability of the Fugl-Meyer assessment for testing motor performance in patients following stroke. Phys Ther. 73: 447.
Schaechter JD. 2004. Motor rehabilitation and brain plasticity after hemiparetic stroke. Prog Neurobiol. 73: 61-72.
Schmidt RA, Lee TD. 2005. Motor control and learning: A behavioral emphasis: Human Kinetics Publishers.
Seidler RD, Bernard JA, Burutolu TB, Fling BW, Gordon MT, Gwin JT, Kwak Y, Lipps DB. 2010. Motor control and aging: links to age-related brain structural, functional, and biochemical effects. Neurosci Biobehav Rev. 34: 721-733.
Shah S, Vanclay F, Cooper B. 1989. Improving the sensitivity of the Barthel Index for stroke rehabilitation* 1. J Clin Epidemiol. 42: 703-709.
Sibley KM, Tang A, Brooks D, Brown DA, McIlroy WE. 2008. Feasibility of adapted aerobic cycle ergometry tasks to encourage paretic limb use after stroke: a case series. Journal of Neurological Physical Therapy. 32: 80-87.
Siggeirsdottir K, Jonsson B, Jonsson H, Iwarsson S. 2002. The timed ‘Up & Go’is dependent on chair type. Clin Rehabil. 16: 609.
Strangman G, Boas DA, Sutton JP. 2002. Non-invasive neuroimaging using near-infrared light. Biol Psychiatry. 52: 679-693.
Strangman G, Goldstein R, Rauch SL, Stein J. 2006. Near-infrared spectroscopy and imaging for investigating stroke rehabilitation: test-retest reliability and review of the literature. Arch Phys Med Rehabil. 87: S12-19.
Subramanian SK, Massie CL, Malcolm MP, Levin MF. 2010. Does Provision of Extrinsic Feedback Result in Improved Motor Learning in the Upper Limb Poststroke? A Systematic Review of the Evidence. Neurorehabil Neural Repair. 24: 113-124.
Suzuki M, Miyai I, Ono T, Kubota K. 2008. Activities in the frontal cortex and gait performance are modulated by preparation. An fNIRS study. NeuroImage. 39: 600-607.
Suzuki M, Miyai I, Ono T, Oda I, Konishi I, Kochiyama T, Kubota K. 2004. Prefrontal and premotor cortices are involved in adapting walking and running speed on the treadmill: an optical imaging study. NeuroImage. 23: 1020-1026.
Swinnen SP, Walter CB, Lee TD, Serrien DJ. 1993. Acquiring bimanual skills: contrasting forms of information feedback for interlimb decoupling. J Exp Psychol Learn Mem Cogn. 19: 1328-1344.
Szecsi J, Krewer C, Muller F, Straube A. 2008. Functional electrical stimulation assisted cycling of patients with subacute stroke: kinetic and kinematic analysis. Clin Biomech. 23: 1086-1094.
Takeda K, Gomi Y, Imai I, Shimoda N, Hiwatari M, Kato H. 2007. Shift of motor activation areas during recovery from hemiparesis after cerebral infarction: a longitudinal study with near-infrared spectroscopy. Neurosci Res. 59: 136-144.
Tombari D, Loubinoux I, Pariente J, Gerdelat A, Albucher JF, Tardy J, Cassol E, Chollet F. 2004. A longitudinal fMRI study: in recovering and then in clinically stable sub-cortical stroke patients. NeuroImage. 23: 827-839.
Tombaugh TN, McIntyre NJ. 1992. The mini-mental state examination: a comprehensive review. J Am Geriatr Soc.
Trinastic JP, Kautz SA, McGregor K, Gregory C, Bowden M, Benjamin MB, Kurtzman M, Chang YL, Conway T, Crosson B. 2010. An fMRI study of the differences in brain activity during active ankle dorsiflexion and plantarflexion. Brain Imaging Behav. 4: 121-131.
Tse CY, Tien KR, Penney TB. 2006. Event-related optical imaging reveals the temporal dynamics of right temporal and frontal cortex activation in pre-attentive change detection. Neuroimage. 29: 314-320.
van der Zee P, Arridge SR, Cope M, Delpy DT. 1990. The effect of optode positioning on optical pathlength in near infrared spectroscopy of brain. Adv Exp Med Biol. 277: 79-84.
Van Peppen RP, Kortsmit M, Lindeman E, Kwakkel G. 2006. Effects of visual feedback therapy on postural control in bilateral standing after stroke: a systematic review. J Rehabil Med. 38: 3-9.
Van Vliet PM, Wulf G. 2006. Extrinsic feedback for motor learning after stroke: What is the evidence? Disabil Rehabil. 28: 831-840.
Villringer A, Planck J, Hock C, Schleinkofer L, Dirnagl U. 1993. Near infrared spectroscopy (NIRS): a new tool to study hemodynamic changes during activation of brain function in human adults. Neurosci Lett. 154: 101-104.
Ward NS, Frackowiak RS. 2003. Age-related changes in the neural correlates of motor performance. Brain. 126: 873-888.
Warlow C, Van Gijn J, Dennis MS, Wardlaw JM, Bamford J. 2008. Stroke: practical management: Wiley-Blackwell.
Watanabe E, Yamashita Y, Maki A, Ito Y, Koizumi H. 1996. Non-invasive functional mapping with multi-channel near infra-red spectroscopic topography in humans. Neurosci Lett. 205: 41-44.
Werhahn KJ, Conforto AB, Kadom N, Hallett M, Cohen LG. 2003. Contribution of the ipsilateral motor cortex to recovery after chronic stroke. Ann Neurol. 54: 464-472.
Williamson J, Nobrega A, McColl R, Mathews D, Winchester P, Friberg L, Mitchell J. 1997. Activation of the insular cortex during dynamic exercise in humans. The Journal of physiology. 503: 277-283.
Wolf M, Ferrari M, Quaresima V. 2007. Progress of near-infrared spectroscopy and topography for brain and muscle clinical applications. J Biomed Opt. 12: 062104.
Wolfe C, Taub N, Woodrow E, Burney P. 1991. Assessment of scales of disability and handicap for stroke patients. Stroke. 22: 1242-1244.
Wood-Dauphinee S, Williams JI, Shapiro S. 1990. Examining outcome measures in a clinical study of stroke. Stroke. 21: 731.
Wulf G, Landers M, Lewthwaite R, Tollner T. 2009. External focus instructions reduce postural instability in individuals with Parkinson disease. Phys Ther. 89: 162-168.
Wulf G, McConnel N, Gartner M, Schwarz A. 2002. Enhancing the learning of sport skills through external-focus feedback. J Mot Behav. 34: 171-182.