Background:Although quite a very few studies have tested structural connectivity changes following an intervention, it reflects only selected key brain regions in the motor network. Thus, the understanding of structural connectivity changes related to the motor recovery process remains unclear. Objective:This study investigated structural connectivity changes of the motor execution network following a combined intervention of low-frequency repetitive transcranial magnetic stimulation (LF-rTMS) and intensive occupational therapy (OT) after a stroke using graph theory approach. Methods:Fifty-six stroke patients underwent Fugl-Meyer Assessment (FMA), Wolf Motor Function Test-Functional Ability Scale (WMFT-FAS), diffusion tensor imaging (DTI), and T1 weighted imaging before and after the intervention. We examined graph theory measures related to twenty brain regions using structural connectomes. Results:The ipsilesional and contralesional hemisphere showed structural connectivity changes post-intervention after stroke. We found significantly increased regional centralities and nodal efficiency within the frontal pole and decreased degree centrality and nodal efficiency in the ipsilesional thalamus. Correlations were found between network measures and clinical assessments in the cuneus, postcentral gyrus, precentral gyrus, and putamen of the ipsilesional hemisphere. The contralesional areas such as the caudate, cerebellum, and frontal pole also showed significant correlations. Conclusions:This study was helpful to expand the understanding of structural connectivity changes in both hemispheric networks during the motor recovery process following LF-rTMS and intensive OT after stroke.

中文翻译：

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中风康复后运动执行网络的结构连接性变化

背景：尽管很少有研究测试了干预后的结构连接变化，但它只反映了运动网络中选定的关键大脑区域。因此，对与运动恢复过程相关的结构连接变化的理解仍不清楚。目的：本研究采用图论方法研究了低频重复经颅磁刺激（LF-rTMS）和强化职业治疗（OT）联合干预后运动执行网络的结构连接变化。方法：56例脑卒中患者在干预前后分别接受了Fugl-Meyer评估（FMA）、Wolf运动功能测试-功能能力量表（WMFT-FAS）、弥散张量成像（DTI）和T1加权成像。我们使用结构连接组检查了与 20 个大脑区域相关的图论测量。结果：脑卒中干预后，同侧半球和对侧半球的结构连接发生变化。我们发现额极内的区域中心性和节点效率显着增加，同侧丘脑的度中心性和节点效率降低。在同侧半球的楔叶、中央后回、中央前回和壳核中发现了网络测量和临床评估之间的相关性。对侧区域如尾状核、小脑和额极也显示出显着的相关性。结论：