Cognitive Alterations in Motor Imagery Process after Left Hemispheric Ischemic Stroke

BACKGROUND Motor imagery training is a promising rehabilitation strategy for stroke patients. However, few studies had focused on the neural mechanisms in time course of its cognitive process. This study investigated the cognitive alterations after left hemispheric ischemic stroke during motor imagery task. METHODOLOGY/PRINCIPAL FINDINGS Eleven patients with ischemic stroke in left hemisphere and eleven age-matched control subjects participated in mental rotation task (MRT) of hand pictures. Behavior performance, event-related potential (ERP) and event-related (de)synchronization (ERD/ERS) in beta band were analyzed to investigate the cortical activation. We found that: (1) The response time increased with orientation angles in both groups, called "angle effect", however, stoke patients' responses were impaired with significantly longer response time and lower accuracy rate; (2) In early visual perceptual cognitive process, stroke patients showed hypo-activations in frontal and central brain areas in aspects of both P200 and ERD; (3) During mental rotation process, P300 amplitude in control subjects decreased while angle increased, called "amplitude modulation effect", which was not observed in stroke patients. Spatially, patients showed significant lateralization of P300 with activation only in contralesional (right) parietal cortex while control subjects showed P300 in both parietal lobes. Stroke patients also showed an overall cortical hypo-activation of ERD during this sub-stage; (4) In the response sub-stage, control subjects showed higher ERD values with more activated cortical areas particularly in the right hemisphere while angle increased, named "angle effect", which was not observed in stroke patients. In addition, stroke patients showed significant lower ERD for affected hand (right) response than that for unaffected hand. CONCLUSIONS/SIGNIFICANCE Cortical activation was altered differently in each cognitive sub-stage of motor imagery after left hemispheric ischemic stroke. These results will help to understand the underlying neural mechanisms of mental rotation following stroke and may shed light on rehabilitation based on motor imagery training.