Clinical Study Functional Brain Correlates of Upper Limb Spasticity and Its Mitigation following Rehabilitation in Chronic Stroke Survivors Svetlana Pundik, 1,2 Adam D. Falchook, 3 Jessica McCabe, 1 Krisanne Litinas, 1 and Janis J. Daly 3 1 Neurology and Research Service, Cleveland VA Medical Center, 10701 East Boulevard, Cleveland, OH 44106, USA 2 Department of Neurology, Case Western Reserve University School of Medicine, 11100 Euclid Avenue, Cleveland, OH 44106, USA 3 Department of Neurology and McKnight Brain Institute, Brain Rehabilitation Research Center of Excellence, Malcom Randall VA Medical Center, University of Florida, 1601 SW Archer Road, Gainesville, FL 32608, USA Correspondence should be addressed to Svetlana Pundik; sxp19@cwru.edu Received 31 March 2014; Revised 23 May 2014; Accepted 11 June 2014; Published 3 July 2014 Academic Editor: Steve Kautz Copyright © 2014 Svetlana Pundik et al. his is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Background. Arm spasticity is a challenge in the care of chronic stroke survivors with motor deicits. In order to advance spasticity treatments, a better understanding of the mechanism of spasticity-related neuroplasticity is needed. Objective. To investigate brain function correlates of spasticity in chronic stroke and to identify speciic regional functional brain changes related to rehabilitation- induced mitigation of spasticity. Methods. 23 stroke survivors (>6 months) were treated with an arm motor learning and spasticity therapy (5 d/wk for 12 weeks). Outcome measures included Modiied Ashworth scale, sensory tests, and functional magnetic resonance imaging (fMRI) for wrist and hand movement. Results. First, at baseline, greater spasticity correlated with poorer motor function ( = 0.001) and greater sensory deicits ( = 0.003). Second, rehabilitation produced improvement in upper limb spasticity and motor function ( < 0.0001). hird, at baseline, greater spasticity correlated with higher fMRI activation in the ipsilesional thalamus (rho = 0.49,  = 0.03). Fourth, following rehabilitation, greater mitigation of spasticity correlated with enhanced fMRI activation in the contralesional primary motor ( = −0.755,  = 0.003), premotor ( = −0.565,  = 0.04), primary sensory ( = −0.614,  = 0.03), and associative sensory ( = −0.597,  = 0.03) regions while controlling for changes in motor function. Conclusions. Contralesional motor regions may contribute to restoring control of muscle tone in chronic stroke. 1. Introduction Motor rehabilitation is a challenging task especially for indi- viduals who exhibit spasticity along with motor impairment. Spasticity can limit efective practice of coordinated move- ment and hinder functional recovery and rehabilitation [1– 3]. In fact, a more complete restoration of motor function is achieved when spasticity is absent [4]. he obstacle that spas- ticity creates for upper limb rehabilitation is due to restric- tion of movement, in opposition to the spastic muscle activity, as in practice of wrist and inger extension when wrist and in- ger lexors exhibit spasticity. Spasticity burdens a significant portion of patients with chronic motor deicits, secondary to stroke and other types of brain injury. Up to 42% of stroke sur- vivors exhibit abnormal hypertonia [4–8]. his abnormally elevated muscle tone is likely to impact quality of life because it afects many aspects of everyday function, produces pain and discomfort, and prevents normal movements [3, 9]. Spasticity can be improved to some degree. Currently available treatment modalities for spasticity include phar- macological agents (oral preparations, neuromuscular block- ade agents) and physical motor therapies (for review, see [10]). Pharmacological agents do not cure spasticity, require contin- uous redosing, and cause untoward side efects. Some reha- bilitation therapies to alleviate spasticity can produce changes in motor function and improve spasticity. hese therapies include stretching, strengthening, and electrical and vibra- tory stimulation [11, 12]. hough these interventions are promising, they produce only partial recovery of normal muscle tone, for some individuals. Hindawi Publishing Corporation Stroke Research and Treatment Volume 2014, Article ID 306325, 8 pages http://dx.doi.org/10.1155/2014/306325