Cortical Reorganization Following Bimanual Training and Somatosensory Stimulation in Cervical Spinal Cord Injury: A Case Report

BACKGROUND AND PURPOSE: Deficits in upper-extremity function in individuals with tetraplegia are primarily due to the loss of motor pathways. Detrimental cortical reorganization, however, may create further loss of function. The purpose of this case report is to describe the cortical changes associated with a combination intervention using bimanual massed practice training with somatosensory stimulation. CASE DESCRIPTION: "BR" was a 22-year-old man with C6 tetraplegia and hand impairment who participated in this training intervention for 3 weeks. OUTCOMES: BR demonstrated improvements in sensory function, strength (the force-generating capacity of muscle), and performance of functional hand skills. Following the training, the cortical motor map of the biceps brachii muscle shifted anteriorly and increased in area and volume. DISCUSSION: This is the first documented case in which changes in the size and location of the cortical map were associated with an intervention and improvement in function in an individual with tetraplegia. This case suggests that an intensive training intervention may induce both functional and neurophysiological changes.