A number of studies have appeared recently that have attempted to evaluate therapeutically driven change with functional imaging techniques (Pariente et al., 2001; Carey et al., 2002; Schaechter et al., 2002; Johansen-Berg et al., 2002a; Jang et al., 2003; Miyai et al., 2003). Each study uses functional imaging before and after a particular therapeutical intervention. In general these studies have shown increased task-related activation in affected hemispheres (e.g. in PMd) and reduced activation in unaffected hemispheres after a period of treatment. Although of interest as discussed earlier in this chapter, these are likely to represent the consequences of functional improvement rather than the mechanism. However, this approach has limitations. Functional imaging is unlikely to be useful purely as a marker of clinical improvement, something that is measurable with simple outcome scores. Functional imaging will become a useful marker of the potential for change in damaged brain. Furthermore, it is to be hoped that the potential of different therapeutical interventions can be assessed, both in groups and individuals. Functional imaging, in conjunction with other techniques such as TMS, electro-encephalography (EEG), and magneto-EEG, has the potential to achieve these aims.
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