LONGITUDINAL CHANGES IN PARIETO-FRONTAL FUNCTIONAL CONNECTIVITY AND THEIR PREDICTIVE VALUE FOR POST-STROKE VISUOMOTOR RECOVERY

Parieto-frontal connectivity is crucial for sensorimotor integration and goal-directed motor control, and disruptions within these networks may relate to post-stroke upper limb sensorimotor deficits. How parieto-frontal functional connectivity evolves from the acute to the chronic phase, and whether early subacute connectivity can predict recovery remains unclear. We investigated resting-state functional connectivity (rsFC) within parieto-frontal motor networks in 60 stroke patients (30% women; mean age = 54.9 ± 12.8 years) evaluated at 3 weeks and 6 months post-stroke. Visuomotor grip force-tracking performance of the paretic hand was assessed, and structural and resting-state functional MRI were acquired. Right-sided lesions were flipped to the left hemisphere for group analyses. Seed-based rsFC analyses targeted bilateral anterior intraparietal sulcus (AIPS), caudal intraparietal sulcus (CIPS), ventral premotor cortex (PMv), primary motor cortex (M1), and supplementary motor area (SMA). Pre-processing was carried out on SPM12 and connectivity analyses were performed using CONN-toolbox, controlling for age, sex, and lesion volume. Group analysis showed a significant increase in interhemispheric M1–M1 connectivity from 3 weeks to 6 months, indicating strengthening bilateral motor connectivity during recovery. Early rsFC patterns predicted 6-month visuomotor performance: stronger early coupling of left SMA-right medial orbital gyrus, of right M1–right cerebellum, and right CIPS-left temporal pole was associated with poorer performance, while stronger right M1–precentral gyrus connectivity related to improved outcomes. These findings highlight a differential role of parieto-frontal and motor network interactions in shaping recovery and suggest that early rsFC markers may have prognostic and therapeutic value for individualized post-stroke rehabilitation.