Cortical Reorganization Following Modified Constraint-Induced Movement Therapy: A Study of 4 Patients With Chronic Stroke
Presented in part to the 30th International Stroke Conference, February 2005, New Orleans, LA.
Accepted 13 April 2006.
Abstract
Szaflarski JP, Page SJ, Kissela BM, Lee J-H, Levine P, Strakowski SM. Cortical reorganization following modified constraint-induced movement therapy: a study of 4 patients with chronic stroke.
Objective
To determine whether cortical changes occur following participation in a program of modified constraint-induced movement therapy (mCIMT).
Design
Pre-post, case series.
Setting
Outpatient rehabilitation hospital.
Participants
Two men and 2 women with unilateral stroke occurring more than 1 year prior to study entry and moderate stable motor deficits.
Intervention
Subjects participated in mCIMT, comprised of structured, 30-minute therapy sessions emphasizing affected arm use in valued activities, which occurred 3 days a week for 10 weeks. Their unaffected arms were restrained 5 days a week for 5 hours.
Main Outcome Measures
The Action Research Arm Test (ARAT), upper-extremity portion of the Fugl-Meyer Assessment (FMA), Motor Activity Log (MAL), and functional magnetic resonance imaging (fMRI) at 4T were administered before and after mCIMT.
Results
Three subjects exhibited score increases on the MAL, ARAT, and FMA, representing increased affected arm use, impairment, and function. These subjects reported new ability to perform valued activities with the affected hand, such as writing. These subjects also displayed cortical reorganization on fMRI. One subject exhibited minimal affected arm use changes, modest function changes, and no cortical fMRI changes.
Conclusions
Increased affected arm use during mCIMT appears to induce cortical reorganization, as measured by fMRI. In patients who responded to mCIMT, cortical reorganization was positively related to degree of increase in affected arm use and ability. Because mCIMT is more easily administered than longer duration protocols, mCIMT may be a more practicable way of studying plasticity.
aDepartment of Neurology, University of Cincinnati Medical Center, Cincinnati, OH
bCenter for Imaging Research, University of Cincinnati Medical Center, Cincinnati, OH
cDepartment of Physical Medicine and Rehabilitation, University of Cincinnati Medical Center, Cincinnati, OH
dNeuromotor Recovery and Rehabilitation Laboratory, Drake Rehabilitation Center, Cincinnati, OH
eDepartment of Biomedical Engineering, University of Cincinnati College of Medicine, Cincinnati, OH
Reprint requests to Stephen J. Page, PhD, Dept of Physical Medicine and Rehabilitation, University of Cincinnati College of Medicine, 3202 Eden Ave, Ste 275, Cincinnati, OH 45267
Supported by the Neuroscience Institute, Cincinnati, OH.
No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the authors or upon any organization with which the authors are associated.
ABSTRACT