|
Sign In to gain access to subscriptions and/or personal tools.
|
Motor Recovery and Cortical Reorganization after Constraint-Induced Movement Therapy in Stroke Patients: A Preliminary Study
Judith D. Schaechter
Massachusetts General Hospital-NMR Center, Department of Radiology, Charlestown, MA
Eduard Kraft
University of Ulm Medical School, Ulm, Germany
Timothy S. Hilliard
Northeastern University, Department of Physical Therapy, Boston
Rick M. Dijkhuizen
Massachusetts General Hospital-NMR Center, Department of Radiology, Charlestown, MA
Thomas Benner
Massachusetts General Hospital-NMR Center, Department of Radiology, Charlestown, MA
Seth P. Finklestein
Massachusetts General Hospital, Department of Neurology, Boston
Bruce R. Rosen
Massachusetts General Hospital-NMR Center, Department of Radiology, Charlestown, MA
Steven C. Cramer
University of Washington, Department of Neurology, Seattle, WA
Constraint-induced movement therapy (CIMT) is a physical rehabilitation regime that has been previously shown to improve motor function in chronic hemiparetic stroke patients. However, the neural mechanisms supporting rehabilitation-induced motor recovery are poorly understood. The goal of this study was to assess motor cortical reorganization after CIMT using functional magnetic resonance imaging (fMRI). In a repeated-measures design, 4 incompletely recovered chronic stroke patients treated with CIMT underwent motor function testing and fMRI. Five age-matched normal subjects were also imaged. A laterality index (LI) was determined from the fMRI data, reflecting the distribution of activation in motor cortices contralateral compared with ipsilateral to the moving hand. Pre-intervention fMRI showed a lower LI during affected hand movement of stroke patients (LI = 0.23 ± 0.07) compared to controls (LI unaffected patient hand = 0.65 ± 0.10; LI dominant normal hand = 0.65 ± 0.11; LI nondominant normal hand = 0.69 ± 0.11; P < 0.05) due to trends toward increased ipsilateral motor cortical activation. Motor function testing showed that patients made significant gains in functional use of the stroke-affected upper extremity (detected by the Motor Activity Log) and significant reductions in motor impairment (detected by the Fugl-Meyer Stroke Scale and the Wolf Motor Function Test) immediately after CIMT, and these effects persisted at 6-month follow-up. The behavioral effects of CIMT were associated with a trend toward a reduced LI from pre-intervention to immediately post-intervention (LI = -0.01 ± 0.06; P = 0.077) and 6 months post-intervention (LI = -0.03 ± 0.15). Stroke-affected hand movement was not accompanied by mirror movements during fMRI, and electromyographic measures of mirror recruitment under simulated fMRI conditions were not correlated with LI values. These data provide preliminary evidence that gains in motor function produced by CIMT in chronic stroke patients may be associated with a shift in laterality of motor cortical activation toward the undamaged hemisphere.
Key Words: Stroke • Hemiparesis • Rehabilitation • Magnetic resonance imaging • Motor cortex
Neurorehabilitation and Neural Repair, Vol. 16, No. 4,
326-338 (2002)
DOI: 10.1177/154596830201600403
 CiteULike  Complore  Connotea  Del.icio.us  Digg  Reddit  Technorati  Twitter What's this?
This article has been cited by other articles:
|
|
|
|
 
T. L. Sutcliffe, W. J. Logan, and D. L. Fehlings
Pediatric Constraint-Induced Movement Therapy Is Associated With Increased Contralateral Cortical Activity on Functional Magnetic Resonance Imaging
J Child Neurol,
October 1, 2009;
24(10):
1230 - 1235.
[Abstract]
[PDF]
|
|
|
|
|
|
|
M. D. Ellis, T. Sukal-Moulton, and J. P. A. Dewald
Progressive Shoulder Abduction Loading is a Crucial Element of Arm Rehabilitation in Chronic Stroke
Neurorehabil Neural Repair,
October 1, 2009;
23(8):
862 - 869.
[Abstract]
[PDF]
|
|
|
|
|
|
|
C. Enzinger, H. Dawes, H. Johansen-Berg, D. Wade, M. Bogdanovic, J. Collett, C. Guy, U. Kischka, S. Ropele, F. Fazekas, et al.
Brain Activity Changes Associated With Treadmill Training After Stroke
Stroke,
July 1, 2009;
40(7):
2460 - 2467.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
K.-c. Lin, Y.-f. Chang, C.-y. Wu, and Y.-a. Chen
Effects of Constraint-Induced Therapy Versus Bilateral Arm Training on Motor Performance, Daily Functions, and Quality of Life in Stroke Survivors
Neurorehabil Neural Repair,
June 1, 2009;
23(5):
441 - 448.
[Abstract]
[PDF]
|
|
|
|
|
|
|
L. Sawaki, A. J. Butler, Xiaoyan Leng, P. A. Wassenaar, Y. M. Mohammad, S. Blanton, K. Sathian, D. S. Nichols-Larsen, S. L. Wolf, D. C. Good, et al.
Constraint-Induced Movement Therapy Results in Increased Motor Map Area in Subjects 3 to 9 Months After Stroke
Neurorehabil Neural Repair,
September 1, 2008;
22(5):
505 - 513.
[Abstract]
[PDF]
|
|
|
|
|
|
|
L. V. Gauthier, E. Taub, C. Perkins, M. Ortmann, V. W. Mark, and G. Uswatte
Remodeling the Brain: Plastic Structural Brain Changes Produced by Different Motor Therapies After Stroke * Supplemental Material
Stroke,
May 1, 2008;
39(5):
1520 - 1525.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. Dechaumont-Palacin, P. Marque, X. De Boissezon, E. Castel-Lacanal, C. Carel, I. Berry, J. Pastor, J.F. Albucher, F. Chollet, and I. Loubinoux
Neural Correlates of Proprioceptive Integration in the Contralesional Hemisphere of Very Impaired Patients Shortly After a Subcortical Stroke: An fMRI Study
Neurorehabil Neural Repair,
April 1, 2008;
22(2):
154 - 165.
[Abstract]
[PDF]
|
|
|
|
|
|
|
S. T. Carmichael
Themes and Strategies for Studying the Biology of Stroke Recovery in the Poststroke Epoch
Stroke,
April 1, 2008;
39(4):
1380 - 1388.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
Y. Murata, N. Higo, T. Oishi, A. Yamashita, K. Matsuda, M. Hayashi, and S. Yamane
Effects of Motor Training on the Recovery of Manual Dexterity After Primary Motor Cortex Lesion in Macaque Monkeys
J Neurophysiol,
February 1, 2008;
99(2):
773 - 786.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
I. Loubinoux, S. Dechaumont-Palacin, E. Castel-Lacanal, X. De Boissezon, P. Marque, J. Pariente, J.-F. Albucher, I. Berry, and F. Chollet
Prognostic Value of fMRI in Recovery of Hand Function in Subcortical Stroke Patients
Cereb Cortex,
December 1, 2007;
17(12):
2980 - 2987.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
T. L. Sutcliffe, W. C. Gaetz, W. J. Logan, D. O. Cheyne, and D. L. Fehlings
Cortical Reorganization After Modified Constraint-Induced Movement Therapy in Pediatric Hemiplegic Cerebral Palsy
J Child Neurol,
November 1, 2007;
22(11):
1281 - 1287.
[Abstract]
[PDF]
|
|
|
|
|
|
|
Y. Dong, C. J. Winstein, R. Albistegui-DuBois, and B. H. Dobkin
Evolution of fMRI Activation in the Perilesional Primary Motor Cortex and Cerebellum With Rehabilitation Training-Related Motor Gains After Stroke: A Pilot Study
Neurorehabil Neural Repair,
October 1, 2007;
21(5):
412 - 428.
[Abstract]
[PDF]
|
|
|
|
|
|
|
S. L Wolf
Revisiting Constraint-Induced Movement Therapy: Are We Too Smitten With the Mitten? Is All Nonuse "Learned"? and Other Quandaries
Physical Therapy,
September 1, 2007;
87(9):
1212 - 1223.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. A. Pizzimenti, W. G. Darling, D. L. Rotella, D. W. McNeal, J. L. Herrick, J. Ge, K. S. Stilwell-Morecraft, and R. J. Morecraft
Measurement of Reaching Kinematics and Prehensile Dexterity in Nonhuman Primates
J Neurophysiol,
August 1, 2007;
98(2):
1015 - 1029.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. C. Cramer, T. B. Parrish, R. M. Levy, G. T. Stebbins, S. D. Ruland, D. W. Lowry, T. P. Trouard, S. W. Squire, M. E. Weinand, C. R. Savage, et al.
Predicting Functional Gains in a Stroke Trial
Stroke,
July 1, 2007;
38(7):
2108 - 2114.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. C. Cramer
The EXCITE Trial: A Major Step Forward for Restorative Therapies in Stroke
Stroke,
July 1, 2007;
38(7):
2204 - 2205.
[Full Text]
[PDF]
|
|
|
|
|
|
|
B. H. Dobkin
Confounders in Rehabilitation Trials of Task-Oriented Training: Lessons From the Designs of the EXCITE and SCILT Multicenter Trials
Neurorehabil Neural Repair,
January 1, 2007;
21(1):
3 - 13.
[Abstract]
[PDF]
|
|
|
|
|
|
|
C. Boake, E. A. Noser, T. Ro, S. Baraniuk, M. Gaber, R. Johnson, E. T. Salmeron, T. M. Tran, J. M. Lai, E. Taub, et al.
Constraint-Induced Movement Therapy During Early Stroke Rehabilitation
Neurorehabil Neural Repair,
January 1, 2007;
21(1):
14 - 24.
[Abstract]
[PDF]
|
|
|
|
|
|
|
J. Underwood, P. C Clark, S. Blanton, D. M Aycock, and S. L Wolf
Pain, Fatigue, and Intensity of Practice in People With Stroke Who Are Receiving Constraint-Induced Movement Therapy
Physical Therapy,
September 1, 2006;
86(9):
1241 - 1250.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
B. H. Dobkin
Rehabilitation and Functional Neuroimaging Dose-Response Trajectories for Clinical Trials
Neurorehabil Neural Repair,
December 1, 2005;
19(4):
276 - 282.
[Abstract]
[PDF]
|
|
|
|
|
|
|
M. Rijntjes, V. Hobbeling, F. Hamzei, S. Dohse, G. Ketels, J. Liepert, and C. Weiller
Individual Factors in Constraint-Induced Movement Therapy after Stroke
Neurorehabil Neural Repair,
September 1, 2005;
19(3):
238 - 249.
[Abstract]
[PDF]
|
|
|
|
|
|
|
N S Ward
Mechanisms underlying recovery of motor function after stroke
Postgrad. Med. J.,
August 1, 2005;
81(958):
510 - 514.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
G. Strangman, W. C. Heindel, J. A. Anderson, and J. P. Sutton
Learning Motor Sequences with and without Knowledge of Governing Rules
Neurorehabil Neural Repair,
June 1, 2005;
19(2):
93 - 114.
[Abstract]
[PDF]
|
|
|
|
|
|
|
C. A. Hanlon, A. L.H. Buffington, and M. J. McKeown
New brain networks are active after right MCA stroke when moving the ipsilesional arm
Neurology,
January 11, 2005;
64(1):
114 - 120.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
N. S. Ward and L. G. Cohen
Mechanisms Underlying Recovery of Motor Function After Stroke
Arch Neurol,
December 1, 2004;
61(12):
1844 - 1848.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. Moffat
Braving New Worlds: To Conquer, to Endure
Physical Therapy,
November 1, 2004;
84(11):
1056 - 1086.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. R. Luft, S. McCombe-Waller, J. Whitall, L. W. Forrester, R. Macko, J. D. Sorkin, J. B. Schulz, A. P. Goldberg, and D. F. Hanley
Repetitive Bilateral Arm Training and Motor Cortex Activation in Chronic Stroke: A Randomized Controlled Trial
JAMA,
October 20, 2004;
292(15):
1853 - 1861.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J.-K. Lee, J.-E. Kim, M. Sivula, and S. M. Strittmatter
Nogo Receptor Antagonism Promotes Stroke Recovery by Enhancing Axonal Plasticity
J. Neurosci.,
July 7, 2004;
24(27):
6209 - 6217.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
S.-W. Park, A. J. Butler, V. Cavalheiro, J. L. Alberts, and S. L. Wolf
Changes in Serial Optical Topography and TMS during Task Performance after Constraint-Induced Movement Therapy in Stroke: A Case Study
Neurorehabil Neural Repair,
June 1, 2004;
18(2):
95 - 105.
[Abstract]
[PDF]
|
|
|
|
|
|
|
N. Byl
Dr. Byl Responds
Neurorehabil Neural Repair,
March 1, 2004;
18(1):
9 - 11.
[PDF]
|
|
|
|
|
