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Constraint-Induced Movement Therapy Results in Increased Motor Map Area in Subjects 3 to 9 Months After StrokeDepartment of Neurology, Program in Rehabilitation, Wake Forest University, Winston Salem, North Carolina, lumy.sawaki{at}uky.edu
Atlanta VAMC Rehabilitation R&D Center of Excellence in Rehabilitation of Aging Veterans with Vision Loss, Decatur, Georgia, Department of Rehabilitation Medicine, School of Medicine, Emory University, Atlanta, Georgia
Department of Neurology, Program in Rehabilitation, Wake Forest University, Winston Salem, North Carolina
Department of Radiology, The Ohio State University, Columbus, Ohio, School of Allied Medical Professions, The Ohio State University, Columbus, Ohio (PAW, DSN-L);
Department of Neurology, The Ohio State University, Columbus, Ohio
Department of Rehabilitation Medicine, School of Medicine, Emory University, Atlanta, Georgia
Department of Neurology, School of Medicine, Emory University, Atlanta, Georgia, Atlanta VAMC Rehabilitation R&D Center of Excellence in Rehabilitation of Aging Veterans with Vision Loss, Decatur, Georgia, Department of Rehabilitation Medicine, School of Medicine, Emory University, Atlanta, Georgia
School of Allied Medical Professions, The Ohio State University, Columbus, Ohio (PAW, DSN-L);
Atlanta VAMC Rehabilitation R&D Center of Excellence in Rehabilitation of Aging Veterans with Vision Loss, Decatur, Georgia, Department of Rehabilitation Medicine, School of Medicine, Emory University, Atlanta, Georgia, School of Allied Medical Professions, The Ohio State University, Columbus, Ohio (PAW, DSN-L);
Department of Neurology, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania, Department of Neurology, Program in Rehabilitation, Wake Forest University, Winston Salem, North Carolina
VAMHCS, Geriatrics Research, Education, and Clinical Center, Baltimore, Maryland, Department of Neurology, Program in Rehabilitation, Wake Forest University, Winston Salem, North Carolina Background. Constraint-induced movement therapy (CIMT) has received considerable attention as an intervention to enhance motor recovery and cortical reorganization after stroke. Objective. The present study represents the first multi-center effort to measure cortical reorganization induced by CIMT in subjects who are in the subacute stage of recovery. Methods. A total of 30 stroke subjects in the subacute phase (>3 and <9 months poststroke) were recruited and randomized into experimental (receiving CIMT immediately after baseline evaluation) and control (receiving CIMT after 4 months) groups. Each subject was evaluated using transcranial magnetic stimulation (TMS) at baseline, 2 weeks after baseline, and at 4-month follow-up (ie, after CIMT in the experimental groups and before CIMT in the control groups). The primary clinical outcome measure was the Wolf Motor Function Test. Results. Both experimental and control groups demonstrated improved hand motor function 2 weeks after baseline. The experimental group showed significantly greater improvement in grip force after the intervention and at follow-up (P = .049). After adjusting for the baseline measures, the experimental group had an increase in the TMS motor map area compared with the control group over a 4-month period; this increase was of borderline significance (P = .053). Conclusions. Among subjects who had a stroke within the previous 3 to 9 months, CIMT produced statistically significant and clinically relevant improvements in arm motor function that persisted for at least 4 months. The corresponding enlargement of TMS motor maps, similar to that found in earlier studies of chronic stroke subjects, appears to play an important role in CIMT-dependent plasticity.
Key Words: Plasticity • Recovery • Transcranial magnetic stimulation • Upper extremity.
Neurorehabilitation and Neural Repair, Vol. 22, No. 5,
505-513 (2008) This article has been cited by other articles:
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