Functional MRI evidence of cortical reorganization in upper-limb stroke hemiplegia treated with constraint-induced movement therapy.
OBJECTIVE
The purpose of this pilot study was to test constraint-induced movement therapy for chronic upper-limb stroke hemiparesis and to investigate the neural correlates of recovery with functional magnetic resonance imaging (MRI) in two subjects. Both subjects had been discharged from traditional therapy because no further improvement was anticipated.


METHODS
Constraint-induced movement therapy consisted of 6 hr of daily upper-limb training for 2 wk; a restrictive mitt was worn on the nonparetic limb during waking hours. Functional MRI was performed on a 1.5-T MRI with echo-planar imaging; at the same time, the subjects attempted sequential finger-tapping.


RESULTS
Compared with baseline, performance time improved an average of 24% immediately after training and also continued to improve up to 33% 3 mo after training. Lift, grip strength, and Motor Activity Log scores likewise improved. Initially, on functional MRI, subject 1 activated scattered regions in the ipsilateral posterior parietal and occipital cortices. Subject 2 showed almost no areas of significant activation. After training, subject 1 showed activity bordering the lesion, bilateral activation in the association motor cortices, and ipsilateral activation in the primary motor cortex. Subject 2 showed activation near the lesion site.


CONCLUSIONS
Constraint-induced movement therapy produced significant functional improvement and resulted in plasticity as demonstrated by functional MRI.
Levy
C E
CE
North Florida/South Georgia Veteran's Health System and the Department of Orthopaedics and Rehabilitation, the University of Florida, Gainesville 32608, USA.
Nichols
D S
DS
Schmalbrock
P M
PM
Keller
P
P
Chakeres
D W
DW
D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D006429:Hemiplegia / Q000473:pathology / Q000503:physiopathology / Q000534:rehabilitation*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009044:Motor Cortex / Q000473:pathology / Q000503:physiopathology*; D009048:Motor Skills / Q000502:physiology; D009473:Neuronal Plasticity; D010865:Pilot Projects; D020521:Stroke / Q000473:pathology* / Q000503:physiopathology; D000071939:Stroke Rehabilitation