title: Cortical reorganization following modified constraint-induced movement therapy: a study of 4 patients with chronic stroke.
abstract: OBJECTIVE
  To determine whether cortical changes occur following participation in a program of modified constraint-induced movement therapy (mCIMT).
  
  
  METHODS
  Pre-post, case series.
  
  
  METHODS
  Outpatient rehabilitation hospital.
  
  
  METHODS
  Two men and 2 women with unilateral stroke occurring more than 1 year prior to study entry and moderate stable motor deficits.
  
  
  METHODS
  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.
  
  
  METHODS
  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.
authors.affiliation: Department of Neurology, University of Cincinnati Medical Center, OH 45267, USA.
authors.forename: Jerzy P
authors.initials: JP
authors.lastname: Szaflarski
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Page
authors.forename: Brett M
authors.initials: BM
authors.lastname: Kissela
authors.forename: Jing-Huei
authors.initials: JH
authors.lastname: Lee
authors.forename: Peter
authors.initials: P
authors.lastname: Levine
authors.forename: Stephen M
authors.initials: SM
authors.lastname: Strakowski
mesh_terms: D000328:Adult; D000368:Aged; D001132:Arm / Q000503:physiopathology*; D001931:Brain Mapping; D002908:Chronic Disease; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D026741:Physical Therapy Modalities; D020127:Recovery of Function; D020521:Stroke / Q000503:physiopathology; D000071939:Stroke Rehabilitation