title: Constraint-induced movement therapy results in increased motor map area in subjects 3 to 9 months after stroke.
abstract: 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.
authors.affiliation: Department of Neurology, Wake Forest University, Winston Salem, North Carolina, USA. lumy.sawaki@uky.edu
authors.forename: Lumy
authors.initials: L
authors.lastname: Sawaki
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Butler
authors.forename: Xiaoyan
authors.initials: X
authors.lastname: Leng
authors.forename: Peter A
authors.initials: PA
authors.lastname: Wassenaar
authors.forename: Yousef M
authors.initials: YM
authors.lastname: Mohammad
authors.forename: Sarah
authors.initials: S
authors.lastname: Blanton
authors.forename: K
authors.initials: K
authors.lastname: Sathian
authors.forename: Deborah S
authors.initials: DS
authors.lastname: Nichols-Larsen
authors.forename: Steven L
authors.initials: SL
authors.lastname: Wolf
authors.forename: David C
authors.initials: DC
authors.lastname: Good
authors.forename: George F
authors.initials: GF
authors.lastname: Wittenberg
mesh_terms: D001931:Brain Mapping; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009043:Motor Activity / Q000502:physiology; D009044:Motor Cortex / Q000503:physiopathology*; D020127:Recovery of Function; D012149:Restraint, Physical; D020521:Stroke / Q000503:physiopathology; D000071939:Stroke Rehabilitation; D013997:Time Factors; D016896:Treatment Outcome
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