Improvement after constraint-induced movement therapy is independent of infarct location in chronic stroke patients.
OBJECTIVE
Disruption of the corticospinal tract at various locations in the brain has been shown to predict worse spontaneous motor recovery after stroke. However, the anatomic specificity of previous findings was limited by the categorical classification of infarct locations. Here we used computational methods to more precisely determine the specific anatomic locations associated with impaired motor ability. More important, however, our study also used these techniques to evaluate whether infarct location could influence motor outcomes after Constraint-Induced Movement therapy (CI therapy), a specific and controlled form of physical therapy.


METHODS
Quantitative voxel-based analyses were used to determine whether infarct location could predict either initial motor ability or clinical improvement after CI therapy in chronic stroke patients.


RESULTS
Although corona radiata infarcts were associated with worse in-laboratory motor ability at pretreatment, infarct location did not predict improvement in either the laboratory or the life situation after CI therapy.


CONCLUSIONS
The extent of improvement from CI therapy does not depend on the location of neurological damage, despite there being a pretreatment relationship between infarct location and in-laboratory motor ability. This dissociation could be explained by brain plasticity induced by CI therapy.
Gauthier
Lynne V
LV
Department of Psychology, University of Alabama at Birmingham, Birmingham, AL 35294, USA. lynnevg@uab.edu
Taub
Edward
E
Mark
Victor W
VW
Perkins
Christi
C
Uswatte
Gitendra
G
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001921:Brain / Q000473:pathology / Q000503:physiopathology; D002544:Cerebral Infarction / Q000175:diagnosis* / Q000473:pathology / Q000534:rehabilitation*; D002908:Chronic Disease; D003936:Diagnosis, Computer-Assisted / Q000379:methods; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009043:Motor Activity / Q000502:physiology; D026741:Physical Therapy Modalities; D011379:Prognosis; D020127:Recovery of Function / Q000502:physiology; D012189:Retrospective Studies; D020521:Stroke / Q000175:diagnosis* / Q000473:pathology; D000071939:Stroke Rehabilitation; D016896:Treatment Outcome