Constraint-induced therapy versus control intervention in patients with stroke: a functional magnetic resonance imaging study.
OBJECTIVE
This study compared the effects of a distributed form of constraint-induced therapy with control intervention in motor recovery and brain reorganization after stroke.


METHODS
A two-group randomized controlled trial with pretreatment and posttreatment measures was conducted. Thirteen patients with stroke were randomly assigned to the distributed form of constraint-induced therapy (n = 5) or the control intervention group (n = 8). Outcome measures included the Fugl-Meyer Assessment, the Motor Activity Log, and functional magnetic resonance imaging examination. The number of activation voxels and laterality index were determined from the functional magnetic resonance imaging data for the study of brain reorganization.


RESULTS
The distributed form of constraint-induced therapy group exhibited significantly greater improvements in the Fugl-Meyer Assessment and Motor Activity Log than the control intervention group. The functional magnetic resonance imaging data showed that distributed form of constraint-induced therapy significantly increased activation in the contralesional hemisphere during movement of the affected and unaffected hand. The control intervention group showed a decrease in primary sensorimotor cortex activation of the ipsilesional hemisphere during movement of the affected hand.


CONCLUSIONS
The preliminary findings indicate that brain adaptation may be modulated by specific rehabilitation practices, although generalization of the functional magnetic resonance imaging findings is limited by sample size. Further research is needed to identify the specific neural correlates of the behavioral gains achieved after rehabilitation therapies.
Lin
Keh-Chung
KC
School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan.
Chung
Hsin-Ying
HY
Wu
Ching-Yi
CY
Liu
Ho-Ling
HL
Hsieh
Yu-Wei
YW
Chen
I-Hsuan
IH
Chen
Chia-Ling
CL
Chuang
Li-Ling
LL
Liu
Jung-Sen
JS
Wai
Yau-Yau
YY
D000203:Activities of Daily Living; D001921:Brain / Q000473:pathology*; D004185:Disability Evaluation; D004292:Dominance, Cerebral; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009044:Motor Cortex / Q000473:pathology; D009068:Movement; D012149:Restraint, Physical; D013003:Somatosensory Cortex / Q000473:pathology; D000071939:Stroke Rehabilitation