Diffusion tensor imaging study of the response to constraint-induced movement therapy of children with hemiparetic cerebral palsy and adults with chronic stroke.
OBJECTIVE
To investigate the relationship of white matter integrity and path of the corticospinal tract (CST) on arm function before and after constraint-induced (CI) movement therapy in children with hemiparetic cerebral palsy (CP) and adults with chronic stroke.


METHODS
Study 1 used a multiple-baseline pre-post design. Study 2 was a randomized controlled trial.


METHODS
Outpatient rehabilitation laboratory.


METHODS
Study 1 included children with hemiparetic CP (n=10; mean age ± SD, 3.2±1.7y). Study 2 included adults with chronic stroke (n=26; mean age ± SD, 65.4±13.6y) who received either CI therapy or a comparison therapy.


METHODS
Children in study 1 received CI therapy for 3.5h/d for 15 consecutive weekdays. Adults in study 2 received either CI therapy or a comparison therapy for 3.5h/d for 10 consecutive weekdays.


METHODS
Diffusion tensor imaging was performed to quantify white matter integrity. Motor ability was assessed in children using the Pediatric Motor Activity Log-Revised and Pediatric Arm Function Test, and in adults with the Motor Activity Log and Wolf Motor Function Test.


RESULTS
Participants in both studies improved in real-world arm function and motor capacity. Children and adults with disrupted/displaced CSTs and children with reduced fractional anisotropy values were worse on pretreatment tests of motor function than participants with unaltered CSTs. However, neither integrity (fractional anisotropy) nor distorted or disrupted path of the CST affected motor improvement after treatment.


CONCLUSIONS
Participants who had reduced integrity, displacement, or interruption of their CST performed worse on pretreatment motor testing. However, this had no effect on their ability to benefit from CI therapy. The results for children and adults are consistent with one another.
Department of Psychology, University of Alabama at Birmingham, Birmingham, AL.
Tyler
T
Rickards
Department of Psychology, University of Alabama at Birmingham, Birmingham, AL.
Chelsey
C
Sterling
Department of Psychology, University of Alabama at Birmingham, Birmingham, AL. Electronic address: etaub@uab.edu.
Edward
E
Taub
Department of Psychology, LaGrange College, LaGrange, GA.
Christi
C
Perkins-Hu
Department of Physical Medicine and Rehabilitation, Ohio State University, Columbus, OH.
Lynne
L
Gauthier
Department of Psychology, University of Alabama at Birmingham, Birmingham, AL.
Michael
M
Graham
Physical Therapy and Occupational Therapy Department, Children's of Alabama, Birmingham, AL.
Angi
A
Griffin
Department of Pediatrics, Division of Pediatric Rehabilitation Medicine, University of Alabama at Birmingham, Birmingham, AL.
Drew
D
Davis
Department of Psychology, University of Alabama at Birmingham, Birmingham, AL; Department of Physical Medicine and Rehabilitation, University of Alabama at Birmingham, Birmingham, AL; Department of Neurology, University of Alabama at Birmingham, Birmingham, AL.
Victor W
VW
Mark
Department of Psychology, University of Alabama at Birmingham, Birmingham, AL; Department of Physical Therapy, University of Alabama at Birmingham, Birmingham, AL.
Gitendra
G
Uswatte
D000368:Aged; D002547:Cerebral Palsy / Q000150:complications / Q000503:physiopathology / Q000534:rehabilitation*; D002675:Child, Preschool; D002908:Chronic Disease; D056324:Diffusion Tensor Imaging; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010291:Paresis / Q000209:etiology / Q000503:physiopathology / Q000534:rehabilitation*; D026741:Physical Therapy Modalities; D011712:Pyramidal Tracts / Q000503:physiopathology; D020521:Stroke / Q000150:complications / Q000503:physiopathology; D000071939:Stroke Rehabilitation
Cerebral palsy; Corticospinal tracts; Diffusion tensor imaging; Hemiparesis; Rehabilitation; Stroke