title: Differential patterns of cortical reorganization following constraint-induced movement therapy during early and late period after stroke: A preliminary study.
abstract: OBJECTIVE
  Constraint-induced movement therapy (CIMT) has been shown to improve upper extremity voluntary movement and change cortical movement representation after stroke. Direct comparison of the differential degree of cortical reorganization according to chronicity in stroke subjects receiving CIMT has not been performed and was the purpose of this study. We hypothesized that a higher degree of cortical reorganization would occur in the early (less than 9 months post-stroke) compared to the late group (more than 12 months post-stroke).
  
  
  METHODS
  17 early and 9 late subjects were enrolled. Each subject was evaluated using transcranial magnetic stimulation (TMS) and the Wolf Motor Function Test (WMFT) and received CIMT for 2 weeks.
  
  
  RESULTS
  The early group showed greater improvement in WMFT compared with the late group. TMS motor maps showed persistent enlargement in both groups but the late group trended toward more enlargement. The map shifted posteriorly in the late stroke group. The main limitation was the small number of TMS measures that could be acquired due to high motor thresholds, particularly in the late group.
  
  
  CONCLUSIONS
  CIMT appears to lead to greater improvement in motor function in the early phase after stroke. Greater cortical reorganization in map size and position occurred in the late group in comparison.
  
  
  CONCLUSIONS
  The contrast between larger functional gains in the early group vs larger map changes in the late group may indicate that mechanisms of recovery change over the several months following stroke or that map changes are a time-dependent epiphenomenon.
authors.affiliation: Department of Neurology, Program in Rehabilitation, Wake Forest University, Winston Salem, NC, USA Department of Physical Medicine and Rehabilitation, University of Kentucky, Lexington, KY, USA.
authors.forename: Lumy
authors.initials: L
authors.lastname: Sawaki
authors.affiliation: Emory University, School of Medicine, Department of Rehabilitation Medicine, Atlanta, GA, USA Atlanta VAMC Rehabilitation R&D Center of Excellence in Rehabilitation of Aging Veterans with Vision Loss, Decatur, GA, USA.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Butler
authors.affiliation: Department of Neurology, Program in Rehabilitation, Wake Forest University, Winston Salem, NC, USA.
authors.forename: Xiaoyan
authors.initials: X
authors.lastname: Leng
authors.affiliation: Department of Radiology, The Ohio State University, Columbus, OH, USA.
authors.forename: Peter A
authors.initials: PA
authors.lastname: Wassenaar
authors.affiliation: Department of Neurology, The Ohio State University, Columbus, OH, USA.
authors.forename: Yousef M
authors.initials: YM
authors.lastname: Mohammad
authors.affiliation: Emory University, School of Medicine, Department of Rehabilitation Medicine, Atlanta, GA, USA.
authors.forename: Sarah
authors.initials: S
authors.lastname: Blanton
authors.affiliation: Emory University, School of Medicine, Department of Rehabilitation Medicine, Atlanta, GA, USA Atlanta VAMC Rehabilitation R&D Center of Excellence in Rehabilitation of Aging Veterans with Vision Loss, Decatur, GA, USA Emory University, School of Medicine, Department of Neurology, Atlanta, GA, USA.
authors.forename: K
authors.initials: K
authors.lastname: Sathian
authors.affiliation: The Ohio State University, School of Allied Medical Professions, Columbus, OH, USA.
authors.forename: Deborah S
authors.initials: DS
authors.lastname: Nichols-Larsen
authors.affiliation: Emory University, School of Medicine, Department of Rehabilitation Medicine, Atlanta, GA, USA Atlanta VAMC Rehabilitation R&D Center of Excellence in Rehabilitation of Aging Veterans with Vision Loss, Decatur, GA, USA.
authors.forename: Steven L
authors.initials: SL
authors.lastname: Wolf
authors.affiliation: Department of Neurology, Program in Rehabilitation, Wake Forest University, Winston Salem, NC, USA Penn State Milton S. Hershey Medical Center, Department of Neurology, Hershey, PA, USA.
authors.forename: David C
authors.initials: DC
authors.lastname: Good
authors.affiliation: Department of Neurology, Program in Rehabilitation, Wake Forest University, Winston Salem, NC, USA VAMHCS, Geriatrics Research, Education, and Clinical Center, and University of Maryland, Department of Neurology, Baltimore, MD, USA.
authors.forename: George F
authors.initials: GF
authors.lastname: Wittenberg
mesh_terms: D001931:Brain Mapping; D002540:Cerebral Cortex / Q000503:physiopathology*; D004576:Electromyography; D005260:Female; D007839:Functional Laterality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009044:Motor Cortex / Q000503:physiopathology; D009048:Motor Skills; D009068:Movement; D011597:Psychomotor Performance; D011999:Recruitment, Neurophysiological; D020521:Stroke / Q000503:physiopathology*; D000071939:Stroke Rehabilitation; D050781:Transcranial Magnetic Stimulation; D034941:Upper Extremity / Q000503:physiopathology
keywords: Plasticity; motor; recovery; transcranial magnetic stimulation; upper extremity