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Motor recovery from constraint induced movement therapy is not constrained by extent of tissue damage following stroke.

Published on Jan 1, 2014in Restorative Neurology and Neuroscience1.839
· DOI :10.3233/RNN-130366
Lynne V. Gauthier13
Estimated H-index: 13
,
Victor W. Mark23
Estimated H-index: 23
+ 5 AuthorsGitendra Uswatte40
Estimated H-index: 40
Abstract
Purpose: The purpose of this study was to delineate the relationship between several types of T1-weighted MRI pathology and motor rehabilitation potential following Constraint Induced Movement therapy (CI therapy) in chronic stroke. Methods: Stepwise regression was employed (n= 80) to identify predictors of motor recovery (prior to therapy) and of response to Constraint-Induced Movement therapy [measured via the Wolf Motor Function Test (WMFT) and Motor Activity Log (MAL)] from among the following: age, side of motor deficit, chronicity, gender, lesion volume, peri-infarct damage volume, white matter hypointensity volume, ventricular asymmetry, and lesion location. Results: Although extent of total stroke damage weakly correlated with poorer performance on the WMFT prior to therapy, this relationship was mediated by the location of the damage. No metric of tissue damage examined here was associated with real-world arm use at baseline (MAL at pre-treatment) or with CI therapy-induced improvement in either best motor performance upon request (WMFT) or spontaneous arm use for daily activities (MAL). Conclusions: In sum, the extent of brain tissue damage of any type examined here poorly predicted motor function and response to rehabilitation in chronic stroke.
  • References (41)
  • Citations (6)
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References41
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#1Qin Jin (Soochow University (Suzhou))H-Index: 1
#2Jian Cheng (Soochow University (Suzhou))H-Index: 12
Last. Xuechu Zhen (Soochow University (Suzhou))H-Index: 25
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Abstract Acute AMPK activation exacerbates ischemic brain damage experimentally. Paradoxically, the clinical use of an AMPK activator metformin reduces the incidence of stroke. We investigated whether post-stroke chronic metformin treatment promotes functional recovery and tissue repair via an M2-polarization mechanism following experimental stroke. Mice were randomly divided to receive metformin or vehicle daily beginning at 24 h after middle cerebral artery occlusion (MCAO). Neurological defic...
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#1Tyler Rickards (UAB: University of Alabama at Birmingham)H-Index: 4
#2Chelsey Sterling (UAB: University of Alabama at Birmingham)H-Index: 3
Last. Gitendra Uswatte (UAB: University of Alabama at Birmingham)H-Index: 40
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Abstract 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. Design Study 1 used a multiple-baseline pre-post design. Study 2 was a randomized controlled trial. Setting Outpatient rehabilitation laboratory. Participants Study 1 included children with hemiparetic CP (n=10; mean age ± SD,...
26 CitationsSource
#1Armin SchneiderH-Index: 32
#2Andreas Rogalewski (Bethel University)H-Index: 1
Last. Wolf-Rüdiger Schäbitz (Bethel University)H-Index: 6
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Background and purpose Both the immobilization of the unaffected arm combined with physical therapy (forced arm use, FAU) and voluntary exercise (VE) as model for enriched environment are promising approaches to enhance recovery after stroke. The genomic mechanisms involved in long-term plasticity changes after different means of rehabilitative training post-stroke are largely unexplored. The present investigation explored the effects of these physical therapies on behavioral recovery and molecu...
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#1Anita Choudhary (AIIMS: All India Institute of Medical Sciences)H-Index: 5
#2Sheffali Gulati (AIIMS: All India Institute of Medical Sciences)H-Index: 21
Last. Veena Kalra (AIIMS: All India Institute of Medical Sciences)H-Index: 19
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Purpose: The objective of this randomized single blind (outcome assessor) controlled trial was to evaluate the efficacy of 4 weeks of modified constraint induced movement therapy (mCIMT) in improving upper limb function in 3–8 years old children with hemiplegic cerebral palsy. Methods: Thirty-one children were randomly assigned to receive the mCIMT (N = 16) with conventional therapy or conventional therapy alone (N = 15). Children were evaluated three times (at enrollment, follow up at 4 weeks a...
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#1Edward Taub (UAB: University of Alabama at Birmingham)H-Index: 77
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Background and Purpose— Constraint-induced movement therapy is a set of treatments for rehabilitating motor function after central nervous system damage. We assessed the roles of its 2 main components. Methods— A 2×2 factorial components analysis with random assignment was conducted. The 2 factors were type of training and presence/absence of a set of techniques to facilitate transfer of therapeutic gains from the laboratory to the life situation (Transfer Package; TP). Participants (N=40) were ...
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#1Stephen J. Page (OSU: Ohio State University)H-Index: 32
#2Lynne V. Gauthier (OSU: Ohio State University)H-Index: 13
Last. Susan White (OSU: Ohio State University)H-Index: 15
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#1Chelsey SterlingH-Index: 3
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from the present laboratory with adult stroke patients showed that structural neuroplastic changes are correlated with clinical improvements due to constraint-induced movement (CI) ther- apy. This pilot study evaluated whether comparable changes occur in children receiving CI therapy. Ten children (6 boys) with congenital hemiparesis (mean age: 3 years, 3 months) underwent MRI scans 3 weeks before, immediately before, and immediately after receiving 3 weeks of CI therapy. Longitudinal voxel-base...
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Damage to the corticospinal tract is a leading cause of motor disability, for example in stroke or spinal cord injury. Some function usually recovers, but whether plasticity of undamaged ipsilaterally descending corticospinal axons and/or brainstem pathways such as the reticulospinal tract contributes to recovery is unknown. Here, we examined the connectivity in these pathways to motor neurons after recovery from corticospinal lesions. Extensive unilateral lesions of the medullary corticospinal ...
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Electrophysiological and neuroimaging studies suggest that the integrity of ipsilesional and inter-hemispheric motor circuits is important for motor recovery after stroke. However, the extent to which each of these tracts contributes to the variance in outcome remains unclear. We examined whether diffusion tensor imaging (DTI)-derived measures of corticospinal and transcallosal tracts predict motor improvement in an experimental neurorehabilitation trial. 15 chronic stroke patients received bihe...
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#1Jeff D. RileyH-Index: 4
#2Vu LeH-Index: 13
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Background and Purpose—Many therapies are emerging that aim to improve motor function in people with stroke. Identifying key biological substrates needed for treatment gains would help to predict treatment effects and to maximize treatment impact. The current study addressed the hypothesis that behavioral gains from therapy targeting distal upper extremity are predicted by the structural integrity of key motor system white matter tracts. Methods—Twenty-three subjects with chronic left-sided stro...
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#2Leiv M. Hove (University of Bergen)H-Index: 20
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Background. Developmental cortical plasticity with reorganization of cerebral cortex, has been known to occur in young and adult animals after permanent, restricted elimination of afferent (visual or somatosensory) input. In animals, cortical representation of unaffected muscles or sensory areas has been shown to invade the neighboring cortex when this is deprived of its normal sensory input or motor functions. Some studies indicate that similar cortical plasticity may take place in adult humans...
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BACKGROUND:Infarct size and location account for only a relatively small portion of post-stroke motor impairment, suggesting that other less obvious factors may be involved. OBJECTIVE:Examine the relationship between white matter hyperintensity (WMH) load among other factors and upper extremity motor deficit in patients with mild to moderate chronic stroke. METHODS:The magnetic resonance images of 28 patients were studied. WMH load was assessed as total WMH volume and WMH overlap with the cortic...
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BACKGROUND: Hemiparesis is one of the most prevalent chronic disabilities after stroke. Biochemical and structural magnetic resonance imaging approaches may be employed to study the neural substrates underpinning upper-extremity (UE) recovery after chronic stroke. OBJECTIVE: The purposes of this study were to 1) quantify anatomical and metabolic differences in the precentral gyrus, and 2) test the relationships between anatomical and metabolic differences, and hemiparetic arm function in individ...
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Abstract. Patients with chronic stroke were given Constraint-Induced Movement Therapy (CIMT) over an intensive two-week course of treatment. The intervention resulted in a large improvement in use of the more-affected upper extremity in the laboratory and in the real-world environment. High-resolution electroencephalography (EEG) showed that the treatment produced marked changes in cortical activity that correlated with the significant rehabilitative effects. Repetitive unilateral self-paced vol...
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Background Perinatal stroke occurs in more than 1 in 2,500 live births and resultant congenital hemiparesis necessitates investigation into interventions which may improve long-term function and decreased burden of care beyond current therapies (http://www.cdc.gov/ncbddd/cp/data.html). Constraint-Induced Movement Therapy (CIMT) is recognized as an effective hemiparesis rehabilitation intervention . Transcranial direct current stimulation as an adjunct treatment to CIMT may potentiate neuroplasti...
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