Original articleDiffusion Tensor Imaging Study of the Response to Constraint-Induced Movement Therapy of Children With Hemiparetic Cerebral Palsy and Adults With Chronic Stroke
Section snippets
Participants
Ten children between 2 and 8 years of age with hemiparetic CP were recruited from an outpatient CI therapy clinic. Inclusion and exclusion criteria for participation in the 2 studies are detailed in appendix 1. This project was approved by the institutional review board for human research at the University of Alabama at Birmingham. A parent of each participant signed informed consent, and the 7.6-year-old participant signed informed assent. Participants were enrolled from 2009 through 2011.
Procedures
Participant characteristics
Table 1 summarizes patient characteristics. The mean age ± SD was 3.2±1.7 years (range, 2.1–7.6y). Three participants were girls; 2 had greater motor dysfunction on the left side. Three participants had moderate impairment of the more affected arm, 1 had moderate to severe impairment, and 5 had very severe impairment according to the classification system in Taub et al.4
Clinical
As can be seen from table 2, large improvements occurred in both spontaneous real-world arm use, as indicated by scores on the
Participants
Twenty chronic stroke participants older than 44 years with mild to moderate upper extremity hemiparesis (see table 1 in Taub et al37) were recruited from stroke survivors who had contacted our laboratory in response to media coverage and from those referred to our laboratory by clinical personnel at a university medical center. Participants were enrolled from 2006 through 2007.
Procedures
Participants were randomly assigned to receive either CI therapy (n=6) or a comparison therapy (n=10). Four
Participant characteristics
Table 1 summarizes patient characteristics. The mean age was 62.5 years (range, 44–86y). Seven of the participants were men, 6 exhibited right-sided hemiparesis, and 14 were right-hand dominant before stroke.
Clinical
The CI therapy group and the comparison therapy group showed improved arm use for daily activities (MAL score) after treatment (F1,10=109.15, P<.000) (see table 2). However, participants in the CI therapy group showed significantly greater improvement on the MAL than participants in the
Discussion
CI therapy–induced improvement in both spontaneous real-world arm use and maximum motor function made on request in the laboratory was independent of WM integrity (as measured via any of the metrics used here) in both children with hemiparetic CP and adults with chronic hemiparetic stroke. The benefit from CI therapy was also equally great for both children and adults with displaced/disrupted CSTs and those with an unaltered tract. Before treatment, however, both children and adults with a
Conclusions
While children with hemiparetic CP and adults with chronic stroke and with damage to their ipsilesional CST perform worse on pretreatment motor testing, their ability to benefit from CI therapy remains unaffected.
Suppliers
- a.
Philips Healthcare, P.O. Box 10.000, 5680 DA Best, The Netherlands.
- b.
FMRIB Centre, University of Oxford, Dept of Clinical Neurology, John Radcliffe Hospital, Headington, Oxford OX3 9DU, UK.
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White matter integrity of contralesional and transcallosal tracts may predict response to upper limb task-specific training in chronic stroke
2021, NeuroImage: ClinicalCitation Excerpt :In subacute stroke, larger FA in CST, alternate motor fibers (such as cortico-rubro-spinal and cortico-reticulo-spinal tract) and transcallosal fibers were positively correlated with larger treatment response (Song et al., 2015; Young et al., 2016). By contrast, in chronic stroke, the current literature lacks evidence for structural plasticity following motor training (Borich et al., 2014; Rickards et al., 2014; Sterr et al., 2014). For instance, two studies showed gains in the use of the UL following constraint-induced movement therapy that were not associated with changes in CST integrity (Rickards et al., 2014; Sterr et al., 2014).
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2020, Research in Developmental DisabilitiesCitation Excerpt :Nine of these studies used a deterministic fiber-tracking algorithm (Weinstein et al., 2015, 2018, Gupta et al., 2017; Hodge et al., 2017; Kim & Son, 2015; Kim et al., 2015; Meyns et al., 2016; Wang et al., 2014; Weinstein et al., 2014), of which ‘Fiber Assignment with Continuous Tracking’ (FACT, (Jiang, van Zijl, Kim, Pearlson, & Mori, 2006)) was most frequently used. Seven studies used probabilistic tracking methods (Fiori et al., 2015; Kuczynski et al., 2016, 2017; Reid et al., 2016; Rickards et al., 2014; Tsao et al., 2014, 2015). Most studies used CSD of which one was fMRI driven (Reid et al., 2016), and two other studies performed an automated atlas based approach involving seeding streamlines randomly over the whole brain and extracting tracts based on cortical projections (Tsao et al., 2014, 2015).
Rehabilitation-induced brain changes detected through magnetic resonance imaging in children with neurodevelopmental disorders: A systematic review
2019, International Journal of Developmental NeuroscienceCitation Excerpt :The other study tracked participants after one to two years of standard rehabilitation (e.g., occupational therapy, physiotherapy, language therapy, etc.) and showed that children who had higher baseline connectivity (higher number of streamlines in sensorimotor tracts) and higher FA showed the most functional improvement after rehabilitation (Englander et al., 2015). Alternatively, one moderate quality study showed that although children with CP benefited from a three-week CIMT to improve their motor skills and arm use, this improvement was not reflected in their brain, more specifically in the corticospinal tract (Rickards et al., 2014). This could be related to intervention dose, its protocol, or lack of control group.
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Study 1 was supported by the Kaul Pediatric Research Institute of the Alabama Children's Hospital Foundation and a predoctoral training grant from the American Heart Association (grant no. 11PRE6830006). Study 2 was supported by the National Institutes of Health (grant no. HD34273).
No commercial party having a direct financial interest in the results of the research supporting this article has conferred or will confer a benefit on the authors or on any organization with which the authors are associated.