Constraint-Induced Movement Therapy Promotes Neuroplasticity After Stroke: mechanisms of neuroplasticity and evidence from animal models

I think these research writeups on neuroplasticity  are stupid. We've known for years that it occurs and works, stop writing that same crap all over again. We however do not know how it works. And until we do we won't be able to consistently repeat that ability.
The full 11 page paper is at the link
http://www.researchgate.net/publication/256160931_English_version_of_text/file/50463521e392acda25.doc

Address correspondence and requests for reprints to:

Lynne V. Gauthier

Department of Psychology, University of Alabama at Birmingham

CPM 720, 1530 3rd Ave. S., Birmingham, AL 35294

Telephone: (205) 934-2471

Fax: (205) 975-6140

E-mail: lynnevg@uab.edu 

Abstract

An increasing body of evidence suggests that not only does the brain control and interpret experience, but that the experiences of the individual can have an equally profound reciprocal effect on the brain’s structure and function. These effects have been observed both macroscopically in humans (using structural magnetic resonance imaging) and at the level of the synapse in rodents. The following will review the impact that experience can have on brain structure and suggest how neuroplasticity may be harnessed through rehabilitation paradigms to promote better recovery of function after neurological damage.

         Most data on the effects of experience in normal individuals and therapeutic intervention in brain-injured humans are from functional neuroimaging techniques, but these often produce highly variable results that are subject to unobvious artifacts and can give rise to conflicting results in the literature. However, in the last 10-15 years, a new family of techniques have been developed that are capable of showing the effect of learning and experience on the structure of the brain. These techniques include morphometry [e.g. voxel-based morphometry (VBM), deformation-based morphometry (DBM)] and diffusion tensor imaging (DTI).

         Several studies making use of these techniques have shown that experience-dependent neuroplasticity operates to modify brain structure in healthy individuals. For example, Draganski and colleagues demonstrated a focal increase in grey matter in brain areas involved in perception and visuomotor integration that paralleled performance in individuals learning to juggle.¹ Intensive studying has also been shown to increase the amount of grey matter in posterior lateral parietal cortex and posterior hippocampus.² Alterations to the structure of the brain were also observed in individuals whose professions required extensive training in a particular domain. London taxi drivers, who engage in extensive spatial learning, had larger posterior hippocampal volumes, the size of which correlated with the amount of time spent as a taxi driver.³ Likewise, pianists show an increase in grey matter density and white matter integrity in brain areas involved in execution and bimanual coordination of motor movements.^4,5

         Similar neuroplastic changes have been observed following Constraint-Induced Movement therapy (CI therapy) after neurological insult. CI therapy provides a valuable paradigm for studying rehabilitation-induced plasticity in humans because: it is one of the only rehabilitation therapies with considerable empirical validation of its efficacy. It is primarily performed in the chronic phase of injury when confounding spontaneous reorganization is unlikely to occur, it is highly standardized, and it yields large therapeutic effects.^6-12 The therapy has three main elements. One component is intensive training of the more affected arm. This training consists of shaping movements during repetitive task practice performed by trained physical or occupational therapists. Shaping is a behavioral procedure in which task difficulty is increased in very small increments as progressive improvements in movement are achieved. This training is similar in some respects to what a patient would receive in traditional physical therapy except that the intensity of this training is much greater than in usual and customary care; patients receive three hours per day of therapy for ten consecutive weekdays at a specified rate of response (i.e. intensity). A second component of the therapy is prolonged restraint of the less affected upper extremity for a target 90% of waking hours to encourage increased use of the more impaired arm. The third component is a “transfer package” of behavioral techniques, designed to facilitate transfer of therapeutic gains to real world activities. The “transfer package” consists of a behavioral contract (in which the patient agrees to wear the restraint on the unimpaired arm for a target 90% of waking hours and use the impaired arm for specified activities), monitoring of life situation arm use by daily administration of a structured interview concerning the amount and quality of 30 activities of daily living carried out in the life situation (the Motor Activity Log), and problem-solving with a therapist to overcome perceived barriers to using the extremity in the life situation. The “transfer package” is critically important for therapeutic outcomes and has been shown to enhance the efficacy of the therapy for promoting use of the arm in the home environment nearly threefold over intensive practice alone.^9,10,13  CI therapy has demonstrated efficacy for treating the motor deficit associated with a number of different neurological conditions including traumatic brain injury,¹⁴ multiple sclerosis,¹⁵ cerebral palsy,¹⁶ and juvenile hemispherectomy.¹⁶