http://www.neurology.org/content/88/16_Supplement/S43.003.short
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Neurology April 18, 2017 vol. 88 no. 16 Supplement S43.003
- Abstract
Abstract
Objective: This presentation will review the basic neuroscience research origins and the effects of Constraint-Induced Movement therapy
(CIMT) on CNS structural neuroplasticity.
Background:
Experimental hemiparesis in primates overcame chronic limb nonuse by
applying specific behavioral neuroscience principles.
This research led to formulating a model for the
origination of sustained motor disability after neurological injury and
its
improvement by a novel therapeutic program. The
therapy became adapted to treating children and adults and termed CIMT.
Over
the past 25 years multiple worldwide Randomized
Controlled Trials of CIMT enrolled nearly 2000 patients with diverse
neurological
disorders (stroke, cerebral palsy [CP], multiple
sclerosis [MS]), which indicated superiority of the approach against
control
therapies, with large treatment Effect Sizes and
sustained retention of improved spontaneous real-world use of the
hemiparetic
limb. Ongoing research will describe basic and
clinical neuroimaging methods to explore the basis for the clinical
efficacy
of CIMT.
Design/Methods: (1)
Basic neuroscience models of experimental limb nonuse in rodents that
had undergone adapted CIMT, which were followed
by histological studies. (2) Voxel-based
morphometry (VBM) of grey matter and Tract-based spatial statistics
(TBSS) of white
matter on structural brain MRI, which evaluated
neuroplastic changes after upper extremity CIMT.
Results: (1) CIMT in
rodents resulted in increased CNS axonal growth, synaptogenesis, and
neurogenesis compared to control interventions,
parallel with improved paretic limb use. (2) VBM
demonstrated profuse cortical and subcortical grey matter increase
following
CIMT for stroke, CP, and MS. TBSS indicated
significantly improved white matter integrity in MS. Neither structural
brain
changes nor comparable improved paretic limb use
followed control interventions.
Conclusions: CIMT is
increasing worldwide practice to improve reduced real-world limb use in
chronic hemiparesis in diverse neurological
diseases and ages of patients. Structural CNS
changes following CIMT may support improved and extended functional use
of the
paretic limb.
Study Supported by: NIH, National MS Society
Disclosure: Dr. Mark has nothing to disclose. Dr. Taub has nothing to disclose.
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