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Author Notes:

Lumy Sawaki, MD, PhD, Associate Professor, Cardinal Hill Endowed Scholar in Stroke and Spinal Cord Injury Research, Department of Physical Medicine and Rehabilitation, University of Kentucky, Cardinal Hill Rehabilitation Hospital, 2050 Versailles Road, Lexington, KY 40504, 859.323.6226 (direct), 859.323.1123 (fax), lumy.sawaki@uky.edu.

We thank the therapists, nurses, and research assistants from all sites for invaluable work during data collection.

We also extend thanks for editing by Cheryl Carrico, MS, OT/L.

Subjects:

Research Funding:

This study was sponsored by NICHD RO1 HD-40984; and partially sponsored by the Cardinal Hill Endowment in Stroke and Spinal Cord Rehabilitation.

Keywords:

  • Science & Technology
  • Life Sciences & Biomedicine
  • Clinical Neurology
  • Rehabilitation
  • Neurosciences & Neurology
  • Plasticity
  • recovery
  • transcranial magnetic stimulation
  • upper extremity
  • motor
  • TRANSCRANIAL MAGNETIC STIMULATION
  • HUMAN MOTOR CORTEX
  • USE-DEPENDENT PLASTICITY
  • SUBACUTE STROKE
  • RECOVERY
  • ACTIVATION
  • BRAIN
  • TRIAL
  • MAPS
  • REHABILITATION

Differential patterns of cortical reorganization following constraint-induced movement therapy during early and late period after stroke: A preliminary study

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Journal Title:

NeuroRehabilitation

Volume:

Volume 35, Number 3

Publisher:

, Pages 415-426

Type of Work:

Article | Post-print: After Peer Review

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. CONCLUSION: 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. SIGNIFICANCE: 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.

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