Influence of gait analysis on decision-marketing for lower extremity surgery

Constraint-induced movement therapy induces neuroplastic changes in congenital hemiparesis: a functional MRI and transcranial magnetic stimulation study


  1. 1. University Freiburg;
  2. 2. University Tubingen;
  3. 3. University Munchen/LMU, Germany

Objectives: Constraint-induced movement therapy (CIMT) is a functional approach focusing on hand motor improvement in hemiparetic patients. Here, we asked whether (1) CIMT induces neuroplastic effects, and (2) if these effects differ with regard to different patterns of corticospinal (re) organization in congenital hemiparesis.

Method: Fifteen patients with congenital hemiparesis were included. Group 1 (n=7; mean age 17y8mo) was characterized by an infraction in the middle cerebral artery territory and preserved crossed corticospinal projections to the paretic hand (as demonstrated by focal transcranial magnetic stimulation [TMS]; group 2 (n=8; mean age 16y 7mo) by unilateral periventricular white matter lesions and ipsilateral corti-cospinal projections to the paretic hand. Functional magnetic resonance imaging (fMRI) during repetitive active movements of the paretic hand was performed  in all patients as well as TMS, to study changes of motor evoked potentials (MEP).

Results: After CIMT, group 1 showed an increase in activation in the (contralaterally preserved) cortical hand representation, whereas in group 2, a decrease in activation was observed in the (ipsulaterally reorganized) cortical hand representation. Parallel results were observed in TMS. The single pulse TMS MEP increased in group 1 (pre- 0.38mV [SD 0.22], post-1.13mV [SD 1.04], p=0.043) and decreased in group 2 (pre-0.90mV [SD 0.21], post- 0.41mV [SD 0.32], p=0.035).

Conclusions: In both types of corticospinal (re-)organization, plastic changes were observed in the cortical motor representation of the paretic hand. Thus, functional improvement of the paretic hand after CIMT was paralleled by plastic hanges in fMRI and TMS. The direction of the changes differed between the two different patterns of corticospinal (re-) organization indicating the impact of corticospinal reorganization on CIMT induced neuronal plasticity.

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