Do patients with congenital hemiparesis and ipsilateral corticospinal projections respond differently to constraint‐induced movement therapy?

Abstract

This study investigates whether the type of corticospinal reorganization (identified by transcranial magnetic stimulation) influences the efficacy of constraint-induced movement therapy (CIMT). Nine patients (five males, four females; mean age 16y [SD 6y 5mo], range 11-30y) controlling their paretic hand via ipsilateral corticospinal projections from the contralesional hemisphere and seven patients (three males, four females; mean age 17y [SD 7y], range 10-30y) with preserved crossed corticospinal projections from the affected hemisphere to the paretic hand underwent 12 consecutive days of CIMT. A Wolf motor function test applied before and after CIMT revealed a significant improvement in the quality of upper extremity movements in both groups. Only in patients with preserved crossed projections, however, was this amelioration accompanied by a significant gain in speed, whereas patients with ipsilateral projections tended to show speed reduction. These data, although preliminary, suggest that patients with congenital hemiparesis and ipsilateral corticospinal projections respond differently to CIMT.Constraint-induced movement therapy (CIMT) is a relatively new therapeutic approach focused on ameliorating upper extremity function in hemiparetic patients. It consists of immobilization of the nonparetic hand combined with individualized, intensive repetitive training of the paretic hand. CIMT has its origins in earlier basic research with rhesus monkeys that underwent deafferentation (surgical abolition of sensation by dorsal rhizotomy) of a single forelimb, followed by intensive training of the deafferented limb combined with constraint of the other, intact limb.

Plasticity in the developing brain: Implications for rehabilitation

“…fMRI studies of cerebral activation of children with hemiplegia showed a shift in laterality from the ipsilateral to contralateral hemisphere after CIMT therapy in association with improved function [Eliasson et al, 2005]. Kuhnke et al [2008] found that children with congenital hemiparesis and preserved contralateral corticospinal tracts from the damaged hemisphere respond differentially to CIMT than children with only ipsilateral responses to TMS. Both groups respond to CIMT with improved function but only those with contralateral corticospinal tracts have improvement in speed of movement.…”

Constraint‐induced movement therapy (CIMT): Pediatric applications

“…Gordon et al, 2006], while others have extended treatment to 2 months [Eliasson et al, 2005]. In addition, some therapy sessions have been provided on an individual basis [Crocker et al, 1997;DeLuca et al, 2003;Karman et al, 2003;Miller and Hale, 2005;Dickerson and Brown, 2007;Naylor and Bower, 2005;Cope et al, 2008;Fergus et al, 2008;Martin et al, 2008] while others are group based [Eliasson et al, 2003;Gordon et al, 2006;Charles and Gordon, 2007], or have combined both group and individual treatment sessions [Kuhnke et al, 2008]. Treatment environments have included home, clinic, and camp models, while interventionists have also varied from study to study including mostly Occupational and Physical Therapists but also trained caregivers, aides, and teachers.…”

“…One recent study [Kuhnke et al, 2008] noted that prenatal disruption of corticospinal projections may result in two patterns of cortical adaptation: persistence of normally transient ipsilateral projections, which then gain some control over the hemiparetic limb, or preservation of the more typical crossed projection pattern in weakened form. They determined type of corticospinal organization in adolescents and adults aged 10-30 with congenital hemiparesis through TMS.…”

Is constraint‐induced movement therapy harmful in unilateral spastic cerebral palsy with ipsilateral cortico‐spinal projections?

“…2 In contrast to us, they did not study prototypical samples of patients with distinct types of cerebral lesions and corticospinal organization, but investigated a typical clinical sample of 16 children and adolescents chosen by their eligibility for CIMT according to clinical characteristics; both transcranial magnetic stimulation and MRI data were available for 11 participants. This sample included patients with contralateral, ipsilateral, and 'mixed type' cortico-spinal projections; underlying lesions comprised maldevelopments, white matter lesions and ischemic cortico-subcortical infarcts.…”

“…Two aspects of mastery motivation are persistence (the duration of task-directed behavior) and mastery pleasure (positive affect during or immediately after task-directed behavior). Children's mastery motivation is a force that energizes, directs, and sustains goal-directed behavior 2 and is a predictor of later functioning. 3 For children with developmental disabilities, mastery motivation is also a predictor of later performance of daily activities and academic achievement.…”