Remodeling the Brain

Abstract

Background and Purpose-Studies on adult stroke patients have demonstrated functional changes in cortical excitability, metabolic rate, or blood flow after motor therapy, measures that can fluctuate rapidly over time. This study evaluated whether evidence could also be found for structural brain changes during an efficacious rehabilitation program. Methods-Chronic stroke patients were randomly assigned to receive either constraint-induced movement therapy (nϭ16) or a comparison therapy (nϭ20). Longitudinal voxel-based morphometry was performed on structural MRI scans obtained immediately before and after patients received therapy. Results-The group receiving constraint-induced movement therapy exhibited far greater improvement in use of the more affected arm in the life situation than the comparison therapy group. Structural brain changes paralleled these improvements in spontaneous use of the more impaired arm for activities of daily living. There were profuse increases in gray matter in sensory and motor areas both contralateral and ipsilateral to the affected arm that were bilaterally symmetrical, as well as bilaterally in the hippocampus. In contrast, the comparison therapy group failed to show gray matter increases. Importantly, the magnitude of the observed gray matter increases was significantly correlated with amount of improvement in real-world arm use. Conclusions-These findings suggest that a previously overlooked type of brain plasticity, structural remodeling of the human brain, is harnessed by constraint-induced movement therapy for a condition once thought to be refractory to treatment: motor deficit in chronic stroke patients. Key Words: constraint-induced movement therapy Ⅲ hemiplegia Ⅲ imaging Ⅲ motor activity Ⅲ MRI Ⅲ stroke rehabilitation Ⅲ voxel-based morphometry M erzenich et al 1 and other investigators 2 showed in animals that altering behaviorally relevant afferent input to the central nervous system can produce plastic changes in the function and organization of the brain. Sustained increased use of a body part by an animal leads to an increase in the brain's cortical representation of that body part, 3 whereas decreased input reduces the representational zone of that body part, as occurs after amputation of a digit 1 or somatosensory deafferentation of an entire forelimb in monkeys. 4 Similar phenomena have been demonstrated in humans after both increased use 5 and decreased use resulting from upper extremity amputation 6 or stroke 7 using functional imaging or mapping techniques.A neurorehabilitation technique termed Constraint-Induced Movement therapy (CI therapy) was developed in this laboratory from basic research with monkeys. 8 This treatment has been shown to substantially increase the amount of use of an affected upper extremity after stroke 9 -12 and also greatly alter the size of the regional brain activity or activation pattern associated with the more affected arm. 7,[13][14][15] Until now, neuroanatomical evaluations of treatment changes in humans have relied solely on funct...

Plasticity in the developing brain: Implications for rehabilitation

“…Constraint-induced movement therapy (CIMT) is an intervention for patients with hemiplegia in which they wear a restraining mitt on the less-affected hand while engaging in repetitive task practice and behavioral shaping with the hemiplegic hand [Gauthier et al, 2008]. The EXCITE (Effect of Constraint-Induced Movement Therapy on Upper Extremity Function) randomized clinical trial of this therapy in adults with stroke in the previous 6-9 months showed that it produced significant and clinically relevant improvement in arm motion that persisted for at least 1 year [Wolf et al, 2007].…”

“…The EXCITE (Effect of Constraint-Induced Movement Therapy on Upper Extremity Function) randomized clinical trial of this therapy in adults with stroke in the previous 6-9 months showed that it produced significant and clinically relevant improvement in arm motion that persisted for at least 1 year [Wolf et al, 2007]. The effect of this technique on structural plasticity in the brain has been examined using voxelbased morphometry in a group of 49 patients (26 male, 23 female) with an average age of 65 years who were an average of 3.6 years out from a stroke and had mild to moderate upper extremity hemiparesis [Gauthier et al, 2008]. Patients randomized to the CIMT therapy received 3 hr of therapy for the hemiparetic arm daily for 10 consecutive weekdays and restraint of the less-impaired arm for a target of 90% of waking hours.…”

Terapia por contensão induzida: revisão de ensaios clínicos

“…Foram encontrados 352 artigos, dos quais apenas 6 (27)(28)(29)(30)(31)(32) a) há poucos artigos que comparam a TCI com outra técnica de reabilitação; b) dentre os artigos encontrados, com exceção do estudo EXCITE, o número da amostra é pequeno; e c) os artigos somente foram pesquisados em três bases de dados.…”

Cognitive Remediation for Schizophrenia

“…For example, studies of post-stroke therapies demonstrate both restoration of functional organization and creation of neuronal projections [45][46][47] while similar studies of brain or spinal cord injuries correlate clinical improvement with observable changes in functional and structural neuroimaging. 48,49) There has been increasing interest in the possibility of involving neuroplasticity in the treatment of psychiatric disorders. Just as physical rehabilitation in the setting of trauma to the nervous system leads to functional improvement of the motor system, cognitive training is being developed across a variety of clinical conditions, from neurodevelopmental disorders 50) to aging 51) to neuropsychiatric illnesses, including schizophrenia.…”