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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