Download PDF
Neuropediatrics 2007; 38(3): 130-136
DOI: 10.1055/s-2007-985904
Original Article

© Georg Thieme Verlag KG Stuttgart · New York

Cortical Neuromodulation by Constraint-Induced Movement Therapy in Congenital Hemiparesis: An fMRI Study

H. Juenger 1 , 2 [*] , M. Linder-Lucht 3 [*] , M. Walther 3 , S. Berweck 4 [*] , V. Mall 3 [*] , M. Staudt 1 , 2 [*]
  • 1Department of Pediatric Neurology and Developmental Medicine, University Children's Hospital, Tübingen, Germany
  • 2Section Experimental MR of the CNS, Department of Neuroradiology, Radiological Clinic, University of Tübingen, Germany
  • 3Department of Neuropediatrics and Muscle Disorders, University Children's Hospital, Freiburg, Germany
  • 4Department of Pediatric Neurology and Developmental Medicine, Dr. von Hauners’ Children's Hospital, University of Munich, Munich, Germany
Further Information

Publication History

received 05. 12. 2006

accepted 07. 08. 2007

Publication Date:
05 November 2007 (online)

Also available at
    Permissions and Reprints

Abstract

Objective: The aim of this study was to assess neuromodulative effects of CIMT in congenital hemiparesis.

Patients and Methods: Ten patients (age range: 10-30 years) with congenital hemiparesis due to unilateral cortico-subcortical infarctions in the middle cerebral artery territory, and with preserved cortico-spinal projections from the affected hemisphere to the paretic hand, were included. After a twelve-day period of constraint-induced movement therapy (CIMT), all showed a significant improvement of paretic hand function. Immediately before and after therapy, functional MRI during active and passive hand movements was performed to monitor cortical activation.

Results: Four patients showed consistent increases in cortical activation during movements of the paretic hand in the primary sensorimotor cortex of the affected hemisphere. Of the remaining six patients, three showed similar changes, but these results were potentially contaminated by an improved task performance after therapy. No significant alteration in activation was observed in two patients, and one showed movement artifacts.

Conclusions: Even a short period of CIMT can induce changes of cortical activation in congenital hemiparesis. In our sample, increases in fMRI activation were consistently observed in the primary sensorimotor cortex of the affected hemisphere. Thus, the potential for neuromodulation is preserved in the affected hemisphere after early brain lesions.

Key words

fMRI - CIMT - congenital hemiparesis - plasticity

References

  • 1 Carey JR, Kimberley TJ, SM. et al . Analysis of fMRI and finger tracking training in subjects with chronic stroke.  Brain. 2002;  125 773-788
    CrossrefPubMedSearch in Google Scholar
  • 2 Carr LJ, Harrison LM, Evans AL, Stephens JA. Patterns of central motor reorganization in hemiplegic cerebral palsy.  Brain. 1993;  116 1223-1247
    CrossrefPubMedSearch in Google Scholar
  • 3 Cramer SC, Weisskoff RM, Schaechter JD, Nelles G, Foley M, Finklestein SP. et al . Motor cortex activation is related to force of squeezing.  Hum Brain Mapp. 2002;  16 197-205
    CrossrefPubMedSearch in Google Scholar
  • 4 Dong Y, Dobkin BH, Cen SY, Wu AD, Winstein CJ. Motor cortex activation during treatment may predict therapeutic gains in paretic hand function after stroke.  Stroke. 2006;  37 1552-1555
    CrossrefPubMedSearch in Google Scholar
  • 5 Gordon AM, Charles J, Wolf SL. Methods of constraint-induced movement therapy for children with hemiplegic cerebral palsy: development of a child-friendly intervention for improving upper-extremity function.  Arch Phys Med Rehabil. 2005;  86 837-844
    CrossrefPubMedSearch in Google Scholar
  • 6 Hamzei F, Liepert J, Dettmers C, Weiller C, Rijntjes M. Two different reorganization patterns after rehabilitative therapy: An exploratory study with fMRI and TMS.  Neuroimage. 2006;  31 710-720
    CrossrefPubMedSearch in Google Scholar
  • 7 Hlustik P, Solodkin A, Noll DC, Small SL. Cortical plasticity during three-week motor skill learning.  J Clin Neurophysiol. 2004;  21 180-191
    PubMedSearch in Google Scholar
  • 8 Hlustik P, Mayer M. Paretic hand in stroke: from motor cortical plasticity research to rehabilitation.  Cogn Behav Neurol. 2006;  19 34-40
    PubMedSearch in Google Scholar
  • 9 Johansen-Berg H, Dawes H, Guy C, Smith SM, Wade DT, Matthews PM. Correlation between motor improvements and altered fMRI activity after rehabilitative therapy.  Brain. 2002;  125 2731-2742
    CrossrefPubMedSearch in Google Scholar
  • 10 Karni A, Meyer G, Jezzard P, Adams MM, Turner R, Ungerleider LG. Functional MRI evidence for adult motor cortex plasticity during motor skill learning.  Nature. 1995;  377 155-158
    CrossrefPubMedSearch in Google Scholar
  • 11 Karni A, Meyer G, Rey-Hipolito C, Jezzard P, Adams MM, Turner R. et al . The acquisition of skilled motor performance: fast and slow experience-driven changes in primary motor cortex.  Proc Natl Acad Sci. 1998;  95 861-868
    CrossrefPubMedSearch in Google Scholar
  • 12 Klose U, Erb M, Wildgruber D, Müller E, Grodd W. Improvement of the acquisition of a large amount of MR images on a conventional whole body system.  Magn Reson Imaging. 1999;  17 471-474
    PubMedSearch in Google Scholar
  • 13 Krageloh-Mann I. Imaging of early brain injury and cortical plasticity.  Exp Neurol. 2004;  190 84-90
    CrossrefPubMedSearch in Google Scholar
  • 14 Kunkel A, Kopp B, Muller G. et al . Constraint-induced movement therapy for motor recovery in chronic stroke patients.  Arch Phys Med Rehabil. 1999;  80 624-628
    CrossrefPubMedSearch in Google Scholar
  • 15 Liepert J, Miltner WH, Bauder H. et al . Motor cortex plasticity during constraint-induced movement therapy in stroke patients.  Neurosci Lett. 1998;  250 5-8
    CrossrefPubMedSearch in Google Scholar
  • 16 Liepert J, Bauder H, Wolfgang HR, Miltner WH, Taub E, Weiller C. Treatment-induced cortical reorganization after stroke in humans.  Stroke. 2000;  6 1210-1216
    PubMedSearch in Google Scholar
  • 17 Liepert J, Hamzei F, Weiller C. Lesion-induced and training-induced brain reorganization.  Restor Neurol Neurosci. 2004;  22 269-277
    PubMedSearch in Google Scholar
  • 18 Lindberg P, Schmitz C, Forssberg H, Engardt M, Borg J. Effects of passive-active movement training on upper limb motor function and cortical activation in chronic patients with stroke: a pilot study.  J Rehabil Med. 2004;  36 117-123
    CrossrefPubMedSearch in Google Scholar
  • 19 Mall V, Linder M, Herpers M. et al . Recruitment of the sensorimotor cortex - a developmental fMRI study.  Neuropediatrics. 2005;  36 373-379
    Thieme ConnectPubMedSearch in Google Scholar
  • 20 Mark VW, Taub E, Morris DM. Neuroplasticity and constraint-induced movement therapy.  Eura Medicophys. 2006;  42 269-284
    PubMedSearch in Google Scholar
  • 21 Miltner WH, Bauder H, Sommer M, Dettmers C, Taub E. Effects of constraint-induced movement therapy on patients with chronic motor deficits after stroke: a replication.  Stroke. 1999;  30 586-592
    CrossrefPubMedSearch in Google Scholar
  • 22 Nelles G, Jentzen W, Jueptner M, Muller S, Diener HC. Arm training induced brain plasticity in stroke studied with serial positron emission tomography.  Neuroimage. 2001;  13 1146-1154
    PubMedSearch in Google Scholar
  • 23 Plewnia C, Bartels M, Cohen L, Gerloff C. Noradrenergic modulation of human cortex excitability by the presynaptic alpha(2)-antagonist yohimbine.  Neurosci Lett. 2001;  307 41-44
    CrossrefPubMedSearch in Google Scholar
  • 24 Plewnia C, Hoppe J, Hiemke C, Bartels M, Cohen LG, Gerloff C. Enhancement of human cortico-motoneuronal excitability by the selective norepinephrine reuptake inhibitor reboxetine.  Neurosci Lett. 2002;  330 231-234
    CrossrefPubMedSearch in Google Scholar
  • 25 Schaechter JD, Kraft E, Hilliard TS. et al . Motor recovery and cortical reorganization after constraint-induced movement therapy in stroke patients: a preliminary study.  Neurorehabil Neural Repair. 2002;  16 326-338
    PubMedSearch in Google Scholar
  • 26 Scheidtmann K, Fries W, Muller F, Koenig E. Effect of levodopa in combination with physiotherapy on functional motor recovery after stroke: a prospective, randomised, double-blind study.  Lancet. 2001;  358 787-790
    CrossrefPubMedSearch in Google Scholar
  • 27 Shaffer JP. Multiple Hypothesis Testing.  Annu Rev Psychol. 1995;  46 561-584
    CrossrefPubMedSearch in Google Scholar
  • 28 Staudt M, Grodd W, Gerloff C, Erb M, Stitz J, Krägeloh-Mann I. Two types of ipsilateral reorganization in congenital hemiparesis: a TMS and fMRI study.  Brain. 2002;  125 2222-2237
    CrossrefPubMedSearch in Google Scholar
  • 29 Staudt M, Gerloff C, Grodd W, Holthausen H, Niemann G, Krägeloh-Mann I. Reorganization in congenital hemiparesis acquired at different gestational ages.  Ann Neurol. 2004;  56 854-863
    CrossrefPubMedSearch in Google Scholar
  • 30 Szaflarski JP, Page SJ, Kissela BM, Lee JH, Levine P, Strakowski SM. Cortical reorganization following modified constraint-induced movement therapy: a study of 4 patients with chronic stroke.  Arch Phys Med Rehabil. 2006;  87 1052-1058
    CrossrefPubMedSearch in Google Scholar
  • 31 Taub E, Miller NE, Novack TA. et al . Technique to improve chronic motor deficit after stroke.  Arch PhysMed Rehabil. 1993;  74 347-354
    PubMedSearch in Google Scholar
  • 32 Taub E, Crago JE, Burgio LD. et al . An operant approach to rehabilitation medicine: overcoming learned nonuse by shaping.  J Exp Anal Behav. 1994;  61 281-293
    CrossrefPubMedSearch in Google Scholar
  • 33 Taub E, Ramey SL, DeLuca S, Echols K. Efficacy of constraint-induced movement therapy for children with cerebral palsy with asymmetric motor impairment.  Pediatrics. 2004;  113 305-312
    CrossrefPubMedSearch in Google Scholar
  • 34 Ungerleider LG, Doyon J, Karni A. Imaging brain plasticity during motor skill learning.  Neurobiol Learn Mem. 2002;  78 553-564
    CrossrefPubMedSearch in Google Scholar
  • 35 Vandermeeren Y, Sebire G, Grandin CB, Thonnard JL, Schlogel X, De Volder AG. Functional reorganization of brain in children affected with congenital hemiplegia: fMRI study.  Neuroimage. 2003;  20 289-301
    CrossrefPubMedSearch in Google Scholar
  • 36 Mier HI van, Perlmutter JS, Petersen SE. Functional changes in brain activity during acquisition and practice of movement sequences.  Motor Control. 2004;  8 500-520
    PubMedSearch in Google Scholar
  • 37 Wittenberg GF, Chen R, Ishii K. et al . Constraint-induced therapy in stroke: magnetic-stimulation motor maps and cerebral activation.  Neurorehabil Neural Repair. 2003;  17 48-57
    PubMedSearch in Google Scholar
  • 38 Wolf SL, Catlin PA, Ellis M, Archer AL, Morgan B, Piacentino A. Assessing Wolf motor function test as outcome measure for research in patients after stroke.  Stroke. 2001;  32 1635-1639
    CrossrefPubMedSearch in Google Scholar
  • 39 Yousry TA, Schmid UD, Alkadhi H. et al . Localization of the motor hand area to a knob on the precentral gyrus.  A new landmark. Brain. 1997;  120 141-157
    CrossrefPubMedSearch in Google Scholar

1 These authors contributed equally to this work

Correspondence

Dr. H. Juenger

Department of Pediatric Neurology

University Children's Hospital

Hoppe-Seyler-Str. 1

72076 Tübingen

Germany

Phone: +49/7071/298 14 48

Fax: +49/7071/29 54 73

Email: Hendrik.Juenger@med.uni-tuebingen.de