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Functional MRI Evidence of Cortical Reorganization in Upper-Limb Stroke Hemiplegia Treated with Constraint-Induced Movement Therapy

Levy, Charles E., MD; Nichols, Deborah S., PhD; Schmalbrock, Petra M., PhD; Keller, Paul, PhD; Chakeres, Donald W., MD

American Journal of Physical Medicine & Rehabilitation: January 2001 - Volume 80 - Issue 1 - p 4-12
Research Article: Hemiparesis

Levy CE, Nichols DS, Schmalbrock PM, Keller P, Chakeres DW: Functional MRI evidence of cortical reorganization in upper-limb stroke hemiparesis treated with constraint-induced movement therapy. Am J Phys Med Rehabil 2001;80:4–12.

Objective The purpose of this pilot study was to test constraint-induced movement therapy for chronic upper-limb stroke hemiparesis and to investigate the neural correlates of recovery with functional magnetic resonance imaging (MRI) in two subjects. Both subjects had been discharged from traditional therapy because no further improvement was anticipated.

Design Constraint-induced movement therapy consisted of 6 hr of daily upper-limb training for 2 wk; a restrictive mitt was worn on the nonparetic limb during waking hours. Functional MRI was performed on a 1.5-T MRI with echo-planar imaging; at the same time, the subjects attempted sequential finger-tapping.

Results Compared with baseline, performance time improved an average of 24% immediately after training and also continued to improve up to 33% 3 mo after training. Lift, grip strength, and Motor Activity Log scores likewise improved. Initially, on functional MRI, subject 1 activated scattered regions in the ipsilateral posterior parietal and occipital cortices. Subject 2 showed almost no areas of significant activation. After training, subject 1 showed activity bordering the lesion, bilateral activation in the association motor cortices, and ipsilateral activation in the primary motor cortex. Subject 2 showed activation near the lesion site.

Conclusion Constraint-induced movement therapy produced significant functional improvement and resulted in plasticity as demonstrated by functional MRI.


From the North Florida/South Georgia Veteran’s Health System and the Department of Orthopaedics and Rehabilitation (CEL), the University of Florida, Gainesville, Florida; the Department of Physical Medicine and Rehabilitation (CEL), the Physical Therapy Division, The School of Allied Medical Professions (DSN), and the Department of Radiology (PMS, DWC), The Ohio State University Medical Center, Columbus, Ohio; and Barrow Neurological Institute (PK), St. Joseph’s Hospital and Medical Center, Mercy Healthcare, Phoenix, Arizona.

Presented, in part, at the 60th Annual Meeting of the American Academy of Physical Medicine and Rehabilitation, October 1998, Seattle, Washington.

All correspondence and requests for reprints should be addressed to Charles E. Levy, MD, Chief, Physical Medicine and Rehabilitation Service, North Florida/South Georgia Veterans Health System, 1601 SW Archer Road, Gainesville, FL 32608.

Supported, in part, from the Veterans Affairs Brain Rehabilitation Research Center.

© 2001 Lippincott Williams & Wilkins, Inc.