DNC News

Exciting News for Stroke Patients:

"New Therapy promising for victimes of strokes"
By Sandra Blakeslee
The New York Times
June 2, 2,000

"Using a new kind of stroke rehabilitation therapy, scientists have shown for the first time that the brain can be coaxed into reorganizing its circuitry so that people can regain nearly full use of their paralyzed limbs in just two to three weeks---even if the stroke happened years ago.

"The rehabilitation called constraint-induced-movement therapy, involves imobilizing a good arm or leg so that the patient is forced to use the paralyzed arm or leg for familiar tasks. "By intensively using the paralyzed limb, people can literally rewire parts of their brains, researchers said, and overcome a kind of learned helplessness that prevented their limbs from moving. Moreover, the technique works for patients who had their strokes even decades ago and have limited use of their limbs ever since........."

This is the kind of story that gets my attention! If this interests you, here is a website and the reference and abstract the article is based on. The second abstract and reference is a review article on the technique used published a year ago.

Website about CI therapy: [set this up!!]

Stroke 2000 Jun;31(6):1210-1216 Treatment-Induced Cortical Reorganization After Stroke in Humans. Liepert J, Bauder H, Miltner WH, Taub E, Weiller C Departments of Neurology (J.L., C.W.) and Biological and Clinical Psychology (H.B., W.H.R.M.), Friedrich-Schiller-University of Jena, Jena, Germany. Background and Purpose-Injury-induced cortical reorganization is a widely recognized phenomenon. In contrast, there is almost no information on treatment-induced plastic changes in the human brain. The aim of the present study was to evaluate reorganization in the motor cortex of stroke patients that was induced with an efficacious rehabilitation treatment. Methods-We used focal transcranial magnetic stimulation to map the cortical motor output area of a hand muscle on both sides in 13 stroke patients in the chronic stage of their illness before and after a 12-day-period of constraint-induced movement therapy. Results-Before treatment, the cortical representation area of the affected hand muscle was significantly smaller than the contralateral side. After treatment, the muscle output area size in the affected hemisphere was significantly enlarged, corresponding to a greatly improved motor performance of the paretic limb. Shifts of the center of the output map in the affected hemisphere suggested the recruit ment of adjacent brain areas. In follow-up examinations up to 6 months after treatment, motor performance remained at a high level, whereas the cortical area sizes in the 2 hemispheres became almost identical, representing a return of the balance of excitability between the 2 hemispheres toward a normal condition. Conclusions-This is the first demonstration in humans of a long-term alteration in brain function associated with a therapy-induced improvement in the rehabilitation of movement after neurological injury. PMID: 10835434

J Rehabil Res Dev 1999 Jul;36(3):237-51 Constraint-Induced Movement Therapy: a new family of techniques with broad application to physical rehabilitation--a clinical review. Taub E, Uswatte G, Pidikiti R Physical Medicine and Rehabilitation Service, Birmingham Department of Veterans Affairs Medical Center, AL 35233, USA. etaub@uab.edu A new family of rehabilitation techniques, termed Constraint-Induced Movement Therapy or CI Therapy, has been developed that controlled experiments have shown is effective in producing large improvements in limb use in the real-world environment after cerebrovascular accident (CVA). The signature therapy involves constraining movements of the less-affected arm with a sling for 90% of waking hours for 2 weeks, while intensively training use of the more-affected arm. The common therapeutic factor in all CI Therapy techniques would appear to be inducing concentrated, repetitive practice of use of the more-affected limb. A number of neuroimaging and transcranial magnetic stimulation studies have shown that the massed practice of CI Therapy produces a massive use-dependent cortical reorganization that increases the area of cortex involved in the innervation of movement of the more-affected limb. The CI Therapy approach has been used successfully to date for the upper limb of patients with chronic and subacute CV A and patients with chronic traumatic brain injury and for the lower limb of patients with CVA, incomplete spinal cord injury, and fractured hip. The approach has recently been extended to focal hand dystonia of musicians and possibly phantom limb pain. PMID: 10659807, UI: 20123203

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