[ARTICLE] The Functional Recovery and the Associated Cortical Reorganization Following Constraint-Induced Movement Therapies (CIMTs) in Stroke. – Full Text PDF

Abstract

Constraint-Induced Movement Therapies (CIMTs) including the original Constraint- Induced Movement Therapy (CIMT) and the Modified Constraint-Induced Movement Therapy (mCIMT) gained considerable popularity as a treatment approach for upper extremity rehabilitation among patients with mild-to-moderate stroke.

However, a major barrier in rehabilitation generally and in CIMTs specifically; is the limited objectivity of some commonly used outcome measures and lack sensitivity to define “True” recovery vs. compensation. Thereby, they may not sufficiently detect of long term consequences and the associated neurological recovery. An essential approach to overcome such barrier is to better understand functional motor recovery, associated neural changes and how they may relate to recovery of the pre-morbid movement pattern.

Such Understanding for these relationships would add more in-depth insights on the
functional relevance of plastic brain changes in stroke following CIMTs to optimize the field of neuro-rehabilitation. This review synthesizes findings from studies to on the use of the CIMTs including CIMT and mCIMT as efficient practice in the management of upper limb dysfunction following a stroke. The analysis will include (1) the functional recovery and (2) the cortical reorganization following the use of mCIMT and CIMT on patients in the chronic stage following stroke.

Introduction

Stroke is considered the fifth leading cause of death in the United
States [1]. To date, stroke affects at least 6.4 million persons in the United
States [2]. Projections show that by 2030, an additional 3.4 million
people above 18 years will have had a stroke which is approximately a
20.5% increase in prevalence from 2012 statistics [1]. Stroke is a leading
cause of serious long-term disability in the United States [1].

Arm paresis is one of the most common impairments after stroke
[3,4]. After six months, about two-thirds of patients continue to suffer
from arm sensorimotor impairment that impacts the individual’s
activities of daily living [5]. Motor deficits consist of weakness of
specific muscles [6], abnormal muscle tone [7-9], abnormal postural
adjustments [10], abnormal movement synergies [11], lack of mobility
between structures at the shoulder girdle [10] and incorrect timing
of components within a movement pattern [12]. As a result of such
impairment, patients may progressively avoid using the affected arm in
favor of the unaffected arm for successful ADL, resulting in a learned
non-use phenomenon [13].[…]

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