Article

OBJECTIVE: To investigate the relationship of white matter integrity and path of
the corticospinal tract (CST) on arm function before and after constraint-induced
(CI) movement therapy in children with hemiparetic cerebral palsy (CP) and adults
with chronic stroke. DESIGN: Study 1 used a multiple-baseline pre-post design.
Study 2 was a randomized controlled trial. SETTING: Outpatient rehabilitation
laboratory. PARTICIPANTS: Study 1 included children with hemiparetic CP (n=10;
mean age +/- SD, 3.2+/-1.7y). Study 2 included adults with chronic stroke (n=26;
mean age +/- SD, 65.4+/-13.6y) who received either CI therapy or a comparison
therapy. INTERVENTIONS: Children in study 1 received CI therapy for 3.5h/d for 15
consecutive weekdays. Adults in study 2 received either CI therapy or a
comparison therapy for 3.5h/d for 10 consecutive weekdays. MAIN OUTCOME MEASURES:
Diffusion tensor imaging was performed to quantify white matter integrity. Motor
ability was assessed in children using the Pediatric Motor Activity Log-Revised
and Pediatric Arm Function Test, and in adults with the Motor Activity Log and
Wolf Motor Function Test. RESULTS: Participants in both studies improved in
real-world arm function and motor capacity. Children and adults with
disrupted/displaced CSTs and children with reduced fractional anisotropy values
were worse on pretreatment tests of motor function than participants with
unaltered CSTs. However, neither integrity (fractional anisotropy) nor distorted
or disrupted path of the CST affected motor improvement after treatment.
CONCLUSIONS: Participants who had reduced integrity, displacement, or
interruption of their CST performed worse on pretreatment motor testing. However,
this had no effect on their ability to benefit from CI therapy. The results for
children and adults are consistent with one another.
CI - Copyright (c) 2014 American Congress of Rehabilitation Medicine. Published by
Elsevier Inc. All rights reserved.

Langue : ANGLAIS