Neuropediatrics 2006; 37 - PS4_2_4
DOI: 10.1055/s-2006-945795

CONSTRAINT INDUCED MOVEMENT THERAPY IN CONGENITAL HEMIPARESIS III: FMRI REVEALS INCREASED ACTIVATION IN PRIMARY SENSORIMOTOR CORTEX (M1S1)

H Juenger 1, M Linder 1, S Berweck 1, V Mall 1, M Staudt 1
  • 1Department of Pediatric Neurology and Developmental Medicine, Tübingen, Baden-Württemberg, Germany

Objectives: To assess the neurobiological basis for the functional improvement achieved by Constraint Induced Movement Therapy (CIMT) in congenital hemiparesis.

Methods: Eleven patients (age: 10–30 years; 6 females) with congenital hemiparesis (4 left-, 7 right-sided) due to a pre-, peri- or neonatally acquired, unilateral cortico-subcortical infarction in the middle cerebral artery territory and preserved crossed cortico-spinal projections to the paretic hand (as determined by transcranial magnetic stimulation) were included. After a twelve-day CIMT training period in an inpatient setting, all patients showed a significant improvement of the motor function of the paretic hand (Wolf Motor Function Test). Functional MRI (fMRI) during repetitive active and passive movements of the paretic and the non-paretic hand was performed immediately (<48h) before and after CIMT. During the active condition, patients had to squeeze an air-filled rubber ball connected to a pressure sensor in the same frequency before and after CIMT. During the passive condition, an examiner performed flexion-extension movements of the patient's metacarpophalangeal joints (fingers 2–5).

Results: After CIMT, 8 / 11 patients showed increased fMRI activation during paretic hand movement. Of these, potentially confounding factors (e.g., higher squeezing pressures after CIMT) were identified in 4. The increase in brain activation was located in the contralateral M1S1 (4 / 4), the supplementary motor area (2 / 4), the cerebellum (1 / 4), the ipsilateral M1S1 (1 / 4) and the ipsilateral premotor cortex (1 / 4).

Conclusion: In children and young adults with congenital hemiparesis and preserved crossed cortico-spinal projections, CIMT leads to consistent activation increases in the contralateral M1S1 region. Thus, the neuromodulatory effects of CIMT parallel activation changes during motor learning in healthy adults.