UC HEALTH LINE: Arm Therapy 'Rewires' Brain After Stroke

CINCINNATI—A therapy known to improve arm function in stroke patients actually works by forcing the brain to “rewire” itself, say UC researchers.

A study led by Stephen Page, PhD, and published in the August 2006 issue of Archives of Physical Medicine and Rehabilitation, reports that when stroke patients participate in modified constraint-induced movement therapy, or mCIMT, areas of their brain normally used for other functions are “recruited” to help move the affected arm.

Patients in the study were offered 10 weeks of mCIMT, in which restraint of the unaffected arm forced them to use their affected arm for everyday tasks.

Study participants were given 30-minute therapy sessions three times a week. They were asked to follow up at home, still using only their affected arm for five hours each day, five days a week.

“Previous studies have shown that mCIMT can improve arm function in patients, but we weren’t quite sure how it was working,” says Page, assistant professor and director of research in the department of physical medicine and rehabilitation. “The cool thing about this study is that we now know the mechanism.”

That mechanism, referred to by the researchers as cortical reorganization, was confirmed through functional magnetic resonance imaging (fMRI) scans of the participants at the beginning and end of the study.

In patients who benefited from constraint therapy, says Page, fMRI scans clearly show activity in brain areas that weren’t active at the start of the study

“To our knowledge,” says Page, “this is the first study showing this kind of ‘rewiring.’ We think it’s particularly important to stroke patients, because this particular outpatient therapy is often covered by insurance providers, so it’s quite accessible.”

Coauthors—all from UC—include Brett Kissela, MD, Jing-Huei Lee, PhD, Peter Levine, Stephen Strakowski, MD, and Jerzy Szaflarski, MD.