Constraint-induced movement therapy for individuals after cerebral hemispherectomy: a case series

Abstract

Background and purpose: This case report describes the feasibility and efficacy of the use of constraint-induced movement therapy (CIMT) in 4 individuals (aged 12-22 years) who underwent cerebral hemispherectomy (age at time of surgery=4-10 years). The aims of this case series were: (1) to evaluate the feasibility of this therapeutic approach involving a shortened version of CIMT, (2) to examine improvements that occurred within the upper extremity of the hemiparetic side, (3) to investigate the feasibility of conducting brain imaging in individuals with depressed mental ages, and (4) to examine changes in the sensorimotor cortex following intervention.

Case description: The patients received a shortened version of CIMT for 3 hours each day for a period of 10 days. In addition, a standard resting splint was used for the unimpaired hand for an 11-day period. Each patient was encouraged to wear the splint for 90% of his or her waking hours. The following outcome measures were used: the Actual Amount of Use Test (AAUT), the Box and Block Test (BBT), and the upper-extremity grasping and motor portions of the Fugl-Meyer Assessment of Motor Recovery (FM).

Outcomes: Immediately after therapy, improvements were found in AAUT and BBT scores, but no improvements were found in FM scores. Three patients underwent brain imaging before and after therapy and showed qualitative changes consistent with reorganization of sensorimotor cortical representations of both paretic and nonparetic hands in one isolated hemisphere.

Discussion: The findings suggest that CIMT may be a feasible method of rehabilitation in individuals with chronic hemiparesis, possibly leading to neuroplastic therapy-related changes in the brain.

Figure 1.

Individual Scores for the Actual Amount of Use Test (AAUT)

Figure 2.

Individual Scores for the Box and Block Test

Figure 3.

Functional magnetic resonance imaging (fMRI) activations of the paretic hand before therapy (green) and after therapy (red) and for the nonparetic hand (blue) for 2 of the 3 patients who underwent fMRI testing.

Figure 4.

Cortical representation of the nonparetic (blue) and paretic (red) hands in patient 4 following therapy.