Constraint Induced Movement Therapy as a Rehabilitative Strategy for Ischemic Stroke-Linking Neural Plasticity with Restoration of Skilled Movements

Abstract

Background: Stroke leads to devastating impact on health as well as quality of life making it one of the leading causes of disability. Restoring the functions of upper extremities after ischemic (ISC) stroke is one of the challenges for rehabilitation. Lack of trained professionals and accessibility to rehabilitation centers are limited in many counties. Constraint induced movement therapy (CIMT) has been practiced in regaining the functional activity following stroke. CIMT can be practiced with minimum clinical set up which makes it cost effective. However, the neural plasticity mechanism underlying the recovery with CIMT is not well understood.

Methods: In the current study, we sought to investigate the extent to which CIMT helps in ameliorating neurological deficits in rat model of ISC stroke, induced by Endothelin-1 (ET-1). As well as to understand the cortical plasticity with Golgi-Cox staining and interhemispheric interaction with biotinylated dextran amine (BDA) following CIMT. Neurological deficits were identified within 24 hours of ET-1 infusion.

Results: CIMT restored the impaired skilled movements after ISC stroke and improved the quality of fine movements. Golgi-Cox staining showed significant decrease in dendritic arborization in the injured motor cortex following ISC stroke. CIMT was efficient in reversing this effect as indicated by increased dendritic arborization especially in layer III pyramidal neurons. Also, the stroke induced asymmetry in dendritic length across both hemispheres was found to be reduced with CIMT. BDA tracing showed a re-establishment of the axonal connections between the hemispheres after CIMT.

Conclusions: Implications of CIMT can be one of the promising and low cost rehabilitative technique for the individuals with upper limb movement deficits.

Keywords: Ischemic stroke; constraint induced movement therapy; endothelin 1; functional recovery; layer III pyramidal neurons; motor cortex; neural plasticity; reach to grasp task.