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Cortical Reorganization After Modified Constraint-Induced Movement Therapy in Pediatric Hemiplegic Cerebral Palsy

Department of Pediatrics University of Toronto Faculty of Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, California

William C. Gaetz, PhD

Department of Diagnostic Imaging University of Toronto Faculty of Medicine, Neuromagnetic Imaging Laboratory, Hospital for Sick Children Research Institute

William J. Logan, MD, FRCPC

Department of Pediatrics University of Toronto Faculty of Medicine

Douglas O. Cheyne, PhD

Department of Diagnostic Imaging University of Toronto Faculty of Medicine, Neuromagnetic Imaging Laboratory, Hospital for Sick Children Research Institute

Darcy L. Fehlings, MD, MSc, FRCPC

Department of Pediatrics University of Toronto Faculty of Medicine, Bloorview Research Institute, Bloorview Kids Rehab, Toronto, Ontario, Canada,dfehlings{at}bloorview.ca

Constraint-induced movement therapy improves motor function in the affected hand of children with hemiplegic cerebral palsy and results in cortical changes in adults with stroke. This study measured clinical improvement and cortical reorganization in a child with hemiplegia who underwent modified constraint-induced movement therapy for 3 weeks. Clinical, functional magnetic resonance imaging and magnetoencephalography measurements were done at baseline, after therapy, and 6 months after therapy. Modified constraint-induced movement therapy resulted in clinical improvement as measured by the Pediatric Motor Activity Log. Functional magnetic resonance imaging showed bilateral sensorimotor activation before and after therapy and a shift in the laterality index from ipsilateral to contralateral hemisphere after therapy. Magnetoencephalography showed increased cortical activation in the ipsilateral motor field and contralateral movement evoked field after therapy. Cortical reorganization was maintained at the 6-month follow-up. This is the first study to demonstrate cortical reorganization after any version of constraint-induced movement therapy in a child with hemiplegia.

Key Words: constraint-induced movement therapy • cerebral palsy • functional magnetic resonance imaging • magnetoencephalography • synthetic aperture magnetometry

Journal of Child Neurology, Vol. 22, No. 11, 1281-1287 (2007)
DOI: 10.1177/0883073807307084


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