Constraint-Induced Movement Therapy (CIMT) in patients with congenital hemiparesis: Differences between two groups of patients, one with controlateral, one with ipsilateral cortico-spinal reorganisation

Objectives: CIMT is an established therapy for adults with acquired stroke and has been shown to be effective in the rehabilitation of children with congenital hemiparesis. In this CIMT study concerning congenital hemiparesis we compared the therapy-outcome between patients with contralateral cortico-spinal reorganisaition (Group 1) and patients with ipsilateral cortico-spinal reorganisation of the non-affected hemisphere (Group 2). Method: Group 1: n=7; 10–30 years old; MRT: unilateral cortico-subcortical infarcation in the arteria cerebri media area; transcranial magnetstimulation (TMS): persisting overcrossing projection to the paretic hand. Group 2: n=9; 10–29 years old; MRT: unilateral periventricular lesion. TMS: reorganised ipsilateral projection from the intact hemisphere to the paretic hand. CIMT: 12 day training period in an in-patient setting, restraint of the non-paretic hand by a immobile glove (worn from 8:00 a.m to 7:00p.m.); Shaping exercises were developed according to the patients functional goals. Results: The WMFT results showed an improvement in the quality of movement (scale 1–5) for both groups (Group 1: 3.73±0.64 → 4.17±0.70; p=0.016; Group 2: 3.3±0.35 → 3.9±0.24; p=0.007. Only Group 1 showed an improvement regarding the time of performance (1.7s±0.33s → 1.5s±0.41s, p=0.018), Group 2 to on the other hand showed a decline regarding the time of performance (2.2s±0.79s → 2.8±0.76; p=0.051; Wilcoxon). Conclusion: Different types of cortico-spinal (re-) organisation show different outcomes in the effectiveness of CIMT. Our results suggest that patients with ipsilateral cortico-spinal reorganisation may only be able to improve in the quality of movement by loosing out in speed.