All ETDs from UAB

Advisory Committee Chair

Edward Taub

Advisory Committee Members

David Knight

Victor W Mark

John Rinker

Gitendra Uswatte

Document Type

Dissertation

Date of Award

2014

Degree Name by School

Doctor of Philosophy (PhD) College of Arts and Sciences

Abstract

In adults with chronic stroke and children with cerebral palsy, structural changes in grey matter correlate with clinical improvements due to an efficacious upper-extremity (UE) rehabilitation therapy, Constraint-Induced Movement (CI) Therapy. Changes in white matter following CI therapy have not been observed, but damage to white matter tracts has not been found to decrease motor improvement resulting from this treatment. The objectives of this project were to: 1) evaluate the efficacy of CI therapy compared to complementary and alternative medicine (CAM) treatments on improving impaired UE function in participants with the progressive form of multiple sclerosis (MS), 2) investigate whether white matter integrity is correlated with motor function prior to treatment and improvement due to therapy, and 3) determine if change in white matter tracts is associated with CI therapy. Diffusion Tensor Imaging (DTI) was utilized to quantify white matter integrity. Eighteen participants with hemiparetic slowly progressing MS received either CI therapy or a set of CAM techniques. Fractional anisotropy (FA) values were calculated over the whole brain prior to and following treatment and tractography was used to isolate the corticospinal tract (CST). The CI therapy group improved use of the more-affected arm in the life situation that was 4.1 times greater than the CAM group. The groups improved similarly on the in-laboratory measure of arm function. FA value of the CST was not related to motor function. Pretreatment contralateral CST FA value correlated with motor improvement following CI therapy, but not CAM treatments. These results confirm the efficacy of CI therapy in improving motor function in individuals with CNS damage. The lack of a relationship between pretreatment motor function and integrity of the CST in individuals with MS may suggest that motor function relates to another structure necessary for motor function and a site of frequent pathology in individuals with MS: the spinal cord. Pretreatment integrity of the CST related to improvement in motor function following CI therapy.

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