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

Constraint-Induced Movement (CI) therapy has been found to produce substantial improvements in upper-extremity functioning in both adults and children following damage to the central nervous system (CNS), including stroke, traumatic brain injury and cerebral palsy. In addition, structural changes in the sensorimotor cortices and bilateral hippocampi have been observed in both adults and children following CI therapy treatment for upper extremity hemiparesis. Although most research has been conducted in patients with such static injuries as strokes and TBI, clinical efficacy of CI therapy has also been demonstrated in a small number of patients with the progressive autoimmune disorder, multiple sclerosis (MS). However, neurostructural changes occurring alongside motor improvement in MS patients had not yet been explored and may differ from the neuroplastic changes identified in patients with stroke and cerebral palsy due to the progressive nature of the disorder and different nature of the CNS lesions. The present study utilized voxel-based morphometry (VBM) to evaluate structural changes in the brain due to CI therapy compared to a complementary and alternative medicine (CAM) comparison treatment group. Eighteen patients with hemiparetic, progressive presentations of MS were randomized to receive either CI therapy or CAM techniques for 3.5 hours per day over 10 consecutive weekdays. Patients underwent MRI scanning and were given tests of motor ability before and after treatment. VBM was used to analyze MRI scans and determine magnitude and location of any grey matter changes within the two treatment groups. Neurostructural changes were correlated with motor abilities as measured by the Wolf Motor Function Test and Motor Activity Log. Participants who received CI therapy showed significant grey-matter increases in bilateral sensorimotor areas. No significant grey matter changes were seen following CAM treatment and no significant correlation was found between changes in grey matter and performance for either the CI therapy group or the CAM group. These results confirm the efficacy of CI therapy in improving use of the more-affected arm in daily life for individuals with MS and are similar to previous CI therapy studies which found significant motor improvement and grey matter increases following injury to the CNS.

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