뇌의 재조직화를 이용한 중풍재활운동(CI movement therapy)

[문형철]

뇌는 평생에 걸쳐 수초화하면서 끊임없이 변화한다. 이를 "가소성(plasticity)"이라하고 "뇌의 재조직화(reorganization)"라고 하기도 한다.

중풍환자가 한쪽 팔다리를 못쓸때 뇌의 재조직화를 유도할 수 있는 재활운동법이 있다.

CI( constraint-induce) movement therapy

하루 6-8시간씩, 2주정도 정상팔을  못쓰게 박탈시키면 병이 발생한 팔을 억지로 사용하면서 뇌가 재조직화되어 빠른 재활운동이 된다.

panic bird...

Alterations in cortical excitability in chronic-stroke afte.pdf

C-I Movement Therapy during early stroke rehabilitationj.pdf

Background. Limited data are available about the effectiveness of early rehabilitation after stroke.

Objective. This is the 1st randomized controlled trial of constraint-induced movement therapy (CIMT) in subacute stroke to investigate neurophysiologic mechanisms and long-term outcome.

Methods. Within 2 weeks after stroke, 23 patients with upper extremity (UE) weakness were randomized to 2 weeks of CIMT or traditional therapy at an equal frequency of up to 3 h/day. Motor function of the affected UE was blindly assessed before treatment, after treatment, and 3 months after stroke. Transcranial magnetic stimulation (TMS) measured the cortical area evoking movement of the affected hand.

Results. Long-term improvement in motor function of the affected UE did not differ significantly between patients who received CIMT versus intensive traditional therapy. All outcome comparisons showed trends favoring CIMT over intensive traditional therapy, but none was statistically significant except for improvements in the Fugl-Meyer (FM) UE
motor scale immediately following treatment and in reported quality of hand function at 3 months. Improvement in UE
motor function on the FM was associated with a greater number of sites on the affected cerebral hemisphere where
responses of the affected hand were evoked by TMS.

Conclusions. Future trials of CIMT during early stroke rehabilitation need greater statistical power, more inclusive eligibility criteria, and improved experimental control over treatment intensity. The relationship between changes in motor function and in evoked motor responses suggests that motor recovery during the 1st 3 months after stroke is associated with increased motor excitability of the affected cerebral hemisphere.

Alterations in cortical excitability in chronic stroke after constraint-induced movement therapy

Objective: Cerebral stroke is a major cause for long-term disability in the elderly and it is often manifested in hemiparesis of the upper extremity. Constraint-induced movement therapy (CIMT), an intensive 2 week rehabilitation program, improves affected upper limb motor abilities in subjects with stroke. Intensive training has also been suggested to modify neural function. We wanted to find out if there are changes in cortical excitability in subjects with chronic stroke after CIMT.

Methods: Participants were 13 subjects with stroke who fulfilled the entry criteria for the CIMT program. The motor function of the affected arm and hand was assessed using a structured motor behavior test (WMFT). The cortical excitability changes were assessed in regard to involuntary and voluntary motor control, former with transcranial magnetic stimulation (TMS) and latter with movement-related cortical potentials (MRCP).

Results: The motor abilities of the affected arm improved after 2 week rehabilitation (total time in WMFT shortened 36%). The motor-evoked potential (MEP) amplitudes were unchanged following the stimulation of the non-affected emisphere; however, the MEP amplitudes of lateral stimulation locations increased significantly in the affected side after the intervention. The power spectra of MRCPs revealed reduced peak frequency over the supplementary motor area
when the affected hand was moved. However, no changes occurred when the healthy hand was moved.

Discussion: We show changes in cortical electrical excitability while performing both involuntary and voluntary movements after 2 weeks of CIMT in subjects with chronic stroke. These changes may be seen as a sign of neural reorganization instigated by the intervention.