Annals of Rehabilitation Medicine

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"Neural plasticity"

Review Article

Pediatric rehabilitation

Constraint-Induced Movement Therapy in Children With Hemiplegic Cerebral Palsy: A Scoping Review of Functional Outcomes and Neuroplasticity-Related Evidence: Maria Grazia Maggio, Maria Chiara Valeri, Raffaela Maione, Angela Militi, Alex Martino Cinnera, Irene Ciancarelli, Rocco Salvatore Calabrò, Giovanni Morone; Ann Rehabil Med 2026;50(2):94-104. Published online April 22, 2026; DOI: https://doi.org/10.5535/arm.250165

Objective
To synthesize the available evidence on the effects of constraint-induced movement therapy (CIMT) in children with hemiplegic cerebral palsy (CP), focusing on upper limb functional outcomes and neuroplasticity-related changes assessed through direct or indirect measures.
Methods
This scoping review was conducted in accordance with PRISMA-ScR guidelines and was prospectively registered on the Open Science Framework (DOI: 10.17605/OSF.IO/DU8RE). A search of four databases (PubMed, Scopus, Embase, and Web of Science) was performed to identify studies involving children (0–18 years) with CP who received CIMT as the primary intervention. Eligible studies assessed neuroplasticity through neuroimaging or neurophysiological techniques.
Results
Eleven studies involving 221 children met the inclusion criteria. CIMT protocols varied in duration, intensity, and setting (e.g., clinical, home-based, camp-based). Across studies, CIMT was associated with improvements in upper limb function and spontaneous use. Neuroplastic changes included increased activation in the contralateral sensorimotor cortex, normalization of somatosensory responses, and structural brain adaptations. Adjunctive therapies such as repetitive transcranial magnetic stimulation, transcutaneous auricular vagus nerve stimulation, or occupational therapy further enhanced outcomes.
Conclusion
CIMT is an effective intervention that promotes cortical reorganization and improves motor function in children with hemiplegic CP. Customizing rehabilitation based on neurophysiological profiles may optimize clinical outcomes.

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Original Article

The Persisted Effects of Low-Frequency Repetitive Transcranial Magnetic Stimulation to Augment Task-Specific Induced Hand Recovery Following Subacute Stroke: Extended Study: Jarugool Tretriluxana, Jenjira Thanakamchokchai, Chutima Jalayondeja, Narawut Pakaprot, Suradej Tretriluxana; Ann Rehabil Med 2018;42(6):777-787. Published online December 28, 2018; DOI: https://doi.org/10.5535/arm.2018.42.6.777

Abstract
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Objective
To examine the long-term effects of the low-frequency repetitive transcranial magnetic stimulation (LFrTMS) combined with task-specific training on paretic hand function following subacute stroke.
Methods
Sixteen participants were randomly selected and grouped into two: the experimental group (real LFrTMS) and the control group (sham LF-rTMS). All the 16 participants were then taken through a 1-hour taskspecific training of the paretic hand. The corticospinal excitability (motor evoke potential [MEP] amplitude) of the non-lesioned hemisphere, and the paretic hand performance (Wolf Motor Function Test total movement time [WMFT-TMT]) were evaluated at baseline, after the LF-rTMS, immediately after task-specific training, 1 and 2 weeks after the training.
Results
Groups comparisons showed a significant difference in the MEP after LF-rTMS and after the training. Compared to the baseline, the MEP of the experimental group significantly decreased after LF-rTMS and after the training and that effect was maintained for 2 weeks. Group comparisons showed significant difference in WMFT-TMT after the training. Only in the experimental group, the WMFT-TMT of the can lifting item significantly reduced compared to the baseline and the effect was sustained for 2 weeks.
Conclusion
The results of this study established that the improvement in paretic hand after task-specific training was enhanced by LF-rTMS and it persisted for at least 2 weeks.

Citations

Citations to this article as recorded by

Effects of electrical and magnetic stimulation on upper extremity function after stroke: A systematic review and network meta‐analysis
Apisara Keesukphan, Monchai Suntipap, Kunlawat Thadanipon, Suparee Boonmanunt, Pawin Numthavaj, Gareth J. McKay, John Attia, Ammarin Thakkinstian
PM&R.2025; 17(8): 978. CrossRef
A meta-analysis of the effects of transcranial magnetic stimulation on hand function and daily living ability after stroke
Yue Shen, Jinchao Du, Xiaoduo Yao, Jiqin Tang
Medicine.2025; 104(35): e44029. CrossRef
Effects of Repetitive Transcranial Magnetic Stimulation on Upper and Lower Limb Motor Function and Spasticity After Stroke: A Meta-Analysis
Hoo Young Lee, Byungju Ryu
Brain & Neurorehabilitation.2025;[Epub] CrossRef
Application effectiveness analysis of multidisciplinary collaboration within the Enhanced Recovery After Surgery concept in elderly patients undergoing hip fracture surgery
Chao Duan, Guoliang Che, Lin Yang, Zhengzhi Liu, Yi Wang
Geriatrics & Gerontology International.2025; 25(8): 1089. CrossRef
High-frequency rTMS and home-based exercise in individuals with Parkinson’s disease: A double-blind randomized controlled trial
Jenjira Thanakamchokchai, Amornpan Ajjimaporn, Jim Richards, Sutang Tantanavivat, Paulo Roberto Pereira Santiago, Papatsorn Ramyarangsi, Prachaya Srivanitchapoom, Weerawat Saengphatrachai, Yuvadee Pitakpatapee, Jarugool Tretriluxana, Fuengfa Khobkhun
Clinical Neurophysiology.2025; 178: 2110957. CrossRef
Applications of Repetitive Transcranial Magnetic Stimulation to Improve Upper Limb Motor Performance After Stroke: A Systematic Review
Afifa Safdar, Marie-Claire Smith, Winston D. Byblow, Cathy M. Stinear
Neurorehabilitation and Neural Repair.2023; 37(11-12): 837. CrossRef
The Application of Technological Intervention for Stroke Rehabilitation in Southeast Asia: A Scoping Review With Stakeholders' Consultation
Siti Nur Suhaidah Selamat, Rosalam Che Me, Husna Ahmad Ainuddin, Mazatulfazura S. F. Salim, Hafiz Rashidi Ramli, Muhammad Hibatullah Romli
Frontiers in Public Health.2022;[Epub] CrossRef
Effects of transcranial magnetic stimulation in modulating cortical excitability in patients with stroke: a systematic review and meta-analysis
Zhongfei Bai, Jiaqi Zhang, Kenneth N. K. Fong
Journal of NeuroEngineering and Rehabilitation.2022;[Epub] CrossRef

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Case Report

Ipsilateral Motor Pathway Confirmed by Brain Mapping in a Patient with Traumatic Brain Injury: A case report.: Jang, Sung Ho , Han, Bong Soo , Chang, Yongmin , Byun, Woo Mok , Ahn, Sang Ho , Kim, Sung Ho; J Korean Acad Rehabil Med 2000;24(6):1202-1206.

Abstract
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The aim of this study is to investigate the mechanism of motor recovery using both functional Magnetic Resonance Imaging (fMRI) and Transcranial Magnetic Stimulation (TMS) in a patient with hemorrhagic contusion on the right basal ganglia area. Functional MRI showed that the left primary sensorimotor cortex and the supplementary motor area were activated when the right fingers performed the flexion-extension exercise. On the other hand, the bilateral primary sensorimotor cortex and the left premotor area were activated with the excerise of left hand. Brain mapping for both abductor pollicis brevis muscles (APB) using TMS revealed that ipsilateral motor evoked potentials (MEPs) were obtained at left APB. Ipsilateral MEPs of left APB showed delayed latency and lower amplitude compared to that of right APB when stimulated at the left motor cortex. We concluded that ipsilateral motor pathway from undamaged motor cortex seems to contribute to the motor recovery in this patient and combining TMS with fMRI may provide a powerful tool for investigating the mechanism of motor recovery.