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Journal of the Korean Academy of Rehabilitation Medicine 2009;33(4):408-414.
Effects of the Constraint-Induced Movement Therapy on Cortical Reorganization in Patients with Hemiplegic Cerebral Palsy.
Lee, Zee Ihn , Byun, Seung Deuk , Chun, Kyung Ah
1Department of Rehabilitation Medicine, Dae-gu Fatima Hospital, Korea. sato1009@hanmail.net
2Department of Nuclear Medicine, Yeungnam University College of Medicine, Korea.
소아 편마비 환자에서 구속유도 운동치료가 뇌피질 재조합에 미치는 영향
이지인, 변승득, 천경아1
대구파티마병원 재활의학과, 1영남대학교 의과대학 핵의학교실
Abstract
Objective
To investigate the effects of modified constraint- induced movement therapy (CIMT) on motor function and cortical activation in children with hemiplegic cerebral palsy (CP).
Method
Five children with hemiplegic cerebral palsy were studied with Jebsen hand function test and quality of upper extremity skills test (QUEST), dynamic electromyography (EMG), and single photon emission computed tomography (SPECT) at rest before and after the CIMT period. Children were treated with a 4-week protocol of modified CIMT, consisting of twice-weekly 2-hour sessions of structured activities and a home program for non-treatment days. Children wore orthoses on their less affected upper extremities for 6 hours per day, during which time they were engaged in play, functional activities and 2-hour protocol of motor tasks.
Results
Improvements in upper-extremity function were found in Jebsen hand function test and QUEST. Increased muscle activities in elbow extensors were observed in dynamic EMG during affected hand grip. In right hemiplegic patients, regional cerebral perfusion increased in right Brodmann area (BA) 3 and lentiform nucleus. In left hemiplegic patients, regional cerebral perfusion increased in right BA 6, 9, 21, left BA 19 and left cerebellum, but decreased in left BA 11.
Conclusion
Modified CIMT appears to change local cerebral perfusion in areas known to participate in movement planning and execution. These changes might be a sign of cortical activation after CIMT in the children with hemiplegic cerebral palsy.
Results
of this study suggest that modified CIMT may be an effective way of treating children with hemiplegic CP. (J Korean Acad Rehab Med 2009; 33: 408-414)
Key Words: Constraint-induced movement therapy (CIMT), Hemiplegic cerebral palsy, Single photon emission computed tomography (SPECT), Cortical activation


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