Treatment for Movement Problems in Elderly Stroke Patients

Stroke afflicts over 700,000 Americans each year. Behavioral techniques that impact
plasticity of the nervous system need to be incorporated into practical, evidence-based
therapeutic interventions. This is especially true at a time when the duration of
treatments reimbursed by third party payers has shortened.

CI therapy was derived from basic research with animal subjects and human volunteers.
Randomized, controlled studies indicate that it can substantially reduce the motor deficit
of patients with mild to moderate chronic strokes and can increase their independence over a
period of years. CI therapy involves motor restriction of the less affected upper extremity
for a period of 2 to 3 weeks while concurrently training the more affected upper limb. This
gives rise to massed or concentrated repetitive use of the more affected extremity. CI
therapy leads to a large increase in use-dependent cortical reorganization involving the
recruitment of other regions of the brain in the innervation of the more affected extremity
movement.

One of the main aims of the proposed research is to determine if CI therapy can be used with
therapeutic success for increasing the amount of real-world extremity use in patients with
chronic stroke. Another aim is to ascertain whether the locus of the lesion and its size,
as determined by MRI, are factors influencing the extent to which motor function can be
recovered through the use of CI therapy.

Eighty patients with chronic stroke will be randomly assigned to receive either CI therapy
or a General Fitness control intervention. Two years after study entry, the patients in the
control group will be crossed over to receive CI therapy. Primary outcome measures will be a
laboratory motor function test and amount of extremity use in the real-world setting.
Changes in psychosocial functioning will also be measured.