Constraint Induced Movement Therapy influence of restraint and type of training on performance and on brain plasticity

...........................................................................6 ABBREVIATIONS ................................................................7 ORIGINAL PAPERS.............................................................8 PREFACE ...............................................................................9 INTRODUCTION ................................................................10 Stroke epidemiology.................................................................... 10 Impairments and functional recovery after stroke.................. 10 Theories of motor control........................................................... 10 Modern knowledge about motor control of the hand.............. 11 Constraint Induced Movement Therapy .................................. 12 The learned non-use phenomenon ....................................... 12 Patients eligible for CIT....................................................... 14 Modes of hand training in CIT............................................. 15 Limitations of traditional CIT.............................................. 15 Modifications of CIT ........................................................... 15 Effects of CIT....................................................................... 16 Brain plasticity ............................................................................ 16 Mechanisms of plasticity ..................................................... 16 How to measure brain plasticity .......................................... 17 Methodological considerations................................................... 18 AIMS......................................................................................19 METHODS............................................................................20 Patients and subjects................................................................... 20 Inclusion criteria ......................................................................... 20 Interventions................................................................................ 20 Test procedure paper II.............................................................. 21 Outcome measures ...................................................................... 22 Transcranial Magnetic Stimulation ......................................... 22 Statistics ....................................................................................... 23 Ethics ............................................................................................ 24 SUMMARY OF RESULTS.................................................25 Effectiveness of modified forms of CIT (papers I and III)...... 25 Effects of mitt use (papers I and III) ......................................... 25 Effects on somatosensory function (papers I and III) ............. 25 Effects on dexterity and brain plasticity after shaping and general activity training (paper IV) .......................................... 26