Journal of Taiwan Occupational Therapy Research and Practice
Objective: Constraint-induced therapy (CIT) and bilateral training have shown beneficial effects in improving motor function and control of upper extremity (UE) for patients with stroke. This review intends to underscore the treatment mechanisms of CIT and bilateral trainings from the perspective of brain plasticity and reorganization. Summary of Reviews: CIT consists of restricted use of the unaffected UE, intensive training of the affected UE, and is usually applied to stroke patients with mild-to-moderate motor impairments. The CIT studies using the functional neuroimaging techniques have shown that the CIT induced changes in activity in ipsileional sensorimotor cortex, contralesional motor cortex, and perilesional cortex, and facilitate restoration of the normal balance of excitability of the two hemispheres. In contrast, patients with severe motor impairment are more appropriate to be treated by the bilateral training than by the CIT because existing neural networks and connections in patients with lower motor function are not sufficient for activation of the recovered limb. The bilateral symmetrical movements could activate similar neural networks in both hemispheres, reinforce the coupling effects between the two limbs, and promote the involvement of ipsileional projections to restoration of function in affected UE. Conclusions: This review summarized and compared the brain reorganizations after CIT and bilateral training for understanding the neural basis of treatment-induced plasticity, and to promote the optimum of motor rehabilitation for patients with stroke. Future research may underscore the factors that might mediate effects of CIT and bilateral trainings.