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- Title
(RHI01) Significant Structural Neuroplasticity Changes Can Follow Physical Behavioral Change Therapy for Multiple Sclerosis.
- Authors
Mark, Victor W.; Womble, Brent M.; Uswatte, Gitendra; Morris, David M.; Bowman, Mary H.; McKay, Staci; Taub, Edward
- Abstract
Background: Constraint-induced movement therapy (CIMT) is a form of physical behavioral change therapy (BCT) that can significantly improve paretic limb use in the community in progressive multiple sclerosis (MS) for at least 1 year (Mark et al, 2018). Although a few forms of BCT can increase real-life physical activity in MS, none thus far has been examined for whether such treatment can change cerebral cortical grey matter structure. Objectives: To evaluate whether CIMT vs dose-matched control physical training can change cortical grey matter structure in progressive MS. Methods: Twenty adults with chronic MS matched for unilateral arm disability were randomized to 35 hours/2 weeks of either CIMT or a holistic complementary and alternative medicine (CAM) program (yoga, aquatic therapy, massage, relaxation techniques). Paretic limb use was measured with the Motor Activity Log (MAL), which has been validated against real-world upper limb accelerometry. Pre- and post-treatment 3-T structural brain magnetic resonance imaging scans were performed. Tensor-based morphometry (TBM) and voxel-based morphometry (VBM) were used to evaluate group-level changes in primary motor cortex (M1) structure contralateral to the more-affected arm. Whole-brain statistics were conducted using 1-sample t tests within Statistical Parametric Mapping software with a cluster-extent threshold of 10 voxels and false discovery rate of 0.1. Results: The 2 groups were identical in high expectancy to benefit. CIMT produced a much larger effect size (d' = 3.2) on the MAL than did CAM (d' = 0.7). TBM detected an increase in the thickness of M1 after CIMT but not after CAM. VBM detected a change in M1 after CIMT, suggesting an increase in cortical density or volume or both. No change was detected after CAM. Conclusions: TBM and VBM suggest that CIMT increases M1 thickness and either volume or density in MS, unlike dose-matched CAM. The findings suggest for the first time that physical BCT can significantly stimulate cortical neuroplasticity in a degenerative central nervous system disorder. The findings accord with our previous findings of post-CIMT significant white matter structural improvement in progressive MS (Barghi et al, 2018) and grey matter increases in stroke (Gauthier et al, 2008) and cerebral palsy (Sterling et al, 2013). Together, these findings suggest that a specific form of physical BCT can not only stimulate physical activity in the community over the long term but also well improve neurologic structure for progressive MS.
- Subjects
CEREBRAL cortex anatomy; BEHAVIOR modification; BEHAVIOR therapy; CONFERENCES &; conventions; MULTIPLE sclerosis; NEUROPLASTICITY; CONSTRAINT-induced movement therapy; BODY movement; TREATMENT effectiveness; GRAY matter (Nerve tissue); EVALUATION
- Publication
International Journal of MS Care, 2020, Vol 22, Issue S2, p7
- ISSN
1537-2073
- Publication type
Article