Constraint induced movement therapy in subacute stroke

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DESCRIPTION (provided by the applicant): SPECIFIC AIMS: 1. Evaluate the effects of two weeks of treatment with Constraint Induced Movement therapy (CIMT) combined with behavioral training of the paretic upper limb on motor recovery in patients with ischemic or hemorrhagic stroke who are initially treated within 14 days poststroke. 2. Investigate reorganization of cortical motor representation using transcranial magnetic stimulation (TMS) after two weeks of combined CIMT and behavioral training of the paretic upper limb in patients who begin treatment within 14 days after onset of ischemic or hemorrhagic stroke. 3. Using transcranial magnetic stimulation, investigate the relationship between changes in cortical representation and improvement in motor function of the affected upper limb in patients treated within 14 days after sustaining ischemic or hemorrhagic stroke. HYPOTHESES: 1. CIMT given daily for two weeks concomitant with behavioral training of the affected upper limb facilitates motor recovery relative to an equal number of sessions of traditional therapy in patients who are initially treated by day 14 after ischemic or hemorrhagic stroke. 2. Combined CIMT and behavioral training of the affected upper limb administered daily for 2 weeks beginning by day 14 post-stroke will increase cortical representation of the affected hand as measured by TMS. 3. Improved motor function of the affected upper limb will be related to the post treatment increase in cortical representation on TMS.