Phase II Randomized Controlled Trial of Constraint-Induced Movement Therapy in Multiple Sclerosis. Part 2: Effect on White Matter Integrity.
Ameen Barghi, Jane B Allendorfer, Edward Taub and 5 others
PMID 29668401WHAT IT FOUND
A constraint-induced movement therapy package of intensive more-affected arm training, shaping, transfer procedures and a restraining mitt increased white matter integrity in this small pilot of people with MS.
Relaxation, aquatic therapy, massage, music and yoga did not. Components cannot be separated.
Key findings
01The constraint-induced movement therapy package, comprising intensive more-affected arm training, shaping, transfer procedures and a restraining mitt, showed significant pre-post white matter improvements; the relaxation, aquatic therapy, massage, music and yoga package showed none.
02In the constraint package group, fractional anisotropy increased in posterior corpus callosum contralateral to the trained arm and in superior occipital gyrus ipsilateral to it; axial diffusivity increased in ipsilateral superior temporal gyrus, while mean and radial diffusivity decreased in contralateral corticospinal tract.
03Motor Activity Log improvement was correlated with fractional anisotropy increases in corpus callosum (r = 0.61, p < 0.01) and occipital gyrus (r = 0.57, p < 0.01), but Wolf Motor Function Test changes were not correlated with white matter changes.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTs
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What it does not show
The study was a small pilot with 10 participants in each group, so it cannot establish how well the treatment works. The study measured only before and after treatment, so it does not show whether changes lasted. The paper does not report how randomisation was done, whether allocation was concealed, or how many participants were analysed after randomisation. Participants had a variety of non-overlapping white matter lesions, which made comparisons less sensitive to small changes. Diffusion tensor imaging detects changes more readily in areas without crossing fibers, such as corpus callosum and corticospinal tract, so changes in other areas may have been missed. Analyses were one-tailed because the authors expected a positive change, and some regions were examined at a relaxed threshold of alpha = 0.1. The white matter results are MRI research measures, not routine clinical outcomes, and the Wolf Motor Function Test showed similar improvement in both groups.
Declared interests
The article is tagged as supported by NIH extramural and non-U.S. government research; no author conflict declaration is provided.
The easy way to misread this
Do not conclude that constraint-induced movement therapy alone changed white matter or that MRI changes prove clinical benefit. The study was a small pilot, the intervention was a package of intensive more-affected arm training, shaping, transfer procedures and a restraining mitt, and the paper does not show which component produced the effect.