Effect of modified constraint-induced movement therapy on lower extremity hemiplegia due to a higher-motor area lesion

Background: Modified CIT (mCIT) was performed in a stroke patient with a lesion in the left medial frontal region including the supplementary motor area (SMA), which is part of the higher-motor area, and whose primary symptom was motor ignition difficulty observed at the start of voluntary movement of the right leg. Case study: mCIT was performed from awakening to bedtime (not including bath time) with his non-affected limb fixed with a knee splint while he was in the hospital ward. Two days (the total time he wore the appliance was 19.5 hours) after the intervention was introduced, voluntary movement of the right leg occurred, and functional improvement was observed. Conclusions: These findings are speculated to be related to the facts that the unilateral SMA strongly contributes to movement of the ipsilateral limb and that the plasticity of the SMA, which is a higher-motor area, is greater than that of primary areas. It is probable that different regions of the brain have different plasticity, resulting in differences in the process of functional recovery and the level of recovery.