No abstract

In recent years, our understanding of motor learning, neuroplasticity and functional recovery after the occurrence of brain lesion has grown significantly. New findings in basic neuroscience provided stimuli for research in motor rehabilitation. Repeated motor practice and motor activity in a real world environment have been identified in several prospective studies as favorable for motor recovery in stroke patients. EMG initiated electrical muscle stimulation -- but not electrical muscle stimulation alone -- improves motor function of the centrally paretic arm and hand. Although a considerable number of physiotherapeutic "schools" has been established, a conclusive proof of their benefit and a physiological model of their effect on neuronal structures and processes are still missing. Nevertheless, evidence-based strategies for motor rehabilitation are more and more available, particularly for patients suffering from central paresis.

Moderate unilateral weakness of shoulder and hip muscles and limb-kinetic apraxia were observed in 11 patients with frontal lobe lesions on the side opposite to the neurological deficits. On the CT scans, the posterior border of the lesions lay anterior to the precentral gyrus, thus involving the premotor cortex but not the primary motor cortex. In 9 cases, the lesions were caused by a brain infarct, in 2 cases by a tumour. In 1 patient the lesion was purely subcortical. Whereas the paresis affected all hip muscles, in the shoulder mainly those movements associated with abduction and elevation of the arm were disturbed. The EMG showed considerable delays for the preactivation of proximal arm muscles during rapid arm movements, thus interfering with the normal proximal-distal sequencing of muscle action. Limb-kinetic apraxia only became apparent during tasks requiring certain coordinations between both arms or legs. Bimanual interaction was normal. Two patients with proximal hemiparesis and small lesions in the precentral gyrus which have been examined for comparison showed no limb-kinetic apraxia and different distributions of the paretic shoulder girdle muscles. In view of the long-standing controversies as to the functional role of the premotor cortex and the question of specific deficits after lesions of this area, the relevant literature is reviewed.

It was found that 14 hours of aphasia therapy administered within 2 weeks as individual therapy, focusing on individual deficits, combined with group sessions has proven to be most efficient. This approach yielded the same outcome as 30 hours of group therapy, either in the form of CIAT or group therapy without constraints. SLT in an intensive treatment schedule is feasible and was well tolerated in the acute stage after stroke.