Evidence-based physiotherapeutic concepts for improving arm and hand function in stroke patients

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.

Effects of Integrated Volitional Control Electrical Stimulation (IVES) on Upper Extremity Function in Chronic Stroke

“…20 Fujiwara et al 9 reported that treatment with IVES combined with a wrist-hand splint induced restoration of presynaptic and long loop inhibitory connections as well as disynaptic reciprocal inhibition. Previous studies 3,5,7,8 have demonstrated that electrical stimulation combined with volitional efforts or additional therapy is more effective than electrical stimulation alone in the recovery process. Bhatt et al 21 showed that combined intervention may have a more beneficial influence on brain reorganization than either treatment alone.…”

“…1 One of the rehabilitation techniques employed to facilitate motor restoration in chronic stroke survivors is electromyogram (EMG)-triggered electrical stimulation. [2][3][4][5] This technique requires patients to voluntarily initiate arm/hand muscle activities above a target threshold before the onset of electrical stimulation. If the EMG activity reaches the threshold, the muscle activities are augmented by electrical stimulation that assists the muscles to execute a full range of motion.…”

Bilateral upper-limb rehabilitation after stroke using a movement-based game controller

“…Movement practice and repetition form the basis of plasticity-based motor recovery [10][11][12][13][14]. A number of factors are thought to enhance plasticity-based rehabilitation, such as task-oriented movement practice in a challenging, engaging, functional, and meaningful way, and the rehabilitation should address body function and structures, activity, and participation level [9][10][11][12][13]15].…”

Terapia baseada em realidade virtual usando o Leap Motion Controller para reabilitação do membro superior após acidente vascular cerebral

“…O treinamento proposto promoveu mudanças positivas na habilidade manual do membro superior não parético em todos os pacientes, assim como no membro superior parético em dois pacientes. Os resultados obtidos corroboram com estudos que relatam que este aprendizado motor só é possível devido à capacidade de reorganização e plasticidade do cérebro [40,41] e à interação das vias contralaterais e ipsilaterais para promover a recuperação motora [42,43].…”