New treatments in neurorehabiliation founded on basic research

Abstract

The relative dearth of effective interventions in neurorehabilitation could be partly attributable to the weak contribution that this field has received from basic sciences such as neuroscience and behavioural psychology. Neuroscience holds an important place in the curriculum of physical therapy schools, but its influence has been largely didactic and has had little bearing on clinical practice. Behavioural psychology has contributed much to the treatment of chronic pain 1 , but has little or no place in the curriculum of physical rehabilitation schools or in the development of treatments for movement disorders. In other health-related fields, basic research has, of course, been of inestimable value in enabling the development of new therapeutic interventions. In the neurosciences, the fruitfulness of this approach has been amply shown by the development of treatments for Parkinson's disease and other disorders on the basis of the pioneering work of Carlsson and others on chemical neurotransmission 2,3 . The paradigm shift that is mentioned in the preface refers to the fact that this process of translation of basic research into new treatments is beginning to take place in the field of neurorehabilitation and is proceeding at an accelerating pace.After injury to the central nervous system (CNS), the initial deficit in behaviour, perception and/or cognitive ability is frequently followed by a spontaneous recovery of function. This resiliency may be considered as one type of behavioural plasticity. By apparent contrast, the traditional view in neuroscience during the first threequarters of the last century was that the mature CNS has little capacity to reorganize and repair itself in response to injury. This view extends back into the nineteenth century, promoted initially by Broca's studies on the localization of function within the brain 4 , which emphasized the constancy of organization of the mature CNS even after substantial injury. Although contrary views were expressed 5,6 , the mature CNS was generally believed 7 to show little or no plasticity 8 . Hughlings Jackson's hierarchical view 9 that lower centres of the brain substituted in function for higher damaged centres after CNS insult, together with other related formulations, had an important influence for most of the twentieth century on our thinking about the recovery of function. However, the phenomenon of spontaneous recovery of function was never fully explained and received little experimental attention, largely because the techniques needed to explore this process had not yet been developed. Beginning in the 1970s, research from several laboratories, including those of Merzenich Recent discoveries about how the central nervous system responds to injury and how patients reacquire lost behaviours by training have yielded promising new therapies for neurorehabilitation. Until recently, this field had been largely static, but the current melding of basic behavioural science with neuroscience promises entirely new approaches to improving behavioural, ...

Longer versus shorter daily constraint-induced movement therapy of chronic hemiparesis: An exploratory study

“…The data obtained in the 6h1d training group replicates earlier results 18 and thus generally confirms the effectiveness of CIMT for the treatment of chronic hemiplegia. The new data from our present study suggests that a reduced 3-hour training schedule combined with constraint of the unaffected arm significantly improves the patient's movement capabilities and that those capabilities transfer from the therapeutic setting to the home environment.…”

Animal Models of Deficient Sensorimotor Gating in Schizophrenia: Are They Still Relevant?

“…Such a model is applied successfully to stroke rehabilitation, where interventions are designed not to regrow brain circuitry that is lost or damaged, but rather to engage the normal physiological and anatomical properties of healthy brain circuits (e.g., in neighboring regions or parallel circuits) to restore or subsume the function of damaged ones (cf. Taub et al 2002). In many forms of psychotherapy, the therapist's task is to identify an individual's psychological strengths (ego, intellectual, social, or otherwise) and then to engage them to overcome damaging thoughts or behaviors that are otherwise sustained by areas of psychological weakness.…”

Intensive language training in the rehabilitation of chronic aphasia: Efficient training by laypersons

“…CIAT is an adaption of Constraint-Induced Movement Therapy (CIMT), a well-evaluated therapeutic tool for the treatment of poststroke paresis (Taub et al, 1999). Substantial and lasting improvement of motor functions and transfer of therapeutic gains to activities of daily living has been demonstrated after CIMT (for review, see Elbert & Rockstroh, 2004;Taub et al, 2002). In the case of motor rehabilitation, some researchers suggest that the non-use of a paretic extremity is learned during the early period after stroke, when physiological damage induces depression of function (learned non-use model; Taub et al, 1999).…”