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A Journal on Physical Medicine and Rehabilitation after Pathological Events

Official Journal of the Italian Society of Physical and Rehabilitation Medicine (SIMFER), European Society of Physical and Rehabilitation Medicine (ESPRM), European Union of Medical Specialists - Physical and Rehabilitation Medicine Section (UEMS-PRM), Mediterranean Forum of Physical and Rehabilitation Medicine (MFPRM), Hellenic Society of Physical and Rehabilitation Medicine (EEFIAP)
In association with International Society of Physical and Rehabilitation Medicine (ISPRM)
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Europa Medicophysica 2001 March;37(1):15-24

language: English

Physiology, plasticity and therapeutic arm exercise in hemiplegic patients

Franceschini M., Mammi P., Perelli Ercolini D.*

From the Functional Recovery and Re-edu­ca­tion Unit, Parma Hospital, Parma
*Specialisation School in Physical Medicine and Rehabilitation University of Parma, Parma, Italy


Stroke is one of the ­main caus­es of ­death and dis­abil­ity report­ed in the ­world: it is esti­mat­ed ­that ­between 126 and 371 indi­vid­u­als out of 100,000 inhab­i­tants under­go a ­first epi­sode of ­stroke eve­ry ­year. Up to 85% of ­stroke ­patients ­show ­major arm def­i­cits at clin­i­cal ­onset ­with per­sist­ing ­motor prob­lems ­three/six ­months lat­er in ­between 55 and 75% of ­patients. The cor­ti­cal con­trol of the ­upper ­limbs is ­very com­plex and ­this may indi­cate the poten­tial­ly neg­a­tive ­effect, ­even of lim­it­ed ­lesions on the ­final effi­ca­cy of the ­system, result­ing in dam­age to the cor­ti­cal are­as ­linked to the arm, and the ­hand in par­tic­u­lar. In ­spite of ­these con­sid­er­a­tions, a num­ber of neu­ro­phys­io­path­o­log­i­cal stud­ies ­have hypo­the­sised ­more ­room for improve­ment in arm use com­pared to ­that envis­aged by tra­di­tion­al ­research. An anal­y­sis was there­fore ­made of ­some of ­these stud­ies. The con­stant ­progress of knowl­edge regard­ing con­trol of arm ­motor activ­ities, and in par­tic­u­lar the ­hand, ­reveal ­that it is ­even ­more com­plex to try and under­stand the ­more inti­mate mech­a­nisms of ­post-­lesion recov­ery. In the sec­ond ­part of ­this bib­lio­graph­i­cal ­revue, the ­authors exam­ine the dif­fer­ent tech­ni­cal approach­es fol­low­ing pub­lished sci­en­tif­ic evi­dence. When con­sid­er­ing the effi­ca­cy of tra­di­tion­al re-edu­ca­tion­al tech­niques, ­some ­authors ­have con­clud­ed ­that ­they are all val­id ­because it is not pos­sible to ­draw sig­nif­i­cant dis­tinc­tions ­between the ­final ­results. With ­regard to the ­role of the inten­sity of ther­a­peu­tic exer­cise in recov­er­ing arm use ­after ­stroke, a num­ber of stud­ies ­have ­been report­ed in the lit­er­a­ture, but the ­results ­often ­show dis­crep­an­cies. In con­clu­sion, the ­authors exam­ine the new pro­po­sals ­based on the so-­called “Task-Oriented Therapy” ­approach in ­which ther­a­peu­tic exer­cise is ­linked to a spe­cif­ic ­task.

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