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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):51-6

language: English

Learned-non use affects the paretic lower limb in stroke: “occlusive” exercises may force the use

Tesio L.

From the Department of Rehabilitation and the Unit for Research, Functional Assessment and Quality Assurance in Rehabilitation “Salvatore Maugeri” Foundation, ­IRCCS, Pavia, Italy


A set of exer­cis­es is pro­posed aim­ing at increas­ing the recruit­ment of the paret­ic low­er ­limb in hem­i­pleg­ic ­patients dur­ing ­gait. These are a mod­i­fied ­form of ­gait, and of abdom­i­nal ­curl and sit-up. The path­o­phy­sio­logic back­ground and the exer­cise ­design are glo­bal­ly ­referred to as the “occlu­sion mod­el”. This ­stems ­from the learned-non use par­a­digm recent­ly advo­cat­ed for ­upper ­limb reha­bil­i­ta­tion ­after ­stroke. The exer­cis­es aim at caus­ing the “­forced-use” of the pare­ic low­er ­limb.
Exer­cis­es fall­ing with­in the occlu­sive mod­el: a) are ­done ­through ­both ­limbs in nor­mal sub­jects; b) none­the­less they can be suc­cess­ful­ly com­plet­ed through prev­a­lent ­work ­from one ­limb, ­only c) they can be for­cibly com­plet­ed ­through the ­impaired ­limb, by hin­der­ing (“occlu­sion”) the unaf­fect­ed ­limb. Three ­lines of evi­dence sup­port the pro­po­sal: a) patching of the ­sound eye in stra­bis­mus, and of the ­right vis­u­al ­hemi-­field in hem­i­neg­lect are estab­lished tech­niques to ­force ­vision ­through the squint­ing eye, and to ­drive atten­tion to the ­left ­hemi-­field, respec­tive­ly. b) Hindering the ­motion of the unaf­fect­ed ­upper ­limb in hem­i­pa­ret­ic ­stroke ­patients (“con­straint-­induced” move­ment ther­a­py) is an estab­lished tech­nique ­able to “­force” ­some recov­ery of the paret­ic ­upper ­limb. c) Learned-non use has ­been dem­on­strat­ed to ­affect loco­mo­tion ­indeed. In hem­i­pa­ret­ic ­patients, uni­lat­er­al low­er ­limb ampu­tees and ­patients ­with uni­lat­er­al hip ­arthritis it has ­been dem­on­strat­ed ­that the paret­ic ­limb ­does not con­trib­ute to the mus­cu­lar ­work ­required to ­keep the ­body ­system in ­motion. This ­occurs ­despite its rel­e­vant resid­u­al pow­er in vol­un­tary move­ments, its for­ward/back­ward dis­place­ment and its ­weight-bear­ing ­action at ­each ­stride. The exer­cis­es ­thus ­extend the appli­cabil­ity of the “­forced-use” par­a­digm to res­to­ra­tion of ­gait ­after ­stroke.

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