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Europa Medicophysica 2001 March;37(1):15-24

Copyright © 2001 EDIZIONI MINERVA MEDICA

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


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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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