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Europa Medicophysica 2001 March;37(1):51-6

Copyright © 2001 EDIZIONI MINERVA MEDICA

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


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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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