Construction of Efficacious Gait and Upper Limb Functional Interventions Based on Brain Plasticity Evidence and Model-Based Measures For Stroke Patients

Abstract

For neurorehabilitation to advance from art to science, it must become evidence-based. Historically, there has been a dearth of evidence from which to construct rehabilitation interventions that are properly framed, accurately targeted, and credibly measured. In many instances, evidence of treatment response has not been sufficiently robust to demonstrate a change in function that is clinically, statistically, and economically important. Research evidence of activity-dependent central nervous system (CNS) plasticity and the requisite motor learning principles can be used to construct an efficacious motor recovery intervention. Brain plasticity after stroke refers to the regeneration of brain neuronal structures and/or reorganization of the function of neurons. Not only can CNS structure and function change in response to injury, but also, the changes may be modified by "activity". For gait training or upper limb functional training for stroke survivors, the "activity" is motor behavior, including coordination and strengthening exercise and functional training that comprise motor learning. Critical principles of motor learning required for CNS activity-dependent plasticity include: close-to-normal movements, muscle activation driving practice of movement; focused attention, repetition of desired movements, and training specificity. The ultimate goal of rehabilitation is to restore function so that a satisfying quality of life can be experienced. Accurate measurement of dysfunction and its underlying impairments are critical to the development of accurately targeted interventions that are sufficiently robust to produce gains, not only in function, but also in quality of life. The Classification of Functioning, Disability, and Health Model (ICF) model of disablement, put forth by the World Health Organization, can provide not only some guidance in measurement level selection, but also can serve as a guide to incorporate function and quality of life enhancement as the ultimate goals of rehabilitation interventions. Based on the evidence and principles of activity-dependent plasticity and motor learning, we developed gait training and upper limb functional training protocols. Guided by the ICF model, we selected and developed measures with characteristics rendering them most likely to capture change in the targeted aspects of intervention, as well as measures having membership not only in the impairment, but also in the

Movement therapy induced neural reorganization and motor recovery in stroke: A review

“…Motor learning leads to sprouting of dendrites, formation of new synapses, alteration in existing synapses and production of neurochemicals (Mulder and Hochstenbach, 2001). These changes are greater if the practice method is meaningful, repetitive and intensive in nature (Daly and Ruff, 2007). Further, such practice method leads to long-term retention and generalization of the learned motor behavior.…”

Application of neuroplasticity theory through the use of the Feldenkrais Method® with a runner with scoliosis and hip and lumbar pain: A case report

“…2), the goal of physical therapy is to facilitate functional improvement for return to participation in life activities, health and quality of life. Interventions directed towards the lower levels of the model e pathology, impairment and function e could effect change and improvement at higher levels of function and participation (Daly and Ruff, 2007). The ICF Model was used for goal setting (Table 1) and determining interventions (Table 3).…”

Changes in center of pressure displacement with the use of a foot drop stimulator in individuals with stroke

“…An alternative rehabilitation approach is to apply functional electrical stimulation (FES) to the common peroneal nerve to help provide active movement during ambulation (Bethoux et al, 2014(Bethoux et al, , 2015Everaert et al, 2013;Sabut et al, 2010;Stein et al, 2010). The stimulation paradigm for FES is to elicit task-specific movement patterns that result in dynamic functional activity (Daly and Ruff, 2007).…”