Improvements in limb kinetic apraxia by repetition of a newly designed facilitation exercise in a patient with corticobasal degeneration

Abstract

Corticobasal degeneration is a progressive neurological disorder characterized by a combination of parkinsonism and cortical dysfunction such as limb kinetic apraxia, alien limb phenomenon, and dementia. To study the effect of repetitive facilitation exercise (RFE) in a patient with corticobasal degeneration, we used a newly designed facilitation exercise designed to elicit movements isolated from the synergy in hemiplegia. This exercise included movements of each isolated finger using stretch reflex and skin-muscle reflex and repetitive movements demanded in activities of daily living (ADL) and manipulating objects. To evaluate improvements in hand functions by RFE, 1-week RFE sessions for the hand were administered alternatively to the left or right hand. The number of finger taps by the hand increased during each 1-week RFE session for the hand, but did not increase during 1-week sessions without RFE. After 1 month of treatment, the patient's difficulties in ADL, including wearing clothes, manipulating objects and cooking, decreased. Our results suggest the importance of the repetition of facilitation exercises and movements in ADL for recovery in patients with degenerative neurogenic diseases.

Long-Term Exercise Training for an Individual With Mixed Corticobasal Degeneration and Progressive Supranuclear Palsy Features: 10-Year Case Report Follow-up

“…The authors suggested that RFE may have prevented a decrease of neuronal or neural circuit loss. 15 No other evidence describing the effects of exercise in clients with CBD was found in the literature.…”

“…A case report described the effects of repetitive facilitation exercise (RFE) combined with occupational therapy in a single client with CBD. 15 Following 4 weeks of these exercises, both activities of daily living and finger motor function improved. The authors suggested that RFE may have prevented a decrease of neuronal or neural circuit loss.…”

Cerebral functional imaging using near-infrared spectroscopy during repeated performances of motor rehabilitation tasks tested on healthy subjects

“…Furthermore, previous studies have focused on acquisition of a new task, but not improving performance in the same task, which is usually achieved in motor rehabilitation. The simple test for evaluating hand function (STEF) is a standardized test for upper-extremity functions, in which the time required for completing repetitive manual tasks is measured (Yamanaka et al, 2005; Kawahira et al, 2009). In the present study, we investigated a role of the aDMPFC in performance improvement during repetitive STEF in healthy subjects using functional near infrared spectroscopy (fNIRS).…”

Effects of intensive repetition of a new facilitation technique on motor functional recovery of the hemiplegic upper limb and hand

“…The repetitive facilitation exercises (RFEs) using these novel facilitation methods for the upper limb and fingers, as shown in Figure 1, give sufficient physical stimulation, such as by the stretch reflex or skin-muscle reflex that is elicited immediately before or at the same time as when the patient makes an effort to move his hemiplegic hand or finger, in order to elevate the level of excitation of the corresponding injured descending motor tracts and it allows the patient to initiate movements of the hemiplegic hand or finger in response to his intention. The functional improvements seen with repetitive training of finger flexion and extension for the hemiparetic hand [17] and with RFEs for the hemiplegic lower limb [18] and for limb kinetic apraxia of the upper limb and fingers [19] have suggested that functional recovery of the hemiplegic upper limb and hand might depend on repetition of voluntary movements elicited by the RFEs, especially when they are influenced by a synergic pattern.…”