Physiotherapeutic strategies in the rehabilitation of patients with central motor disorders

Frequent repetition of identical movements is an essential prerequisite for motor learning in healthy subjects and for motor recovery in hemiparetic stroke patients. This contribution summarizes the results of four studies dealing with the benefit of a repetitive training of simple and complex arm, hand and finger movements in a cohort of 60 stroke patients. Repetitive execution of simple and/or task related complex movements is appropriate to improve biomechanical as well as functional movement parameters of ann and hand significantly and proves to be superior to conventional occupational and physiotherapy. The same positive results have been obtained when EMG-initiated electrical muscle stimulation is used for the extensor and flexor muscle groups of hand and fingers. Pure electrical stimulation, however, reduces enhanced muscle tone in hand and finger flexors but does not improve motor capacity of arm and hand. The physiological mechanisms of repeated execution of movements and its significance for motor learning and recovery will be discussed. Furthermore, sensorimotor coupling, i.e. the fact that afferent impulses generated by the moving limb converge on active motor centers of the brain involved in the movement appears to plays a major role in motor rehabilitation. Promising results obtained in patients with Parkinson's disease in whom repetitive training of postural reactions improves balance and gait significantly suggest to extend the repetitive training to this patient group.