Biomedical Engineering Reference
In-Depth Information
hemisphere. Processes enabling cortical reorganization are:
— activation of previously inactive neurons: unmasking of latent synapses;
— facilitation of alternative networks;
— and collateral sprouting: growth of new axons.
These processes allow development of new paths for neural communication,
to sidestep those neural paths that were damaged due to the infarct. To induce cor-
tical reorganization these processes need to be stimulated, which can be induced
by rehabilitation therapy (Speach 1995, Krakauer 2005, Kwakkel 2004).
10.3 REHABILITATION THERAPY
Spontaneous neurological recovery can be stimulated by rehabilitation therapy.
Stimulation of sensory and motor areas induces reorganization of brain tissue
through which motor skills can be relearned. This process of motor relearning can
improve arm function. Several key elements of motor relearning for rehabilitation
therapy have been identified (Schaechter 2004).
10.3.1 Key Elements
Several studies into principles of motor relearning and processes of cortical reorga-
nization are performed. They provide a neurophysiological basis for key elements
that have the potential for stimulation of restoration of arm and hand function after
stroke (Krakauer 2005).
10.3.1.1 Intensity
Intensity of training is defined as the number of repetitions (frequency) of a
particular movement in a certain period of time. Several studies have indicated
that training with a higher frequency or longer duration stimulates functional
recovery of the arm (Kwakkel 1999, 2006). From brain studies it is known that
repetition of movements strengthens the representation of the trained movements
in the brain (Fischer 2001).
10.3.1.2 Task-specificity
Functional exercises are exercises which focus on activities of daily living that
are relevant for the patient's independence. Several studies have shown that
functional training results in a more normalized brain activity pattern (Schaechter
2004). Such normalization of brain a activity is related to improvements in motor
control and functional abilities. (Nelles 2001) Therefore, task-specific exercises of
activities of daily living are important to stimulate motor recovery after stroke
(Fischer 2001).
 
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