Biomedical Engineering Reference
In-Depth Information
10.3.1.3 Active-initiation
It is shown in brain studies that cortical activity during active execution of move-
ments is larger than during passive movements. Also, motor cortex excitability
is higher after active movement training. Therefore exercise therapy focusing on
active initiation and execution of movements is associated with improved arm
function, and is essential to implement in rehabilitation therapy (Kaelin-Lang 2005,
Feys 1998).
10.3.1.4 Motivation and Feedback
Motivation and feedback are also important elements for rehabilitation therapy.
Addition of augmented feedback to exercises can stimulate the learning process
by making patients more aware of their performance. In several review studies
the additional motivational effect of virtual environments has been shown to be
positive (Holden 2005, van Vliet 2006, Henderson 2007).
10.3.2 Current Therapies
A number of current therapy strategies incorporate several of these key elements
(intensity, task-specificity, active-initiation, motivation and feedback).
10.3.2.1 CIMT
Constrained-induced movement therapy (CIMT) combines three key elements of
motor learning in therapy; intensity, task-specificity, and active-initiation. The
unaffected arm is restricted from being used, by means of wearing a sling, and
therefore the patient is forced to use the affected arm and hand. This therapy has
shown positive effects on arm and hand function in stroke survivors. A drawback
of CIMT is that only patients with a considerable level of hand function, at least
20 degrees wrist and 10 degrees finger extension, are eligible for treatment (Wolf
2002).
10.3.2.2 Mirror-therapy
During a mirror therapy, patients place a mirror beside the unaffected arm. In
this way the view of the affected arm is blocked, thereby creating the illusion that
the affected arm is moving as well as the unaffected arm. This therapy uses two
key elements: intensity and active-initiation. Studies on mirror therapy show
beneficial effects on the treatment for the hemiparetic arm (Ezendam 2009). A
drawback of mirror-therapy is the potential reliance of the patient on the image
of the apparently functional arm. If the reliance is too large, the intention of using
the affected arm decreases.
