Repetitive training of isolated movements improves the outcome of motor rehabilitation of the centrally paretic hand

      This paper is only available as a PDF. To read, Please Download here.


      The effect of a standardized training on movements of the affected hand has been studied in 27 hemiparetic patients using a multiple baseline approach across individuals. The training consisted of repetitive hand and finger flexions and extensions against various loads and was carried out twice daily during 15-min periods. Grip strength (p < 0.006), peak force of isometric hand extensions (p < 0.05), peak acceleration (p < 0.05) of isotonic hand extensions as well as contraction velocities as indicators of motor performance significantly improved during the training period. In contrast to the standardized training of hand and finger movements, therapeutic strategies following the Bobath concept aim at reducing enhanced muscle tone without reinforcing the activity in centrally paretic distal muscle groups directly. Patients undergoing this treatment approach alone did not experience a significant improvement in the motor capacity of the hand. Therefore, the results of the present study emphasize the importance of frequent movement repetition for the motor rehabilitation of the centrally paretic hand and challenge conventional physiotherapeutic strategies that focus on spasticity reduction instead of early initiation of active movements.


      To read this article in full you will need to make a payment


        • Aizawa H.
        • Inase M.
        • Mushiake H.
        • Shima K.
        • Tanji J.
        Reorganization of activity in the supplementary motor area associated with motor learning and functional recovery.
        Exp. Brain Res. 1991; 84: 668-671
        • Almay B.G.L.
        • Johansson F.
        • von Knorring L.
        • Sakaruda T.
        • Terenius L.
        Long-term high frequency transcutaneous electrical nerve stimulation (hi-TENS) in chronic pain. Clinical response and effects of CSF-endorphins, monoamine metabolites, substance P-like immunoreactivity (SPLI) and pain measures.
        Psychosom. Res. 1985; 29: 247-257
        • Asanuma H.
        • Keller A.
        Neuronal mechanisms of motor learning in mammals.
        NeuroReport. 1991; 2: 217-224
        • Asanuma H.
        • Keller A.
        Neurobiological basis of motor learning and memory.
        Conc. Neurosci. 1991; 2: 1-30
        • Ashworth B.
        Preliminary trial of carisoprodol in multiple sclerosis.
        Practitioner. 1964; 192: 540-542
        • Bach-y-Rita P.
        • Bach-y-Rita E.Wicab
        Biological and psychosocial factors in recovery from brain damage in humans.
        Can. J. Psychol. 1990; 44: 148-165
        • Bard G.
        • Hirschberg G.G.
        Recovery of voluntary motion in upper extremity following hemiplegia.
        Arch. Phys. Med. Rehabil. 1965; 46: 567-572
        • Basmajian J.V.
        • Gowland C.A.
        • Finlayson M.A.J.
        • Hall A.L.
        • Swanson L.R.
        • Stratford P.W.
        • Trotter J.E.
        • Brandstater M.E.
        Stroke treatment: Comparison of integrated behavioral-physical therapy vs traditional physical therapy programs.
        Arch. Phys. Med. Rehabil. 1987; 68: 267-272
        • Bobath B.
        Abnormal Postural Reflex Activity Caused by Brain Lesions.
        Heinemann Medical Books, London1965
        • Bobath B.
        Adult Hemiplegia: Evaluation and Treatment.
        Heinemann Medical Books, London1970
        • Bohannon R.W.
        • Smith M.B.
        Interrater reliability of a modified Ashworth-scale of muscle spasticity.
        Phys. Ther. 1987; 67: 206-207
        • Brunnstrom S.
        Movement Therapy in Hemiplegia.
        Harper and Row, New York1970
        • Chollet F.
        • Di Piero V.
        • Wise R.J.S.
        • Brooks D.J.
        • Dolan R.J.
        • Frackowiak R.S.J.
        The functional anatomy of motor recovery after stroke in humans: a study with positron emission tomography.
        Ann. Neurol. 1991; 29: 63-71
        • Collen F.M.
        • Wade D.T.
        • Bradshaw C.M.
        Mobility after stroke: reliability of measures of impairment and disability.
        Int. Disabil. Stud. 1990; 12: 6-9
        • Dickstein R.
        • Hochermann S.
        • Pillar T.
        • Shaham R.
        Stroke rehabilitation: three exercise therapy approaches.
        Phys. Ther. 1986; 66: 1233-1238
        • Di Piero V.
        • Chollet F.M.
        • MacCarthy P.
        • Lenzi G.L.
        • Frackowiak R.S.J.
        Motor recovery after acute ischaemic stroke: a metabolic study.
        J. Neurol. Neurosurg. Psychiat. 1992; 55: 990-996
        • Freund H.J.
        • Hummelsheim H.
        Lesions of premotor cortex in man.
        Brain. 1985; 108: 697-733
        • Fries W.
        • Danek A.
        • Scheidtmann K.
        • Hamburger C.
        Motor recovery following stroke. Role of descending pathways from multiple motor areas.
        Brain. 1993; 116: 369-382
        • Fugl-Meyer A.R.
        • Jaasko L.
        • Leyman I.
        • Olsson S.
        • Steglind S.
        The post-stroke hemiplegic patient. A method for evaluation of physical performance.
        Scand. J. Rehabil. Med. 1975; 7: 13-31
        • Harlow H.F.
        Higher cortical functions of the nervous system.
        Annu. Rev. Physiol. 1953; 15: 493-514
        • Heller A.
        • Wade D.T.
        • Wood V.A.
        • Sunderland A.
        • Hewer R.Langton
        • Ward E.
        Arm function after stroke: measurement and recovery over the first three months.
        J. Neurol. Neurosurg. Psychiat. 1987; 50: 714-719
        • Hummelsheim H.
        • Mauritz K.H.
        Neurophysiologische Grundlagen krankengymnastischer Übungsbehandlung bei Patienten mit zentralen Hemiparesen.
        Fortsch. Neurol. Psychiat. 1993; 61: 208-216
        • Knott M.
        • Voss D.E.
        Proprioceptive Neuromuscular Facilitation.
        Harper and Row, New York1968
        • Levin M.F.
        • Hui-Chan W.Y.
        Relief of hemiparetic spasticity by TENS is associated with improvement in reflex and voluntary motor functions.
        Electroenceph. Clin. Neurophysiol. 1992; 85: 131-142
        • Lincoln N.
        • Leadbitter D.
        Assessment of motor function in stroke patients.
        Physiotherapy. 1979; 65: 48-51
        • Logigian M.K.
        • Samuels M.A.
        • Falconer J.
        • Zagar R.
        Clinical exercise trial for stroke patients.
        Arch. Phys. Med. Rehabil. 1983; 46: 364-367
        • Salar G.
        • Job I.
        • Mingrino S.
        • Bosio A.
        • Trabucchi M.
        Effect of transcutaneous electrotherapy on CSF b-endorphin content in patients with pain problems.
        Pain. 1981; 10: 169-172
        • Stern P.H.
        • McDowell F.
        • Miller J.M.
        • Robinson M.
        Effects of facilitation exercise techniques in stroke rehabilitation.
        Arch. Phys. Med. Rehabil. 1970; 51: 526-531
        • Sunderland A.
        • Tinson D.
        • Bradley L.
        • Hewer R.Langton
        Arm function after stroke. An evaluation of grip strength as a measure of recovery and a prognostic indicator.
        J. Neurol. Neurosurg. Psychiat. 1989; 52: 1267-1272
        • Sunderland A.
        • Tinson D.J.
        • Bradley E.L.
        • Fletcher D.
        • Hewer R.Langton
        • Wade D.T.
        Enhanced physical therapy improves recovery of arm function after stroke. A randomised controlled trial.
        J. Neurol. Neurosurg. Psychiat. 1992; 55: 530-535
        • Taub E.
        • Miller N.E.
        • Novack T.A.
        • Cook E.W.
        • Fleming W.C.
        • Nepomuceno C.S.
        • Conell J.S.
        • Crago J.E.
        Technique to improve chronic motor deficit after stroke.
        Arch. Phys. Med. Rehabil. 1993; 74: 347-354
        • Wade D.T.
        Measurement in Neurological Rehabilitation.
        in: Oxford University Press, New York1992: 162-164
        • Wagenaar R.C.
        • Meijer O.G.
        • van Wieringen P.C.W.
        • Kuik D.J.
        • Hazenberg G.J.
        • Lindeboom J.
        • Wichers F.
        • Rijswijk H.
        The functional recovery of stroke: A comparison between neuro-developmental treatment and the Brunnstrom method.
        Scand. J. Rehabil. Med. 1990; 22: 1-8
        • Wolf S.L.
        • Lecraw D.E.
        • Barton L.A.
        • Jann B.B.
        Forced use of hemiplegic upper extremities to reverse the effect of learned nonuse among chronic stroke and head injured patients.
        Exp. Neurol. 1989; 104: 125-132