Neurorehabilitation for Stroke Patients with Hemiparesis - Functional Recovery and Motor Learning -

Abstract

　Stroke is a disease that leads to long-term disability, with about 80% of stroke patients having upper extremity paresis just after stroke and more than 40% in the chronic phase. The functional prognosis of the paretic upper extremity is dependent on its severity, and for severe paresis, it is difficult to obtain the function for practical use of daily living. Therefore, symptomatic approaches such as effective utilization of residual functions and compensation by the unaffected side, including dominant hand exchange training, self-help devices, and environment setting after accepting the state of paresis, are adopted in the conventional rehabilitation adjuvant approaches for paretic upper extremity. Neurorehabilitation techniques have been developed to modulate cortical excitability and improve paretic upper extremity function. The main concept of the newly developed neurorehabilitation techniques is task-oriented training and dose dependent plasticity. Constraint-induced movement therapy is an intensive training of the paretic upper extremity in which patients use their paretic upper extremity with their unaffected hand constrained and overcome learned non-use. Neuromuscular electrical stimulation is usually performed along with other rehabilitation approaches. Stimulation of the target nerve assists the movement of the paretic upper extremity and reduces the difficulty of the task. Non-invasive brain stimulation, such as repetitive transcranial magnetic stimulation and transcranial direct current stimulation, could temporarily modulate cortical excitability by preconditioning before rehabilitation and is usually performed before conventional rehabilitation. Robotics is used to assist the patient’s performance like a neuromuscular electrical stimulation. These new rehabilitation techniques are combined and used as a hybrid rehabilitation therapy. The tailor-made neurorehabilitation approaches adjusted to the paresis and needs of individual patients are needed for functional recovery.