Physiology, plasticity and therapeutic arm exercise in hemiplegic patients

Stroke is one of the main causes of death and disability reported in the world: it is estimated that between 126 and 371 individuals out of 100,000 inhabitants undergo a first episode of stroke every year. Up to 85% of stroke patients show major arm deficits at clinical onset with persisting motor problems three/six months later in between 55 and 75% of patients. The cortical control of the upper limbs is very complex and this may indicate the potentially negative effect, even of limited lesions on the final efficacy of the system, resulting in damage to the cortical areas linked to the arm, and the hand in particular. In spite of these considerations, a number of neurophysiopathological studies have hypothesised more room for improvement in arm use compared to that envisaged by traditional research. An analysis was therefore made of some of these studies. The constant progress of knowledge regarding control of arm motor activities, and in particular the hand, reveal that it is even more complex to try and understand the more intimate mechanisms of post-lesion recovery. In the second part of this bibliographical revue, the authors examine the different technical approaches following published scientific evidence. When considering the efficacy of traditional re-educational techniques, some authors have concluded that they are all valid because it is not possible to draw significant distinctions between the final results. With regard to the role of the intensity of therapeutic exercise in recovering arm use after stroke, a number of studies have been reported in the literature, but the results often show discrepancies. In conclusion, the authors examine the new proposals based in the so- called 'Task-Oriented Therapy' approach in which threrapeutic exercise is linked to a specific task.