Hemiparesis is one of the most common impairments experienced by individuals with stroke. It is one of the most disabling of conditions, and regaining adequate use of the arm and leg after stroke is a highly desired goal for many individuals. Currently, the only treatment for hemiparesis is motor rehabilitation. Thus, it is important that therapists provide the most efficacious and effective motor rehabilitation. The goal of this course is to present the attendee with information about the kinds of motor training that facilitate the most motor function recovery in the upper extremities after stroke. The first module will review the neurology of the motor system, and discuss the main motor impairments that arise following a stroke. Module two will present the principles of practice that facilitate neuroplasticity in the motor system. These principles serve as a basis for designing motor rehabilitation protocols for promoting motor recovery after stroke. The third module will discuss the evidence for the most commonly studied upper extremity motor rehabilitation protocols, while the last module of the course will expose the attendee to experimental treatments for post-stroke hemiplegia/hemiparesis.
Dr. Richards has been an occupational therapy educator and rehabilitation researcher for over 20 years. She is currently the Chair and Associate professor in the Division of Occupational Therapy at the University of Utah, with previous appointments at the University of Kansas Medical Center, the University of Florida, and the Malcom Randall VA Medical Center. She has been conducting clinical trials of motor rehabilitation after stroke since 1994. The interventions she tests are based on principles of neuroplasticity and motor learning. She is the Editor-in-Chief of the American Journal of Occupational Therapy and a Fellow of the American Heart Association. Explore her courses on MedBridge!
Basic physiological and anatomical information about disabling condition forms the background knowledge for therapists. This chapter will remind the attendee of the neuroanatomy and neural mechanisms associated with stroke.
Recovery of motor function after stroke is believed to rely on neural re-organization. The basis for motor rehabilitation approaches comes from basic animal and human studies of how behavioral experience influences neuroplasticity. This chapter will review the literature that has led to the development of basic principles of practice structure and the greatest neuroplasticity.
Rehabilitation needs to be evidence-based so that the most efficacious and effective interventions are provided to individuals with stroke. This chapter will present the evidence for the most-studied motor rehabilitation approaches for hemiparesis post-stroke.
It is clear from research conducted over the past 20 years that therapy facilitates motor recovery from stroke. Despite such rehabilitation however, individuals with stroke continue to experience long-term reduced motor function that interferes with successful engagement in daily activities. More effective interventions are needed. This chapter will describe some new approaches, mostly interventions to be used as instigators of motor practice, that offer promise for enhancing the brain’s ability to re-organize in response to motor practice.