title: Repetitive training of isolated movements improves the outcome of motor rehabilitation of the centrally paretic hand.
abstract: 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.
authors.affiliation: Klinik BERLIN, Department of Neurological Rehabilitation, Free University of Berlin, Germany.
authors.forename: C
authors.initials: C
authors.lastname: Bütefisch
authors.forename: H
authors.initials: H
authors.lastname: Hummelsheim
authors.forename: P
authors.initials: P
authors.lastname: Denzler
authors.forename: K H
authors.initials: KH
authors.lastname: Mauritz
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004185:Disability Evaluation; D015444:Exercise; D005081:Exercise Therapy; D005260:Female; D006225:Hand / Q000502:physiology*; D018737:Hand Strength; D006801:Humans; D007551:Isotonic Contraction; D008297:Male; D008875:Middle Aged; D010291:Paresis / Q000178:diet therapy / Q000534:rehabilitation*; D004561:Transcutaneous Electric Nerve Stimulation