Beneficial effects of postural intervention on prehensile action for an individual with ataxia resulting from brainstem stroke.

PRIMARY OBJECTIVE: This paper examined the effectiveness of postural training on upper extremity performance in an ataxic individual. The ataxia resulted from a brain stem stroke. RESEARCH DESIGN: Before-after, single-subject experimental design. EXPERIMENTAL INTERVENTION: Four-week course of postural training, comprised of three one-hour sessions/week. MAIN OUTCOMES AND RESULTS: The patient demonstrated an increase in function of the ataxic limb, as evidenced by appreciable increases in the Fugl-Meyer score and modest increases in the Postural Assessment Scale for Stroke Patients (PASS) score. CONCLUSIONS: Improvement in postural control influences upper extremity function affecting the speed and accuracy of the movement. We demonstrate the effectiveness of using postural training as an intervention towards reducing the effects of ataxia, a movement coordination impairment for which relatively few therapeutic techniques have been specifically developed or evaluated.

Simulation of bilateral movement training through mirror reflection: a case report demonstrating an occupational therapy technique for hemiparesis.

In rehabilitation for hemiparesis, one of the goals of an occupational therapist is to practice upper extremity tasks with the recovering individual. The practice is intended to strengthen muscles and refine movements. It also provides examples for the recovering body and brain as they attempt to reestablish the now delicate cognitive and neural connections mediating voluntary behavior. However, the paresis significantly limits the movement sequence possibilities that may be physically practiced. We outline a method for using simulation of movement, which is intended to provide a means for experiencing a range of smooth and controlled movements completed by a paretic limb. The simulation provides a compelling perceptual experience of bilateral motion beyond the current capabilities of the affected limb. The benefits of this technique after a 3-week course of the simulation practice are exemplified by the presented case study that reveals improved function as demonstrated by increases in Fugl-Meyer scores and faster movement speeds as demonstrated by decreased movement times for the Jebsen test of hand function.

Using motor imagery in the rehabilitation of hemiparesis.

OBJECTIVE: To examine the effectiveness of using motor imagery training in the rehabilitation of hemiparesis. DESIGN: A before-after trial with clinical and behavioral analyses of single cases. SETTING: Academic-affiliated rehabilitation hospital. PARTICIPANTS: Two survivors of embolic middle cerebral artery stroke that resulted in chronic hemiparesis. INTERVENTION: A motor imagery training program consisting of imagined wrist movements (extension, pronation-supination) and mental simulations of reaching and object manipulation making use of a mirror box apparatus. Twelve 1-hour experimental sessions were delivered, 3 times a week for 4 consecutive weeks. MAIN OUTCOME MEASURES: Two clinical assessments, grip strength, 4 wrist functionality measurements, and 3 timed performance tests. All outcome measures were recorded before training began, at 3 times during the intervention month, with 2 additional long-term measurements. RESULTS: Performance of the paretic limb improved after the imagery intervention, indicated by increases in assessment scores and functionality and decreases in movement times. The improvements over baseline performance remained stable over a 3-month period. CONCLUSIONS: These results demonstrate the potential for using motor imagery as a cognitive strategy for functional recovery from hemiparesis. The intervention targets the cognitive level of action processing while its effects may be realized in overt behavioral performance.