Motor rehabilitation - Current principles and strategies

In recent years, rehabilitation strategies have been influenced by neurobiological research on brain plasticity as well as on the mechanisms of motor learning. Emerging insights into the relationship between the recovery of motor function after brain lesion, symptom-related physiotherapeutic approaches and the impact of centrally acting drugs form the basis of modern rehabilitation medicine. Traditional physiotherapeutic concepts do not differ in respect of their efficacy in motor rehabilitation of patients with upper motor neuron lesions, given that efficacy is assessed on the disability or handicap level (according to the WHO definition). Recent electrophysiological studies emphasize the importance of direct activation of functionally relevant muscle groups, particularly of arm and hand, instead of indirect strategies working with proximal and trunk muscles. Furthermore, repeated execution of the very same movement that is often neglected in conventional physiotherapeutic approaches forms a further essential prerequisite in motor learning and rehabilitation. Treatment with centrally acting drugs may promote or impair motor recovery after brain lesion. Benzodiazepines, phenobarbital, phenytoin as well dopamine receptor antagonists alpha(1)-adrenergic receptor antagonists and alpha(2)-receptor agonists are supposed to be detrimental with respect to functional improvement and should be avoided during rehabilitation.