http://nnr.sagepub.com/content/27/7/622.abstract?etoc
Abstract
Background. Knowledge of how damage to
brain regions and pathways affects central nervous system control of
coordination of reach-to-grasp
(RTG) following stroke may not be sufficiently used
in existing treatment interventions or in research that assesses their
effectiveness. Objective. To review current knowledge of motor control of coordination of RTG and discuss the extent to which this information is
being used in research evaluating treatment interventions. Method.
This review (1) summarizes the current knowledge of motor control of
RTG coordination in healthy individuals, including
speculative models and structures of the brain
identified as being involved; (2) summarizes evidence of RTG
coordination deficits
in people with stroke; (3) evaluates current
interventions directed at retraining coordination of RTG, including a
review
of the extent to which these interventions are
based on putative neurobiological mechanisms and reports on their
effectiveness;
and (4) recommends directions for research on
treatment interventions for coordination of RTG. Results.
Functional task-specific therapy, electrical stimulation, and robot or
computerized training were identified as treatments
targeted at improving coordination of RTG. However,
none of the studies reporting the effect of these interventions related
results to individual brain regions affected, and
neurobiological mechanisms underlying improved performance were only
minimally
discussed. Conclusions. Research on
treatment interventions for coordination of RTG needs to combine
measures of interruption to brain networks
and how remaining intact neural tissue and networks
respond to therapy with measures of spatiotemporal motor control and
upper-limb
function to gain a fuller understanding of
treatment effects and their mechanisms.
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