https://www.intechopen.com/books/physical-disabilities-therapeutic-implications/after-stroke-movement-impairments-a-review-of-current-technologies-for-rehabilitation
Abstract
This
chapter presents a review of the rehabilitation technologies for people
who have suffered a stroke, comparing and analyzing the impact that
these technologies have on their recovery in the short and long term.
The problematic is presented, and motor impairments for upper and lower
limbs are characterized. The goal of this chapter is to show novel
trends and research for the assistance and treatment of motor impairment
caused by strokes.
Keywords: stroke, hemiparesis, rehabilitation, assessment technologies, upper limb, lower limb, FES
1. Introduction
Stroke is the most common acquired neurological disease in the adult population worldwide (15 million every year [1]).
Based on recently published studies, incidence of stroke in Europe at
the beginning of the twenty-first century ranged from 95 to 290/100,000
per year [37].
Between 2000 and 2010, the relative rate of stroke deaths dropped by
35.8% in the United States and other countries. However, each year
stroke affects nearly 800,000 individuals, becoming the first cause of
chronic disability and the third cause of death. It is a global public
health problem worldwide that generates a significant burden of illness
for healthy life years lost due to disability and premature death.
One-third
of stroke survivors achieve only a poor functional outcome 5 years
after the onset of stroke. Although there is great progress in the
management of acute stroke, most of the care to reduce dependence on
post-stroke patients depends on rehabilitation. Optimal functional
recovery is the ultimate goal of neurorehabilitation after acute brain
injury, mainly by optimizing sensorimotor performance in functional
actions. New brain imaging techniques are making it clear that the
neurological system is continually remodeling throughout life and after
damage through experience and learning in response to activity and
behavior.
Rehabilitation in stroke patients seeks to
minimize the neurological deficit and its complications, encourage
family, and facilitate social reintegration of the individual to
ultimately improve their quality of life. Stroke rehabilitation is
divided into three phases. The acute phase usually extends for the 1st
weeks, where patients get treated and stabilized in a hospital and get
stabilized. Subacute phase (1–6 months) is the phase where the
rehabilitation process is more effective for recovering functions. In
chronic phase (after 6 months), rehabilitation is meant to treat and
decrease motor sequels.
The potential ability of the brain
to readapt after injury is known as neuroplasticity, which is the basic
mechanism underlying improvement in functional outcome after stroke.
Therefore, one important goal of rehabilitation of stroke patients is
the effective use of neuroplasticity for functional recovery [38].
As
mentioned before, neural plasticity is the ability of nervous system to
reorganize its structure, function, and connections in response to
training. The type and extent of neural plasticity is task—specific,
highly time-sensitive and strongly influenced by environmental factors
as well as motivation and attention.
Current understanding
of mechanisms underlying neural plasticity changes after stroke stems
from experimental models as well as clinical studies and provides the
foundation for evidence-based neurorehabilitation. Evidence accumulated
during the past 2 decades together with recent advances in the field of
stroke recovery clearly shows that the effects of neurorehabilitation
can be enhanced by behavioral manipulations in combination with adjuvant
therapies that stimulate the endogenous neural plasticity.
Nowadays,
a large toolbox of training-oriented rehabilitation techniques has been
developed, which allows the increase of independence and quality of
life of the patients and their families [39].
The recovery of function has been shown to depend on the intensity of
therapy, repetition of specified-skilled movements directed toward the
motor deficits and rewarded with performance-dependent feedback.
The
use of technological devices not only helps to increase these aspects
but also facilitates the work of therapists in order to enhance the
abilities of patients and a higher level of functional recovery. They
create environments with a greater amount of sensorimotor stimuli that
enhance the neuroplasticity of patients, translating into a successful
functional recovery. The use of technological devices can transfer the
effects of rehabilitation to the different environments where patients
spend their daily life allowing a favorable social reintegration. In
this chapter, a review of technologies for rehabilitation of mobility in
upper and lower extremity is presented.
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