Management of musculoskeletal impairments

Impairments that dominate the difficulties in neurorehabilitation of CNS mediated paralysis/paresis are muscle weakness/atrophy, limited passive and active joint range of motion, loss of motor control, spasticity, pain, and edema. A number of clinical studies in chronic stroke have demonstrated that a daily or three times per week stimulation program over 3-6 weeks strengthens the stimulated muscles and restores some degree of active and passive range of motion of the mobilized joints (Smith, 1990; Hazlewood et al., 1994; Pandyan et al., 1997; Alon et al., 1998; Powell et al., 1999). More recent clinical trials have combined the NMES with task-specific training of the paretic upper limb (Alon, 2003; Cauraugh and Kim, 2002, 2003a, b, c). Significant improvement in motor control as documented by Fugl-Meyer score or EMG has been reported by a number of investigators (Faghri et al., 1994; Chae et al., 1998; Francisco et al., 1998; Powell et al., 1999; Cauraugh et al., 2000; Cauraugh and Kim, 2002, 2003a, b, c; Kimberley et al., 2004). Improved functional ability was limited to improvement in performance speed or increasing number of blocks transferred but not re-learning of hand function or ability lost due to paralysis, however.

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