MOTOR REHABILITATION - CURRENT PRINCIPLES AND STRATEGIES

In recent years, rehabilitation strategies have been influenced by neu robiological research on brain plasticity as well as on the mechanisms of motor learning. Emerging insights into the relationship between th e recovery of motor function after brain lesion, symptom-related physi otherapeutic approaches and the impact of centrally acting drugs form the basis of modern rehabilitation medicine. Traditional physiotherape utic concepts do not differ in respect of their efficacy in motor reha bilitation of patients with upper motor neuron lesions, given that eff icacy is assessed on the disability or handicap level (according to th e WHO definition). Recent electrophysiological studies emphasize the i mportance 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 th e very same movement that is often neglected in conventional physiothe rapeutic approaches forms a further essential prerequisite in motor le arning and rehabilitation. Treatment with centrally acting drugs may p romote or impair motor recovery after brain lesion. Benzodiazepines, p henobarbital, phenytoin as well dopamine receptor antagonists alpha(1) -adrenergic receptor antagonists and alpha(2)-receptor agonists are su pposed to be detrimental with respect to functional improvement and sh ould be avoided during rehabilitation.