Motor rehabilitation after traumatic brain injury and stroke - Advances inassessment and therapy

A long-term goal in motor rehabilitation is that treatment is not selected on the basis of 'schools of thought', but rather, based on knowledge about efficacy and effectiveness of specific interventions for specific situation s (e.g. functional syndromes). Motor dysfunction after stroke or TBI can be caused by many different funct ional syndromes such as paresis, ataxia, deafferentaion, visuoperceptual de ficits, or apraxia, Examples are provided showing that theory-based analysi s of motor behavior makes it possible to describe 'syndrome-specific motor deficits'. Its potential implications for motor rehabilitation are that our understanding of altered motor behavior as well as specific therapeutic ap proaches might be promoted. A methodological prerequisite for clinical trials in rehabilitation is know ledge about test properties of assessment tools in follow-up situations suc h as test-retest reliability and responsiveness to change. Test-retest reli ability assesses whether a test can produce stable measures with test repet ition, while sensitivity to change reflects whether a test detects changes that occur over time. Exemplifying these considerations, a reliability and validity study of a kinematic arm movement analysis is summarized. In terms of new therapeutic developments, two examples of clinical therapeu tic studies are provided assessing the efficacy of specific interventions f or specific situations in arm and gait rehabilitation: the Arm Ability Trai ning for high functioning hemiparetic stroke and TBI patients, and the trea dmill training for non-ambulatory hemiparetic patients. In addition, a new technical development, a machine-controlled gait trainer ist introduced.