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Virtuous and Vicious Cycles of Arm Use and Function Post-stroke

Large doses of movement practice have been shown to restore upper extremities' motor function in a significant subset of individuals post-stroke. However, such large doses are both difficult to implement in the clinic and highly inefficient. In addition, an important reduction in upper extremit...

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Autores principales: Ballester, Belen R., Winstein, Carolee, Schweighofer, Nicolas
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9004626/
https://www.ncbi.nlm.nih.gov/pubmed/35422752
http://dx.doi.org/10.3389/fneur.2022.804211
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author Ballester, Belen R.
Winstein, Carolee
Schweighofer, Nicolas
author_facet Ballester, Belen R.
Winstein, Carolee
Schweighofer, Nicolas
author_sort Ballester, Belen R.
collection PubMed
description Large doses of movement practice have been shown to restore upper extremities' motor function in a significant subset of individuals post-stroke. However, such large doses are both difficult to implement in the clinic and highly inefficient. In addition, an important reduction in upper extremity function and use is commonly seen following rehabilitation-induced gains, resulting in “rehabilitation in vain”. For those with mild to moderate sensorimotor impairment, the limited spontaneous use of the more affected limb during activities of daily living has been previously proposed to cause a decline of motor function, initiating a vicious cycle of recovery, in which non-use and poor performance reinforce each other. Here, we review computational, experimental, and clinical studies that support the view that if arm use is raised above an effective threshold, one enters a virtuous cycle in which arm use and function can reinforce each other via self-practice in the wild. If not, one enters a vicious cycle of declining arm use and function. In turn, and in line with best practice therapy recommendations, this virtuous/vicious cycle model advocates for a paradigm shift in neurorehabilitation whereby rehabilitation be embedded in activities of daily living such that self-practice with the aid of wearable technology that reminds and motivates can enhance paretic limb use of those who possess adequate residual sensorimotor capacity. Altogether, this model points to a user-centered approach to recovery post-stroke that is tailored to the participant's level of arm use and designed to motivate and engage in self-practice through progressive success in accomplishing meaningful activities in the wild.
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spelling pubmed-90046262022-04-13 Virtuous and Vicious Cycles of Arm Use and Function Post-stroke Ballester, Belen R. Winstein, Carolee Schweighofer, Nicolas Front Neurol Neurology Large doses of movement practice have been shown to restore upper extremities' motor function in a significant subset of individuals post-stroke. However, such large doses are both difficult to implement in the clinic and highly inefficient. In addition, an important reduction in upper extremity function and use is commonly seen following rehabilitation-induced gains, resulting in “rehabilitation in vain”. For those with mild to moderate sensorimotor impairment, the limited spontaneous use of the more affected limb during activities of daily living has been previously proposed to cause a decline of motor function, initiating a vicious cycle of recovery, in which non-use and poor performance reinforce each other. Here, we review computational, experimental, and clinical studies that support the view that if arm use is raised above an effective threshold, one enters a virtuous cycle in which arm use and function can reinforce each other via self-practice in the wild. If not, one enters a vicious cycle of declining arm use and function. In turn, and in line with best practice therapy recommendations, this virtuous/vicious cycle model advocates for a paradigm shift in neurorehabilitation whereby rehabilitation be embedded in activities of daily living such that self-practice with the aid of wearable technology that reminds and motivates can enhance paretic limb use of those who possess adequate residual sensorimotor capacity. Altogether, this model points to a user-centered approach to recovery post-stroke that is tailored to the participant's level of arm use and designed to motivate and engage in self-practice through progressive success in accomplishing meaningful activities in the wild. Frontiers Media S.A. 2022-03-29 /pmc/articles/PMC9004626/ /pubmed/35422752 http://dx.doi.org/10.3389/fneur.2022.804211 Text en Copyright © 2022 Ballester, Winstein and Schweighofer. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Neurology
Ballester, Belen R.
Winstein, Carolee
Schweighofer, Nicolas
Virtuous and Vicious Cycles of Arm Use and Function Post-stroke
title Virtuous and Vicious Cycles of Arm Use and Function Post-stroke
title_full Virtuous and Vicious Cycles of Arm Use and Function Post-stroke
title_fullStr Virtuous and Vicious Cycles of Arm Use and Function Post-stroke
title_full_unstemmed Virtuous and Vicious Cycles of Arm Use and Function Post-stroke
title_short Virtuous and Vicious Cycles of Arm Use and Function Post-stroke
title_sort virtuous and vicious cycles of arm use and function post-stroke
topic Neurology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9004626/
https://www.ncbi.nlm.nih.gov/pubmed/35422752
http://dx.doi.org/10.3389/fneur.2022.804211
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