The use of motor learning and neural plasticity in rehabilitation for ataxic hemiparesis: A case report.

Background and Purpose: Although the principles of neural plasticity for stroke rehabilitation are well established, specific intervention plans for patients with ataxia following a lacunar infarct are not well described. The purpose of this case report is to describe the intervention program for a patient with ataxic hemiparesis based on principles of motor learning and neural plasticity. Case Description: An 83-year-old, socially active male presented to the emergency department with right-sided upper extremity weakness and ataxia. The patient's acute hospital course included 4 days in a stoke unit, followed by 13 days in inpatient rehabilitation. Intervention: A 3-phase graded mobility and coordination plan was used during inpatient rehabilitation. Interventions included function-based training with repeated ambulation, coordination activities for the upper and lower extremities, and strengthening to help the patient achieve his goal of walking "without gait deviations." The concepts of motor learning and neural plasticity were utilized for timing and feedback on patient errors when implementing this novel program. Outcomes: The patient's level of assistance for mobility and activities of daily living improved from minimal assistance to modified independence without use of an assistive device. The Dynamic Gait Index score improved from 16/24 to 20/24 suggesting a decreased fall risk. Discussion: This case report describes a novel intervention strategy for a patient with ataxia following a lacunar stroke. The application of the principles of neural plasticity and motor learning was the foundation for a function-based plan of care.

Do Verbal and Tactile Cueing Selectively Alter Gluteus Maximus and Hamstring Recruitment During a Supine Bridging Exercise in Active Females? A Randomized Controlled Trial.

CONTEXT: Hip extension with hamstring-dominant rather than gluteus maximus-dominant recruitment may increase anterior femoracetabular forces and contribute to conditions that cause hip pain. Cueing methods during hip extension exercises may facilitate greater gluteus maximus recruitment. OBJECTIVE: We examined whether specific verbal and tactile cues facilitate gluteus maximus recruitment while inhibiting hamstring recruitment during a bridging exercise. DESIGN: Randomized controlled trial. SETTING: Biomechanics laboratory. PARTICIPANTS: 30 young adult women (age 24 [3] y; BMI 22.2 [2.4] kg/m2). INTERVENTION: Participants were tested over 2 sessions, 1 week apart, while performing 5 repetitions of a bridging exercise. At their second visit, participants in the experimental group received verbal and tactile cues intended to facilitate gluteus maximus recruitment and inhibit hamstring recruitment. Control group participants received no additional cues beyond original instructions. MAIN OUTCOME MEASURES: Gluteus maximus and hamstring recruitment were measured with surface electromyography, normalized to maximal voluntary isometric contractions (MVICs). RESULTS: Gluteus maximus recruitment was unchanged in the control group and increased from 16.8 to 33.0% MVIC in the cueing group (F = 33.369, P < .001). Hamstring recruitment was unchanged in the control group but also increased from 16.5 to 29.8% MVIC in the cueing group (F = 6.400, P = .02). The effect size of the change in gluteus maximus recruitment in the cueing group (Cohen's d = 1.5, 95% CI = 0.9 to 2.2) was not significantly greater than the effect size in hamstring recruitment (Cohen's d = 0.8, 95% CI = 0.1 to 1.5). CONCLUSIONS: Verbal and tactile cues hypothesized to facilitate gluteus maximus recruitment yielded comparable increases in both gluteus maximus and hamstring recruitment. If one intends to promote hip extension by facilitating gluteus maximus recruitment while inhibiting hamstring recruitment during bridging exercises, the cueing methods employed in this study may not produce desired effects.