Evidence-based physiotherapeutic concepts for improving arm and hand function in stroke patients: a review.

In recent years, our understanding of motor learning, neuroplasticity and functional recovery after the occurrence of brain lesion has grown significantly. New findings in basic neuroscience provided stimuli for research in motor rehabilitation. Repeated motor practice and motor activity in a real world environment have been identified in several prospective studies as favorable for motor recovery in stroke patients. EMG initiated electrical muscle stimulation -- but not electrical muscle stimulation alone -- improves motor function of the centrally paretic arm and hand. Although a considerable number of physiotherapeutic "schools" has been established, a conclusive proof of their benefit and a physiological model of their effect on neuronal structures and processes are still missing. Nevertheless, evidence-based strategies for motor rehabilitation are more and more available, particularly for patients suffering from central paresis.