Kazumi Kawahira - Exercise Therapy for Recovery from Hemiplegia: Theory and Practice of Repetitive Facilitative Exercise

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RFE (Repetitive Facilitative Exercise), which the authors advocate is the neural net contracture therapy, achieves and repeats the patients intended movement in order to reconstruct/strengthen the nerve pathway needed to accomplish the voluntary movements. RFE explored a new theory focusing on standing on the intact lower limb for therapy during gait training. RFE has its principle in the selective reconstruction/strengthening (facilitation of learning) of damaged nerve paths, not only for cases with hemiplegia in the upper limbs, in particular finger movements that were not responsive to conventional treatment, but also for the hemiplegic in the lower limbs as well as those with walking impairment for which the effect of conventional treatment was limited. Thus, it may be an effective rehabilitation technique for paralysis and sensory disorder due to a cerebral stroke, spinal injury, or peripheral nerve damage.

In recent years, RFE has proven effective not only in the recovery phase but also in acute and chronic phases. The nerve paths can be strengthened by RFE. Moreover, the effect of combining therapy using RFE with continuous electric stimulation, transcranial magnetic stimulation, botulinum therapy, robot, etc., which enhances the effect of RFE, has each been reported. In rehabilitation after neurological regenerative medicine, RFE, which can facilitate the targeted neural pathways, and combination therapy (neural modulation), which makes RFE more effective, will be essential.

RFE can reconstruct and strengthen the target nerve pathways selectively. RFE development that strengthens the target nerve pathways effectively was supported by the idea of localized brain functions, information processing, and the plasticity after the brain was injured. They were clarified with basic studies on monkeys and clinical studies on humans using fMRI, PET, and MEG. These facts provided a new perspective and logical development for the therapies to facilitate the recovery from hemiplegia, bringing about a drastic change in the exercise as well as occupational therapies for paralysis and apraxia due to cerebral stroke and other central nervous disorders. It replaced the conventional method where the disorder is interpreted based on reflex theory and set up a treatment plan. We began to consider scientific treatment emphasizing the construction of nerve pathways by forming the synapse and improving transmission efficiency, based on localized brain functions, a central program, and a neural net. No new treatment can be developed without this method, as it is indispensable for developing new treatment.

This book has been written to assist the therapists understanding of RFE. First, it briefly explains the localized brain functions, voluntary movements, plasticity of the brain function, sprouting of nerves and other structures, and strengthening mechanisms for nerve pathways. It then presents a proven effect from RFE and describes the basic manual exercise techniques and combination therapies.

In this edition, we placed particular emphasis on (1) extra content written by Dr. Megumi Shimodozono and Dr. Tomokazu Noma, (2) color photos, figures, and tables to elaborate the RFE treatment technique and update the video as Electronic Supplementary Material (ESM), (3) reasonable treatment strategy by adding scientific evidence on treatment effects, and (4) explanations over treatment for walking disorders.

However, we decided to select only those procedures that are important in daily clinical practice as ESM. We could not present all the procedures as there are a tremendous number of them. Moreover, there are many new papers being published. We appreciate your understanding with our limitations.

Many people supported the publication of this book and we express our sincere gratitude toward Ms. Ikumi Nagamori, an occupational therapist who appears as a model in the photos and movies; Dr. Seiji Etoh, Dr. Atsuko Ogata, and Dr. Shuji Matsumoto, who provided their research data; Dr. Tazu Aoki, who provided proofreading on chapter one; OG Wellness Technologies Co., Ltd.; and ITO Co., Ltd., who provided the photo shooting devices.

A recent development in the study of brain science has clarified that neural stem cells also exist in the central nervous system of adults and that the plasticity of the brain is larger and faster than assumed previously. The clinical treatment of functional reconstruction, and regenerative medicine using neural stem cells, is becoming a reality. On the other hand, the response to rehabilitation medicine/treatment has not been adequate yet. Rehabilitation medicine/treatment should be most enthusiastic in developing a technique to reconstruct and strengthen nerve paths.