Neurorehabilitation approaches to facilitate motor recovery

Over the last decade a dramatic change has occurred in the field of neurorehabilitation in motor recovery that is marked by three transitions: first, by movement away from intuitive and ideology-based approaches to evidence-based therapy practices; second, by a change from hands-on treatment of patients to hands-off coaching approaches by motor therapists, who incorporate knowledge about motor reorganization and motor learning; and, finally, by a transition from one-on-one treatments to group-oriented treatments. General rules (such as the need for repetition, feedback of results, shaping task difficulty) have been derived from the animal experimental and human behavioral literature and incorporated into the design of innovative treatment strategies that can be adapted to individual patients' needs. This chapter reviews the state of the art for most of the evidence-based motor therapy concepts in the rehabilitation of patients with motor deficits after stroke, traumatic brain injury, etc., and other conditions. Treatment approaches derived from neuromodulation techniques such as stimulation or blockage of peripheral nerves, noninvasive brain stimulation, and pharmacological means are addressed. Finally, a modular concept is proposed to define optimal therapeutic approaches according to the individual level and type of impairment.