Brain Neuroplasticity And The Hand Rehabilitation

Program After Stroke

Bayu Santoso, Lydia Arfianti, Fatchur Rochman, Imam Subadi

Abstract
The statistics data from USA and European countries shows that stroke is the killer
number 3 after heart diseases and cancer. In Indonesia reports from the Department of Health
(2011) showed that stroke is the main killer in this country. The incidence of stroke is 8 for
every 1000 populations and the death rate is 15.5% or for every 7 people died 1 is caused by
stroke. However, as a disabling disease, stroke is the main cause of disabilities among adult
people.
The functional prognosis for the survive stroke patients is good, 80% of them will be
able to reach an independent self-care. An appropriate and timely management in the acute
stage followed by early and comprehensive rehabilitation medicine program are very
important to reach this goal. A Physical Medicine and Rehabilitation study in Dr. Soetomo
Hospital comprising of 322 stroke patients showed a pretty good resutls following a standard
conventional exercise program. This good results especially concentrated on the ability of
stroke patient to reach the level of ambulation and they can be discharged from the hospital
quite early, however, the ability to reach better hand function is generally still poor. This is
probably caused by the limited time for the patient to stay in the hospital for more
comprehensive rehabilitation medicine program and the limited number of the Occupational
therapist. On the other hand, from an interesting survey, fast majority of stroke patients feel
that a significant improvement of the affected hand is also very important for their daily life.
In developed countries, the use of hand FES orthoses, e.g. Bioness is reported to have very
good results. From our study titled Hand mirror exercise for stroke patients which is very
simple and cheap showed a pretty good results. This study is based on the brain
neuroplasticity character, that is the ability of the human brain to physically rearrange itself in
response to outside stimulus following a damage due to disease or injury. This occurs at
anytime of human life and develop fastly based on the needs and magnitude of stimulation
being applied (use-dependent). The external sensory stimuli can be applied from both
ipsilateral and contralateral sides of the brain hemisphere. The processes in brain plasticity
including angiogenesis, neurogenesis, synaptogenesis and regeneration from neural stem
cells.

Keywords: stroke - hand function neuroplasticity hand mirror exercise