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

<b>Background and Purpose</b>: 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. <b>Case Description</b>: 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. <b>Intervention</b>: 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. <b>Outcomes</b>: 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. <b>Discussion</b>: 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.

<b>背景与研究目的</b>：尽管脑卒中康复的神经可塑性（neural plasticity）原理已得到广泛证实，但腔隙性脑梗死（lacunar infarct）后共济失调患者的特异性干预方案尚未得到充分阐述。本病例报告旨在基于运动学习（motor learning）与神经可塑性原理，描述1例共济失调性偏瘫患者的干预方案。
<b>病例概况</b>：1例83岁社交活跃的男性因右侧上肢无力伴共济失调就诊于急诊科。患者急性期住院期间于卒中单元（stroke unit）治疗4天，随后接受13天住院康复治疗。
<b>干预方案</b>：住院康复阶段采用分三阶段的分级活动与协调训练计划。干预内容包括以功能为导向的重复步行训练、上下肢协调训练以及肌力强化训练，以帮助患者达成“无步态异常行走”的目标。在实施该创新性方案的过程中，本方案运用运动学习与神经可塑性理念，为患者的错误纠正提供时机指导与反馈支持。
<b>干预结果</b>：患者的活动辅助依赖程度与日常生活活动能力从最小辅助提升至无需辅助器具的辅助独立状态。动态步态指数（Dynamic Gait Index）评分从16/24提升至20/24，提示跌倒风险降低。
<b>讨论</b>：本病例报告阐述了1例腔隙性脑卒中后共济失调患者的创新性干预策略。神经可塑性与运动学习原理的应用是该功能导向性康复护理方案的核心基础。