Learned-non use affects the paretic lower limb in stroke: "occlusive" exercises may force the use

A set of exercises is proposed aiming at increasing the recruitment of the paretic lower limb in hemiplegic patients during gait. These are a modified form of gait, and of abdominal curl and sit-up. The pathophysiologic background and the exercise design are globally referred to as the "occlusion model". This stems from the learned-non use paradigm recently advocated for upper limb rehabilitation after stroke. The exercises aim at causing the "forced-use" of the pareic lower limb. Exercises falling within the occlusive model: a) are done through both limbs in normal subjects; b) nonetheless they can be successfully completed through prevalent work from one limb, only c) they can be forcibly completed through the impaired limb, by hindering ("occlusion") the unaffected limb. Three lines of evidence support the proposal: a) patching of the sound eye in strabismus, and of the right visual hemi-field in hemineglect are established techniques to force vision through the squinting eye, and to drive attention to the left hemifield, respectively, b) Hindering the motion of the unaffected upper limb in hemiparetic stroke patients ("constraint-induced" movement therapy) is an established technique able to "force" some recovery of the paretic upper limb. c) Learned-non use has been demonstrated to affect locomotion indeed. In hemiparetic patients, unilateral lower limb amputees and patients with unilateral hip arthritis it has been demonstrated that the paretic limb does not contribute to the muscular work required to keep the body system in motion. This occurs despite its relevant residual power in voluntary movements, its forward/backward displacement and its weight-bearing action at each stride. The exercises thus extend the applicability of the "forced-use" paradigm to restoration of gait after stroke.