Rehabilitation following brain damage: some neurophysiological mechanisms. A therapeutic approach based on theories of motor control.

Rehabilitation programmes concerned with functional recovery of patients with central nervous system (CNS) lesions may be in need of developing processes more consistent with prevailing concepts of motor control and of behavioural requirements by the CNS for motor learning. Both central and peripheral factors can play important roles in providing for finely orchestrated and relatively accurate learned motor performance. The relative influence of each of these factors on motor recovery is determined, in part, by the actions observed, i.e. control of body ("mid-line") and/or limb ("peripheral") position, by the interaction between two principal features of the control system, fixation (stability) and motion, by the inherent plasticity of structures, and by the ability of cerebral mechanisms to code, store and recall information with minimal error and time delay. A functional theory for governing spatial and temporal components of motor performance is presented; this is based upon three attributes: (a) attainment of control of fixation and motion of midline (eye-head-trunk) and peripheral structures in developmental order; (b) organization of serial fixation-motion steps in the guidance-manipulation functions of limbs, and (c) provision for coding spatial and temporal information related to both fixation and motion.