Research in the Acute Rehabilitation Setting: a Bridge Too Far?

Comparing a Novel Neuroanimation Experience to Conventional Therapy for High-Dose Intensive Upper-Limb Training in Subacute Stroke: The SMARTS2 Randomized Trial

“…15 This difficulty with our enrollment time window attests to the continuing challenge of conducting neurorehabilitation trials in this early time period after stroke. 46,58,59 Third, we did not track amount of upper-limb activity at home during this study, and thus, we are unable to quantify whether either of the training interventions influenced amount of limb use in the real world. Fourth, we had to use a historical usual care group, albeit an extensive and well-matched one.…”

“…56,57 Furthermore, incorporation of mechanical thrombectomy as standard of care led to fewer patients with severe to moderate motor deficits. Second, we were only able to begin our interventions after patients were discharged from inpatient acute rehabilitation at the sites in the United States because of the challenges of delivering high doses of therapy in addition to standard care in the inpatient rehabilitation setting 58 ; the average start time was, therefore, about 3 weeks poststroke. From our previous work, we have shown that the time window of heightened neuroplasticity responsible for spontaneous recovery, and perhaps for enhanced training-related improvement that takes advantage of this heightened neuroplasticity, might be as short as 5 weeks.…”

Comparing a novel neuroanimation experience to conventional therapy for high-dose, intensive upper-limb training in subacute stroke: The SMARTS2 randomized trial

“…This is attributable both to our inclusion/exclusion criteria and the challenges of providing two hours of time-on-task upper limb therapy, five days a week beginning in the first six weeks after stroke in addition to usual care 56,57 . Second, we were only able to begin our interventions after patients were discharged from in-patient acute rehabilitation at the sites in the United States due to the challenges of delivering high doses of therapy in addition to standard care in the inpatient rehabilitation setting as well as the need for short length of stay 58 ; the average start time was therefore about three weeks post-stroke. From our previous work, we have shown that the time window of heightened neuroplasticity responsible for spontaneous recovery, and perhaps for enhanced training-related improvement that takes advantage of this heightened neuroplasticity, might be as short as 5 weeks 14 .…”

“…From our previous work, we have shown that the time window of heightened neuroplasticity responsible for spontaneous recovery, and perhaps for enhanced training-related improvement that takes advantage of this heightened neuroplasticity, might be as short as 5 weeks 14 . This difficulty with our enrollment time window attests to the continuing challenge of conducting neurorehabilitation trials in this early time period after stroke 46,58,59 . Third, we had to use a historical usual care group, albeit an extensive and well-matched one 25 .…”

A Unified Model for Stroke Recovery and Rehabilitation

“…Rehabilitation services after stroke in the United States are highly heterogeneous and vary by the type of care setting (acute hospital service, acute inpatient rehabilitation, subacute facility, home care services, or outpatient rehabilitation), duration of rehabilitation (length of stay in the specific setting), frequency of therapy sessions per week, intensity of the therapy sessions, and type of interventions delivered. 4 The American Heart Association's guidelines recommend consultation by a rehabilitation specialist leading a multidisciplinary team as soon as possible, ideally within 24 hours, for a patient admitted with a diagnosis of stroke. 5 Unfortunately, the focus of this consultation is typically on transition of care and selection of the discharge destination, [6][7][8] rather than on providing multidisciplinary rehabilitation interventions focused on facilitating recovery to reduce long-term disability.…”