Strategies for stroke rehabilitation

Abstract

Rehabilitation after hemiplegic stroke has typically relied on the training of patients in compensatory strategies. The translation of neuroscientific research into care has led to new approaches and renewed promise for better outcomes. Improved motor control can progress with task-specific training incorporating increased use of proximal and distal movements during intensive practice of real-world activities. Functional gains are incorrectly said to plateau by 3-6 months. Many patients retain latent sensorimotor function that can be realised any time after stroke with a pulse of goal-directed therapy. The amount of practice probably best determines gains for a given level of residual movement ability. Clinicians should encourage patients to build greater strength, speed, endurance, and precision of multijoint movements on tasks that increase independence and enrich daily activity. Imaging tools may help clinicians determine the capacity of residual networks to respond to a therapeutic approach and help establish optimal dose-response curves for training. Promising adjunct approaches include practice with robotic devices or in a virtual environment, electrical stimulation to increase cortical excitability during training, and drugs to optimise molecular mechanisms for learning. Biological strategies for neural repair may augment rehabilitation in the next decade.Rehabilitation of patients with hemiplegia after stroke has been limited for decades by a lack of theory-driven strategies leading to successful clinical trials with improvement in motor skills for daily activities. Recent therapeutic approaches have begun to build on methods to manipulate the remarkable adaptability or plasticity of the brain in response to task-specific practice, drugs, robotic trainers, and other ways to augment motor learning. 1 In this review, I offer conceptual bases for a clinical science of neurorehabilitation and emphasise mechanisms and procedures to improve walking and arm movement to lessen disability and limitations in daily life. One goal is to diminish the pessimism of physicians regarding the effect of additional rehabilitation and to provide them with sensible advice to offer patients who seek to improve motor skills at any time after stroke. Patients with sensorimotor and visual-field loss are much more dependent on carers than those with pure motor impairments, but even the latter may walk too slowly to participate in out-of-home activities or may be unable to integrate the use of an affected arm into personal care.Rehabilitation for hemiplegic stroke includes organised multidisciplinary, supportive services that begin 48 h after onset in stable patients. Inpatient and outpatient rehabilitation works to the advantage of patients and families in a general sense, but the effectiveness of each component of care falls short of evidence-based practice standards. The training of patients to compensate with the unaffected arm or leg has been a mainstay of rehabilitation. Physical, occupational, and speech therapists ...

Enhancing Rehabilitative Therapies with Vagus Nerve Stimulation

“…As many as 75 % of cases lead to lasting impairments in upper limb function [52]. Physical rehabilitation is the most common post-troke intervention.…”

“…Physical rehabilitation is the most common post-troke intervention. Rehabilitation can yield some functional gains, but recovery is often incomplete and the majority of patients are left with chronic disability [52][53][54]. Motor networks in surviving peri-infarct regions, as well as the undamaged contralateral homotopic cortex and subcortical structures, demonstrate significant reorganization after stroke [55][56][57].…”

mano: A Wearable Hand Exoskeleton for Activities of Daily Living and Neurorehabilitation

“…In such cases, robotic devices could be coupled to techniques aimed at reducing muscular tone (e.g. pharmaceutical drugs or functional electrical stimulation) for the sake of performing continuous motions and limiting the occurrence of limbs contractures due to excessive immobilization [5]. Other important issues to be considered for unsupervised use in ADL are also related to safety and acceptance [3].…”

“…According to the feedback we collected and based on previous literature research [4], [5], [17], the tasks identified as fundamental for regaining independence in ADL were: eating, drinking, toileting and using devices for communication (such as smartphones and computers). Many of these tasks can be performed through the combination of a restricted set of hand motions: power grasp (using all fingers, e.g.…”

“…MANO The mano device was designed with the main purpose of enabling intensive use during ADL by a wide range of users with motor disabilities, while preserving as much as possible patterns of natural interactions with these settings. Several studies have highlighted how ecological interactions with meaningful and relevant environments can lead to increased acceptance of assistive devices and to a better recovery with respect to therapies performed in hospital settings [4], [5]. To this end, we aimed at developing a device intensively usable in ADL, both for assistive and neurorehabilitative purposes.…”