Early Rehabilitation After Stroke: a Narrative Review

Abstract

Purpose of Review Despite current rehabilitative strategies, stroke remains a leading cause of disability in the USA. There is a window of enhanced neuroplasticity early after stroke, during which the brain’s dynamic response to injury is heightened and rehabilitation might be particularly effective. This review summarizes the evidence of the existence of this plastic window, and the evidence regarding safety and efficacy of early rehabilitative strategies for several stroke domain-specific deficits. Recent Findings Overall, trials of rehabilitation in the first 2 weeks after stroke are scarce. In the realm of very early mobilization, one large and one small trial found potential harm from mobilizing patients within the first 24 h after stroke, and only one small trial found benefit in doing so. For the upper extremity, constraint-induced movement therapy appears to have benefit when started within 2 weeks of stroke. Evidence for non-invasive brain stimulation in the acute period remains scant and inconclusive. For aphasia, the evidence is mixed, but intensive early therapy might be of benefit for patients with severe aphasia. Mirror therapy begun early after stroke shows promise for the alleviation of neglect. Novel approaches to treating dysphagia early after stroke appear promising, but the high rate of spontaneous improvement makes their benefit difficult to gauge. Summary The optimal time to begin rehabilitation after a stroke remains unsettled, though the evidence is mounting that for at least some deficits, initiation of rehabilitative strategies within the first 2 weeks of stroke is beneficial. Commencing intensive therapy in the first 24 h may be harmful.

Cholinergic upregulation by optogenetic stimulation of nucleus basalis after photothrombotic stroke in forelimb somatosensory cortex improves endpoint and motor but not sensory control of skilled reaching in mice

“…Importantly, however, the results of the present study did show that the stimulation was not harmful because on all behavioral measures the mice receiving stimulation were not impaired relative to the No Stim group. Third, some evidence suggests that therapy within 24-48 hours of stroke in the mouse can be harmful 65 and so here optogenetic stimulation and behavioral recovery assessment began on Day 4 post stroke and the maximal benefit of optogenetic stimulation was obtained on Day 7 post stroke on the measure of reach success. This present finding suggests that in future work it would be worthwhile to initiate optogenetic stimulation of cholinergic neurons and behavioral assessment as early as the first day after stroke 66 .…”

The SARS‐CoV‐2/COVID‐19 pandemic and challenges in stroke care in India

“…Recovery from a disabling stroke greatly depends on early and easy access to tailored, comprehensive rehabilitative measures, including physical, speech, and occupational therapies, especially in the initial 3-6 months poststroke. 18 India has few rehabilitation centers, and most of the patients with mild-to-moderate strokes receive postacute rehabilitation at home or through outpatient clinics of large hospitals. 19 The stroke recovery curves are likely to turn suboptimal, as patients will have even less access and availability to comprehensive rehabilitation facilities poststroke.…”

Early Incremental Mobilization in the Practice of Neurorehabilitation of Ischemic Stroke

“…Все частіше в фаховій літературі використовується термін «хронічний інсульт» під яким розуміють симптомокомплекс залишкового неврологічного дефіциту через 6 місяців або більше перенесеного інсульту [4,5]. Існують докази того, що рання активізація хворого є запорукою повноцінного функціонального відновлення, під яким розуміють досягнення оптимального фізичного стану, в тому числі функціональної, когнітивної, емоційної та соціальної активності [6,7]. На жаль у 50% хворих, що перенесли ГПМК має місце тривале обмеження функцій, а 25% -досягають неповного функціонального відновлення [6].…”