Neurorehabilitation of stroke

Abstract

Despite ongoing improvements in the acute treatment of cerebrovascular diseases and organization of stroke services, many stroke survivors are in need of neurorehabilitation, as more than two-thirds show persisting neurologic deficits. While early elements of neurorehabilitation are already taking place on the stroke unit, after the acute treatment, the patient with relevant neurologic deficits usually takes part in an organized inpatient multidisciplinary rehabilitation program and eventually continues with therapies in an ambulatory setting afterwards. A specialized multidisciplinary neurorehabilitation team with structured organization and processes provides a multimodal, intense treatment program for stroke patients which is adapted in detail to the individual goals of rehabilitation. There are many parallels between postlesional neuroplasticity (relearning) and learning in the development of individuals as well as task learning of healthy persons. One key principle of neurorehabilitation is the repetitive creation of specific learning situations to promote mechanisms of neural plasticity in stroke recovery. There is evidence of achieving a better outcome of neurorehabilitation with early initiation of treatment, high intensity, with specific goals and active therapies, and the coordinated work and multimodality of a specialized team. In this context, interdisciplinary goal-setting and regular assessments of the patient are important. Furthermore, several further potential enhancers of neural plasticity, e.g., peripheral and brain stimulation techniques, pharmacological augmentation, and use of robotics, are under evaluation.

Multiple sessions of transcranial direct current stimulation and upper extremity rehabilitation in stroke: A review and meta-analysis

“…Stroke is a health concern worldwide and one of the main causes of disability (Kolominsky-Rabas et al, 2001;Albert and Kesselring, 2012). Motor impairment is the main cause of disability after stroke, leading to major health problems (Boggio et al, 2007;Clarke, 1999).…”

Upper-Limb Spasticity During the First Year After Stroke

“…A recent literature review concluded that spasticity develops in 20%Y25% of all patients with firstever stroke and in 27%Y43% of those with paresis 1Y18 mos after stroke. 6 Upper-limb spasticity has been found to influence the functional abilities of the upper-limbs 12 and, therefore, also the rehabilitation process.…”

Cervical selective dorsal rhizotomy for treating spasticity in upper limb neurosurgical way to neurosurgical technique

“…Spasticity is considered to be the important factor hampering patients' functional recovery, especially in the upper limbs, even if multiple neurorehabilitation techniques were conducted [11,12]. For instance, bilateral arm training, one of the active neurorehabilitation treatments, shows less effectiveness when being compared with other treatments [13].…”