Post-stroke Rehabilitation

Clinicians working with stroke survivors believe that post-stroke rehabilitation works, but the evidence base to convince a wider audience is lacking. There are several contributory factors for this. First, we do not know how much of an intervention to provide, although the differences in outcome due to an extra 30 hours1 compared to 300 hours2 of upper limb treatment suggests more is better.

Second, we are not sure when to intervene, although the heightened effect of training due to injury-induced biological events seen early after stroke in rodent models (so-called spontaneous biological recovery3) suggests earlier is better.

Third, because clinical trials in neurorehabilitation are often not based on mechanistic principles, they lack the appropriate stratification that might identify the appropriate subgroups where large clinically meaningful effect sizes are possible.4 In other words, there are clues but they often seem to be ignored. Consequently, it appears difficult to move past the proof of principle study and the failure to translate advances in neuroscience into improved stroke outcomes continues.5

This all adds up to a challenging time for those interested in promoting recovery after stroke.

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