Continuum: Lifelong Learning in Neurology

This article attempts to summarize the current understanding of stroke rehabilitation but fails to realize that the recovery percents do not consider the complete lack of understanding as to why the recovery is so low. This all comes back to the fact that stroke survivors do not get a damage diagnosis.
https://www.aan.com/elibrary/continuum/?event=home.showArticleOrAbstract&id=ovid.com:/bib/ovftdb/00132979-201106000-00013
part of the article;
NATURAL HISTORY AND PREDICTING RECOVERY AFTER STROKE


Most recovery of specific deficits (motor, sensory, language) occurs during the first 3 to 6 months after stroke(WHY?).2,3 There are exceptions, however, and documented improvements can occur many years after stroke in a cooperative patient with an intensive rehabilitation program.4 Recovery of functional abilities can generally be predicted soon after stroke. Severity of disability status at 1 month poststroke is generally a reliable proxy for final outcome.5 Some simple predictions are possible regarding motor recovery. If there is no voluntary movement in the upper extremity at 15 days or no measureable grip at 1 month, the prognosis for recovery of useful arm function is poor. If the patient can move his or her hip within a week, ambulation is usually possible, but often with the use of an assistive device or an ankle orthosis. Motor recovery almost always occurs initially in the proximal muscles of the upper and lower extremity and often occurs in a specific sequence, sometimes called the Brunnstrom stages of motor recovery (Table 8-1). Between 70% and 88% of patients with ischemic stroke have some degree of motor dysfunction6; however, long-term survivors have a good prognosis for motor recovery. In the Framingham Heart Study, 52% of individuals who survived at least 6 months had no residual weakness. Aphasia occurs in approximately 23% of patients following stroke.7,8 Again, much recovery occurs within 3 to 6 months after onset. Some rough generalizations can be made. By 6 months poststroke only 12% of patients have continued aphasia. Degree of recovery correlates with the initial severity of the aphasia,9 although functional communication may recover after 6 months in some cases of severe aphasia. Recovery from sensory perceptual and cognitive deficits generally follows the same pattern as motor and language difficulties. Neglect is present in as many as one-third of patients with acute stroke but resolves in most by 12 weeks.7 When neglect persists, it can become a limiting factor to functional recovery.