Your doctors should be able to concoct a stroke protocol out of this if they are any good at all. But that likely won't occur because doing so is not part of their goals and objectives because the stroke department head and hospital president are not setting up the correct goals. You're screwed unless you contact the board of directors of the hospital to accomplish this. A great stroke association president would be contacting every single stroke hospital to make sure appropriate goals exist for the stroke department. This is way too fucking important to leave to non stroke survivors.
http://www.hindawi.com/journals/np/2016/2961573/
S. M. Mahmudul Hasan, Samantha N. Rancourt, Mark W. Austin, and Michelle Ploughman
Recovery & Performance Laboratory, Faculty of Medicine, Memorial University, L.A. Miller Centre, Room 400, 100 Forest Road, St. John’s, NL, Canada A1A 1E5
Received 4 October 2015; Revised 27 November 2015; Accepted 29 November 2015
Academic Editor: James M. Wyss
Copyright © 2016 S. M. Mahmudul Hasan et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
Although poststroke aerobic exercise (AE) increases markers of neuroplasticity and protects perilesional tissue, the degree to which it enhances complex motor or cognitive outcomes is unknown. Previous research suggests that timing and dosage of exercise may be important. We synthesized data from clinical and animal studies in order to determine optimal AE training parameters and recovery outcomes for future research. Using predefined criteria, we included clinical trials of stroke of any type or duration and animal studies employing any established models of stroke. Of the 5,259 titles returned, 52 articles met our criteria, measuring the effects of AE on balance, lower extremity coordination, upper limb motor skills, learning, processing speed, memory, and executive function. We found that early-initiated low-to-moderate intensity AE improved locomotor coordination in rodents. In clinical trials, AE improved balance and lower limb coordination irrespective of intervention modality or parameter. In contrast, fine upper limb recovery was relatively resistant to AE. In terms of cognitive outcomes, poststroke AE in animals improved memory and learning, except when training was too intense. However, in clinical trials, combined training protocols more consistently improved cognition. We noted a paucity of studies examining the benefits of AE on recovery beyond cessation of the intervention.
1. Introduction
Most people admitted to hospital with stroke continue to have enduring motor and cognitive deficits that interfere with their previous roles and quality of life [1]. Very few people admitted with stroke regain functional use of the hemiplegic arm and hand [2] and recent research suggests that there is a limited time window in which to make the greatest gains [3]. During this window of neuroplasticity, the patient must practice therapist-guided task-specific movements, to drive Hebbian plasticity in order to regain function [4]. However, after stroke, cognitive health and the recovery (or relearning) of complex motor skills are intertwined. Relearning of complex movement, which is fundamental to neurorehabilitation, requires most cognitive domains including working memory [5], attention [6], and executive function [7]. Motor learning is impeded by cognitive impairment [8], limiting the ability of the stroke patient to understand, repeat, refine, and analyze recovering movement [9].
Aerobic exercise (AE) is one intervention recommended as part of stroke best practices to improve gait and cardiovascular fitness [10, 11]. Researchers are beginning to explore how AE, by increasing neurotrophins and blood supply to the brain, could also improve other outcomes (unrelated to fitness and gait) such as cognition and relearning of complex skills [12]. Two recent meta-analyses confirmed that AE enhanced cognitive performance, at least in healthy populations [13, 14]. However, based on the findings of two systematic reviews [8, 15], there was limited evidence to support the use of AE to improve cognition in neurorehabilitation practice. More compelling findings have been reported in animal models of stroke, suggesting that rigorous preclinical and clinical trials are still warranted [16].
AE is defined as “planned, structured repetitive physical activity for extended periods and at sufficient intensity to improve or maintain physical fitness” [11]. To improve physical fitness it is recommended that AE be instituted most days of the week at gradually increasing intensity for at least 8 weeks [11]. Whether the AE parameters to improve physical fitness are the same as those to improve cognition and relearning of complex skills after stroke is not known. In two previous reviews examining mechanistic effects of AE on the brain, we reported that, in animal models, moderately intense forced AE, instituted soon after stroke (24–48 hours), enhances neurotrophins, synaptogenesis, and dendritic branching and protects perilesional tissue against oxidative damage [69, 70]. Whether these training parameters translate into improved cognition and relearning of complex motor skills (in animal models or clinical trials) is not known, important information in order to design future clinical and preclinical studies. Researchers would be concerned about AE parameters: frequency, intensity, duration, mode (i.e., treadmill, swimming, or bicycling), and the timing of exercise onset after stroke. In addition to optimizing parameters, scientists must also target outcomes responsive to AE since AE may not affect all cognitive and motor domains in the same way, if at all.
We undertook this review to consolidate potentially important findings in both animal models and clinical trials testing the effects of AE on cognitive and complex motor performance after stroke. We hoped to gain methodological insights to inform future preclinical and clinical studies investigating this potentially promising area of neurorehabilitation.
Much more at link.
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