https://link.springer.com/article/10.1007/s11883-017-0686-6
Cardiovascular Disease and Stroke (S. Prabhakaran, Section Editor)
First Online:
Part of the following topical collections:
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.
No comments:
Post a Comment