Does Stroke Rehabilitation Really Matter? Part B: An Algorithm for Prescribing an Effective Intensity of Rehabilitation

Once again being completely lazy fuckers, throwing up their hands in defeat and not even trying to solve all the problems in stroke.  THIS IS WHY STROKE WILL NEVER BE SOLVED WITH THE CURRENT STROKE LEADERSHIP!!! THEY ALL NEED TO DIE, DIE, DIE. 
http://journals.sagepub.com/doi/abs/10.1177/1545968317753074

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Matthew Strider Jeffers, MSc¹²

Matthew Strider Jeffers

1University of Ottawa, Ottawa, Ontario, Canada2Canadian Partnership for Stroke Recovery, Ottawa, Ontario, Canada
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, Sudhir Karthikeyan, MSc¹²

Sudhir Karthikeyan

1University of Ottawa, Ottawa, Ontario, Canada2Canadian Partnership for Stroke Recovery, Ottawa, Ontario, Canada
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, Mariana Gomez-Smith, PhD¹²

Mariana Gomez-Smith

1University of Ottawa, Ottawa, Ontario, Canada2Canadian Partnership for Stroke Recovery, Ottawa, Ontario, Canada
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Sarah Gasinzigwa¹

Sarah Gasinzigwa

1University of Ottawa, Ottawa, Ontario, Canada
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, Jannis Achenbach, MD³

Jannis Achenbach

3Ruhr-University of Bochum, Bochum, Germany
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, Astrid Feiten⁴

Astrid Feiten

4University of Osnabrück, Osnabrück, Germany
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, Dale Corbett, PhD¹²*

Dale Corbett

1University of Ottawa, Ottawa, Ontario, Canada2Canadian Partnership for Stroke Recovery, Ottawa, Ontario, Canada
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First Published January 15, 2018 Research Article

https://doi.org/10.1177/1545968317753074

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Article Information

Article first published online: January 15, 2018

https://doi.org/10.1177/1545968317753074

Matthew Strider Jeffers, MSc^{1, 2}, Sudhir Karthikeyan, MSc^{1, 2}, Mariana Gomez-Smith, PhD^{1, 2}, Sarah Gasinzigwa¹, Jannis Achenbach, MD³, Astrid Feiten⁴, Dale Corbett, PhD^{1, 2}*

¹University of Ottawa, Ottawa, Ontario, Canada

²Canadian Partnership for Stroke Recovery, Ottawa, Ontario, Canada

³Ruhr-University of Bochum, Bochum, Germany

⁴University of Osnabrück, Osnabrück, Germany

Corresponding Author: Dale Corbett, Department of Cellular & Molecular Medicine, University of Ottawa, Roger Guindon Hall 3510G, 451 Smyth Road, Ottawa, Ontario K1H 8M5, Canada. Email: dcorbett@uottawa.ca

*This author is a member of The American Society of Neurorehabilitation.

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Abstract

Background. The proportional recovery rule suggests that current rehabilitation practices may have limited ability to influence stroke recovery. However, the appropriate intensity of rehabilitation needed to achieve recovery remains unknown. Similarities between rodent and human recovery biomarkers may allow determination of rehabilitation thresholds necessary to activate endogenous biological recovery processes.  
Objective. We determined the relative influence that clinically relevant biomarkers of stroke recovery exert on functional outcome. These biomarkers were then used to generate an algorithm that prescribes individualized intensities of rehabilitation necessary for recovery of function. Methods. A retrospective cohort of 593 male Sprague-Dawley rats was used to identify biomarkers that best predicted poststroke change in pellet retrieval in the Montoya staircase-reaching task using multiple linear regression. Prospective manipulation of these factors using endothelin-1-induced stroke (n = 49) was used to validate the model.  
Results. Rehabilitation was necessary to reliably predict recovery across the continuum of stroke severity. As infarct volume and initial impairment increased, more intensive rehabilitation was required to engage recovery. In this model, we prescribed the specific dose of daily rehabilitation required for rats to achieve significant motor recovery using the biomarkers of initial poststroke impairment and infarct volume.  
Conclusions. Our algorithm demonstrates an individualized approach to stroke rehabilitation, wherein imaging and functional performance measures can be used to develop an optimized rehabilitation paradigm for rats, particularly those with severe impairments. Exploring this approach in human patients could lead to an increase in the proportion of individuals experiencing recovery of lost motor function poststroke.