Neurorehabilitation: Motor recovery after stroke as an example

This is a perfect example of why stroke survivors need to be in charge. Existing 'professionals' are not tackling the  BHAGs(Big Hairy Audacious Goals) of 100% recovery for all survivors.

Neurorehabilitation: Motor recovery after stroke as an example

Karunesh Ganguly, MD, PhD,1,2
Nancy N. Byl, PT, MPH, PhD,3 and1,2
The field of neurorehabilitation aims to translate neuroscience research toward the goal of maximizing functional recovery after neurological injury.(This is still wrong, maximaztion is not the same as 100% recovery. You have the wrong goal. You still think in terms of the tyranny of low expectations and assume that is good enough for survivors. IT IS NOT GOOD ENOUGH!) A growing body of research indicates that the fundamental principles of neurological rehabilitation are applicable to a broad range of congenital, degenerative, and acquired neurological disorders.In this perspective, we will focus on motor recovery after acquired brain injuries such as stroke. Over the past few decades, a large body of basic and clinical research has created an experimental and theoretical foundation for approaches to neurorehabilitation. Recent randomized clinical trials all emphasize the requirement for intense progressive rehabilitation programs to optimally enhance recovery. Moreover, advances in multimodal assessment of patients with neuroimaging and neurophysiological tools suggest the possibility of individualized treatment plansbased on recovery potential. There are also promising indications for medical as well as noninvasive brain stimulation paradigms to facilitate recovery. Ongoing or planned clinical studies should provide more definitive evidence. We also highlight unmet needs and potential areas of research. Continued research built upon a robust experimental and theoretical foundation should help to develop novel treatments to improve recovery after neurological injury. ANN NEUROL 2013;74:373–381
Neurorehabilitation is the translation of basic and clinical neuroscience research to help patients with nervous system dysfunction to maximize mechanisms of neural and compensation. The ultimate objectives are to restore and maintain functional independence, community participation, and quality of life despite impairments.(Wrong, wrong, wrong. The goal is NO impairments) 1,3,4  Although this conceptual review will examine advances in the rehabilitation of patients poststroke, we emphasize that the fundamental principlesare applicable to a broad range of congenital, degenerative, and traumatic neurological disorders. Stroke is among the leading causes of long-term disability in both developed and developing countries.It is also the leading cause of long-term disability in the United States.8 Of the >700,000 stroke survivors eachyear in the United States alone, approximately 30 to 45% become permanently disabled. 8,9The impact of stroke on individuals and families, as well as the financial burden on the health care system, are substantial and will only grow as the global population ages.6–8 The World Health Organization International Classification of Function differentiates between the primary disease process/body impairments, limitations in“activities,” and the restrictions that limit “participation”http://www.who.int/classifications). One of the main causes of disability after stroke is upper extremity weakness that limits performance of activities activities of daily living(eg, feeding and self-care) as well as broader engagement in society. 8,10However, lower extremity weakness, spasticity, pain, dysphagia, dysarthria, aphasia, visual field deficits, depression, and cognitive deficits can also limit access to the broader community.11–13  Although there has been substantial progress in stroke prevention, early stroke diagnosis (eg, using neuroimaging), and acute treatment, there has only been a modest improvement in functional outcomes. 4,8,9 It is critical to develop novel medical treatments, refine rehabilitative techniques, and translate the principles of neural adaptation and interface technology to enhance recovery poststroke.