Predicting and accelerating motor recovery after stroke

Useless, used words like 'may', plateau and predictable. Nothing here for survivors.  Nocebo is used to prevent further recovery in these patients. 

Predicting and accelerating motor recovery after stroke

 
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CURRENT OPINION
Predicting and accelerating motor recovery after stroke
Cathy M. Stinear a,c and Winston D. Byblow  b,c
Purpose of review This review presents recent developments in the prediction of motor recovery after stroke; explores whether rehabilitation interventions delivered during the spontaneous recovery process can improve outcomes; and identifies the first trials to focus on the rate rather than extent of motor recovery (Supplementary Digital Content 1). Recent findings Two recent studies have attempted to accelerate the rate of motor recovery during the first few weeks afterstroke, with neuromodulation techniques designed to facilitate excitability of the ipsilesional motor cortex.One trial using transcranial direct current stimulation was negative, and the other trial using bilateral priming was positive. These contrasting results may be explained by important differences in trial design.This new focus on modifying rate, rather than extent, of motor recovery is in line with accumulatingevidence that the motor recovery plateau is largely determined by the extent of damage to descending motor pathways, which is currently untreatable. 
Summary Interventions that facilitate neural plasticity and reorganization may accelerate recovery of motor function during the spontaneous recovery period, without affecting final outcome. This may represent a useful new approach for future trials conducted during rehabilitation at the subacute stage of stroke. Video abstract http://links.lww.com/CONR/A30 Keywords motor, recovery, rehabilitation, stroke INTRODUCTION Stroke results in motor impairment for most patients [1], and is a leading cause of long-term adult disability[2].The ability to live independently after stroke critically depends on the recovery of motor function [3,4], particularly of the hand and arm [5]. This review is, therefore, focused on the recovery and rehabilitation of voluntary upper limb movement after stroke. IS MOTOR OUTCOME PREDICTABLE? Large-scale observational studies indicate that recovery is most rapid during the first month after stroke, and motor function reaches plateau within 3 months [1,6–8]. Even the most severely affected patients can expect no further improvements in activities of daily living beyond 6 months(You never use this nocebo wording with stroke patients unless you are trying to get them mad enough to say, 'Fuck you, I'll recover because you know nothing.') poststroke patients at the chronic stage cannot benefit from therapy, discussed below. However, improvements during the first few weeks after stroke map onto the nature and time course of the neurobiological mechanisms of spontaneous recovery(Fig.1),which have been reasonably well characterized using animal models [11,12]. Rehabilitation is delivered during the first few weeks after stroke,to interact with these neurobiological processes and shape the patient’srecovery. Better outcomes are observed when therapy is initiated earlier [13–15], possibly because this maximizes the opportunity for therapy to interact with the spontaneous recovery process.