Rehabilitation of gait after stroke: a review towards a top-down approach

So nothing here that comes anywhere close to a protocol.  You better hope your therapist  has access to a miracle or you will barely recover using the current knowledge.  The only way I see the current rehab guidelines getting anywhere close to 100% recovery is if your doctors prevent  the 5 causes of the neuronal cascade of death in the first week.   Accomplished? Not accomplished? Did you calculate how many neurons your doctors allowed to die? My calculation is that my doctors let 

5.4 billion neurons die. 

21,600 miles dead myelinated fibers 

2.8 trillion dead synapses 

Damn hard to recover from all that with no stroke protocols.  

Rehabilitation of gait after stroke: a review towards a top-down approach

Juan-Manuel Belda-Lois1,2*, Silvia Mena-del Horno1, Ignacio Bermejo-Bosch1,2, Juan C Moreno3, José L Pons3, Dario Farina4, Marco Iosa5, Marco Molinari5, Federica Tamburella5, Ander Ramos6,7, Andrea Caria6, Teodoro Solis-Escalante8, Clemens Brunner8 and Massimiliano Rea6

Abstract 

This document provides a review of the techniques and therapies used in gait rehabilitation after stroke. It also examines the possible benefits of including assistive robotic devices and brain-computer interfaces in this field, according to a top-down approach, in which rehabilitation is driven by neural plasticity. The methods reviewed comprise classical gait rehabilitation techniques (neurophysiological and motor learning approaches), functional electrical stimulation (FES), robotic devices, and brain-computer interfaces (BCI). From the analysis of these approaches, we can draw the following conclusions. Regarding classical rehabilitation techniques, there is insufficient evidence to state that a particular approach is more effective in promoting gait recovery than other. Combination of different rehabilitation strategies seems to be more effective than overground gait training alone. Robotic devices need further research to show their suitability for walking training and their effects on over-ground gait. The use of FES combined with different walking retraining strategies has shown to result in improvements in hemiplegic gait. Reports on non-invasive BCIs for stroke recovery are limited to the rehabilitation of upper limbs; however, some works suggest that there might be a common mechanism which influences upper and lower limb recovery simultaneously, independently of the limb chosen for the rehabilitation therapy. Functional near infrared spectroscopy (fNIRS) enables researchers to detect signals from specific regions of the cortex during performance of motor activities for the development of future BCIs. Future research would make possible to analyze the impact of rehabilitation on brain plasticity, in order to adapt treatment resources to meet the needs of each patient and to optimize the recovery process.