Neurorehabilitation: Motor recovery after stroke as an example

These 9 pages of examples are NOT GOOD ENOUGH. Just guidelines and suggestions.  Nothing here is going to improve the 10% full recovery rate. Written in 2013 but I know nothing has really improved since then.

Neurorehabilitation: Motor recovery after stroke as an example

 Karunesh Ganguly, MD, PhD,1,2 Nancy N. Byl, PT, MPH, PhD,3 and Gary M. Abrams, MD1,2

The field of neurorehabilitation aims to translate neuroscience research toward the goal of maximizing functional recovery after neurological injury. 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(NOT GOOD ENOUGH) of individualized treatment plans based 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 recovery and compensation.1–5 The ultimate objectives are to restore and maintain functional independence, community participation, and quality of life despite impairments.1,3,4 Although this conceptual review will examine advances in the rehabilitation of patients poststroke, we emphasize that the fundamental principles are applicable to a broad range of congenital, degenerative, and traumatic neurological disorders.1 Stroke is among the leading causes of long-term disability in both developed and developing countries.6–8 It is also the leading cause of long-term disability in the United States.8 Of the >700,000 stroke survivors each year in the United States alone, approximately 30 to 45% become permanently disabled.8,9 The 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 of daily living (eg, feeding and self-care) as well as broader engagement in society.8,10 However, lower extremity weakness, spasticity, pain, dysphagia, dysarthria, aphasia, visual field deficits, depression, and cognitive deficits can also limit activities and 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 post stroke.