Instead of 7 pages I could do it in one sentence. 'With no effective rehab protocols you have a 10% chance of getting fully recovered, you're screwed and your stroke hospital is doing nothing to get better at stroke recovery.' 10 years later and I wouldn't have to change that sentence at all. 10 years of stroke research and I see NOTHING better. I look forward to rebuttals with objectively proven results.
Abstract
Stroke rehabilitation is evolving into a clinical field based on the neuroscience of recovery and restoration.There has been substantial growth in the number and quality of clinical trials performed. Much effort now is directed toward motor restoration and is being led by trials of constraint induced movement therapy. Although the results do not necessarily support that constraint induced movement therapy is superior to other training methods,this treatment has become an important vehicle for developing clinical trial methods and studying the physiology underlying activity-based rehabilitation strategies.Other promising interventions include robotic therapy delivery, magnetic and electrical cortical stimulation,visualization, and constraint-driven aphasia therapies.Amphetamine has not been demonstrated to be effective,and studies of other pharmacologic agents are still preliminary. Future studies will incorporate refinements in clinical trial methods and improved activity and technology based interventions.
Introduction
In the past two decades, stroke rehabilitation has evolved from a field dominated by expert opinion and clinical tradition to one focused on exploiting recent advances in the neuroscience of development, physiology, imaging, and cognition. Many laboratory findings have progressed to preliminary and small-scale studies testing the relevance and utility of these interventions in the clinical setting. Now large scale phase 2 studies are commonplace, and the first cohort of phase 3 rehabilitation trials is entering the literature.See Table 1 for a list of some of the largest clinical trials that are ongoing at the time of this writing.By far, the strongest focus in rehabilitation research has been on motor restoration of hemiplegic limbs, perhaps the most obvious and disabling consequence of stroke and one particularly accessible to imaging and physiologic investigation. However, substantial work in aphasia remediation, hemispatial neglect, pharmacotherapy, and biomechanics alsohas been done. In this article, we critically review important findings from this area and place these findings in the context of current clinical practice and future research directions.
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