You can check and see if your hospital has put any new rehab in their hospital in the last ten years.
Rehabilitation After Stroke: Current State of the Science - 2010
Alex R. Carter &
Lisa T. Connor &
Alexander W. Dromerick
Published online: 13 March 2010
#
Springer Science+Business Media, LLC 2010
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.
Keywords
Rehabilitation.Clinical tr ials.Cerebrovascular disease.Recovery
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 also has 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.
Constraint-induced Movement Therapy
Constraint-induced movement therapy (CIMT) emerged from 19th century primate models of deafferentation and was developed as a clinical intervention by Taub and Uswatte [1], Wolf et al. [2], and others. It has two major components: restraint of the less affected upper extremity
A. R. Carter Department of Neurology,Washington University School of Medicine,660 South Euclid, Campus Box 8518, St. Louis, MO 63110, USAe-mail: cartera@neuro.wustl.eduL. T. Connor Program in Occupational Therapy,Washington University School of Medicine,660 South Euclid, Campus Box 8505, St. Louis, MO, USAe-mail: lconnor@wustl.eduA. W. Dromerick (
*
) National Rehabilitation Hospital,Georgetown University School of Medicine,102 Irving Street Northwest,Washington, DC 20010, USAe-mail: Alexander.w.dromerick@medstar.ne
Lisa T. Connor &
Alexander W. Dromerick
Published online: 13 March 2010
#
Springer Science+Business Media, LLC 2010
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.
Keywords
Rehabilitation.Clinical tr ials.Cerebrovascular disease.Recovery
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 also has 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.
Constraint-induced Movement Therapy
Constraint-induced movement therapy (CIMT) emerged from 19th century primate models of deafferentation and was developed as a clinical intervention by Taub and Uswatte [1], Wolf et al. [2], and others. It has two major components: restraint of the less affected upper extremity
A. R. Carter Department of Neurology,Washington University School of Medicine,660 South Euclid, Campus Box 8518, St. Louis, MO 63110, USAe-mail: cartera@neuro.wustl.eduL. T. Connor Program in Occupational Therapy,Washington University School of Medicine,660 South Euclid, Campus Box 8505, St. Louis, MO, USAe-mail: lconnor@wustl.eduA. W. Dromerick (
*
) National Rehabilitation Hospital,Georgetown University School of Medicine,102 Irving Street Northwest,Washington, DC 20010, USAe-mail: Alexander.w.dromerick@medstar.ne
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