In the 8 years since this came out, IS THERE EFFECTIVE STROKE REHAB ANYWHERE? Meaning 100% recovery!
NO?
Then everyone in stroke needs to be fired.
Towards Effective Neurorehabilitation for Stroke Patients
Jerzy Krupinski
1,2
, Julio J Secades
3*
and Rena K Shiraliyeva
4
1
Hospital Universitari Mutua Terrassa, Neurology Department, Barcelona, Spain
2
Manchester Metropolitan University, Healthcare Sciences, Manchester, UK
3
Grupo Ferrer, Barcelona, Spain
4
Department of Neurology, Republican Clinical Hospital, Baku, Azerbaijan
*
Corresponding author:
Julio J. Secades, Scientific Department, Grupo Ferrer, 08029, Barcelona, Spain, Tel: +34936003837; Fax: +34934907078; E-mail:
jsecades@ferrergrupo.com
Rec date:
03 Feb 2014;
Acc date:
20 March 2014;
Pub date:
23 March 2014
Copyright:
© 2014 Krupinski J, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Keywords:
Stroke; Rehabilitation; Neuroplasticity; Robotics;Pharmacological therapy; Citicoline
Introduction
Each year during the world stroke awareness day we recall that 1 in 6 people(now 1 in 4)worldwide will have a stroke in their lifetime. This makes stroke the first cause of disability worldwide with 30% survivors having long-term sequelae and in 50% residual disability requires assistance for basic activities of daily living (ADL) [1]. It has an important socioeconomic impact with estimated costs of 27.314 euro per person/year [2,3], exceeds any pharmacological interventions and call for better, and more effective recovery approaches. XXI century neurorehabilitation is a very young field with an evolving concepts and important literature supporting its impact on outcomes. This article provides an overview of the field and summarises the most recent and continuosly evolving paradigms of current and modern neurorehabilitation. We examine concept of teacher, or neurotherapist crucial for successfull neurorehabilitation [4]. We provide practicing neurology and rehabilitation clinicians with a review of concepts of neuroplasticity, engagement, enriched environments, smart roboticsand neuroelectronic devices and explain how they could be linked and applied in daily practise. For the purpose of the following review, we selected literature based on the most recent publications in the fieldand international guidelines.
Changing Paradigms of Current Neurorehabilitation Concepts
What is a modern neurorehabilitation? It is all about recovery of functional skills after injury through evidence-based interventions that operate to manipulate the sensorimotor environment of the patient.This involves patient engagement for greater neuroplastic changes and functional outcomes. Engagement is motivation, passion, desire,dedication, trust, attitude about treatment, and active participation of the subject.One of the biggest discoveries in XX century in neuroscience was neuroplasticity [5,6]. It is a capacity for reorganization and adaptation throughout the lifespan, including post-injury adaptive capacities of the nervous system to change following deprivation of input or over stimulation, increased or decreased usage or learning of new skills.These changes are engendered by creating new neural pathways or through modification of existing ones. Studies show that post-injury,neural reorganization occurs without any clinical intervention based on use and functional compensation. The theoretical foundation of initial and older concepts concentrated on motor recovery was usually based on spinal reflex physiology and hierarchical concepts of motor development going back to the beginning of the 20th century [4]. Much of the knowledge of modern neurophysiology and psychology is not embedded in previous theoretical frameworks. Currently, it is recommended that we move away from intuitive purely motor rehabilitation strategies to knowledge-based selection of therapeutic regimes.
So, How Should We Work Neuroplasticity Post Injury in Hard-Wired Brain?
We can increase neuroplasticity by enriched environments, mental practice, attention and motivation, building trust and rapport,motivational interviewing, enhancing the client education process.Interventions that empower client’s therapeutic relationship with clinicians is essential. We should even shift further from the traditional neurological model (focused on intervention and neuroplasticity) to a neuropsychological perspective of a teacher concept. Therefore, XXI century definition of neuroplasticity includes the concept of
International Journal of Physical Medicine &Rehabilitation
Krupinski et al., Int J Phys Med Rehabil 2014, 2:2http://dx.doi.org/10.4172/2329-9096.1000183
Review ArticleOpen Access
Int J Phys Med RehabilStroke RehabilitationISSN:2329-9096 PMR, an open access journal
1,2
, Julio J Secades
3*
and Rena K Shiraliyeva
4
1
Hospital Universitari Mutua Terrassa, Neurology Department, Barcelona, Spain
2
Manchester Metropolitan University, Healthcare Sciences, Manchester, UK
3
Grupo Ferrer, Barcelona, Spain
4
Department of Neurology, Republican Clinical Hospital, Baku, Azerbaijan
*
Corresponding author:
Julio J. Secades, Scientific Department, Grupo Ferrer, 08029, Barcelona, Spain, Tel: +34936003837; Fax: +34934907078; E-mail:
jsecades@ferrergrupo.com
Rec date:
03 Feb 2014;
Acc date:
20 March 2014;
Pub date:
23 March 2014
Copyright:
© 2014 Krupinski J, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Abstract
Despite global and regional health crises, global life expectancy has increased continuously and substantially over the past 40 years. This is associated with an increase in incidence of age-related diseases, such as ischemic stroke and has an important socioeconomic impact. There is a growing demand to have more effective treatments to reduce disability and improve the outcome of stroke patients. We reviewed the latest advances on neurorehabilitation and the new trends in this field. We provide practicing neurology and rehabilitation clinicians with a review of concepts of neuroplasticity, engagement, enriched environments, smart robotics, neuroelectronic devices and explain how they could be linked and applied in daily practise. Also, we review pharmacological interventions with a direct effect in neurorehabilitation. We conclude that there is some degree of evidence suggesting a possible positive coadjuvant effect of citicoline in the rehabilitation phase of patients after stroke.Keywords:
Stroke; Rehabilitation; Neuroplasticity; Robotics;Pharmacological therapy; Citicoline
Introduction
Each year during the world stroke awareness day we recall that 1 in 6 people(now 1 in 4)worldwide will have a stroke in their lifetime. This makes stroke the first cause of disability worldwide with 30% survivors having long-term sequelae and in 50% residual disability requires assistance for basic activities of daily living (ADL) [1]. It has an important socioeconomic impact with estimated costs of 27.314 euro per person/year [2,3], exceeds any pharmacological interventions and call for better, and more effective recovery approaches. XXI century neurorehabilitation is a very young field with an evolving concepts and important literature supporting its impact on outcomes. This article provides an overview of the field and summarises the most recent and continuosly evolving paradigms of current and modern neurorehabilitation. We examine concept of teacher, or neurotherapist crucial for successfull neurorehabilitation [4]. We provide practicing neurology and rehabilitation clinicians with a review of concepts of neuroplasticity, engagement, enriched environments, smart roboticsand neuroelectronic devices and explain how they could be linked and applied in daily practise. For the purpose of the following review, we selected literature based on the most recent publications in the fieldand international guidelines.
Changing Paradigms of Current Neurorehabilitation Concepts
What is a modern neurorehabilitation? It is all about recovery of functional skills after injury through evidence-based interventions that operate to manipulate the sensorimotor environment of the patient.This involves patient engagement for greater neuroplastic changes and functional outcomes. Engagement is motivation, passion, desire,dedication, trust, attitude about treatment, and active participation of the subject.One of the biggest discoveries in XX century in neuroscience was neuroplasticity [5,6]. It is a capacity for reorganization and adaptation throughout the lifespan, including post-injury adaptive capacities of the nervous system to change following deprivation of input or over stimulation, increased or decreased usage or learning of new skills.These changes are engendered by creating new neural pathways or through modification of existing ones. Studies show that post-injury,neural reorganization occurs without any clinical intervention based on use and functional compensation. The theoretical foundation of initial and older concepts concentrated on motor recovery was usually based on spinal reflex physiology and hierarchical concepts of motor development going back to the beginning of the 20th century [4]. Much of the knowledge of modern neurophysiology and psychology is not embedded in previous theoretical frameworks. Currently, it is recommended that we move away from intuitive purely motor rehabilitation strategies to knowledge-based selection of therapeutic regimes.
So, How Should We Work Neuroplasticity Post Injury in Hard-Wired Brain?
We can increase neuroplasticity by enriched environments, mental practice, attention and motivation, building trust and rapport,motivational interviewing, enhancing the client education process.Interventions that empower client’s therapeutic relationship with clinicians is essential. We should even shift further from the traditional neurological model (focused on intervention and neuroplasticity) to a neuropsychological perspective of a teacher concept. Therefore, XXI century definition of neuroplasticity includes the concept of
International Journal of Physical Medicine &Rehabilitation
Krupinski et al., Int J Phys Med Rehabil 2014, 2:2http://dx.doi.org/10.4172/2329-9096.1000183
Review ArticleOpen Access
Int J Phys Med RehabilStroke RehabilitationISSN:2329-9096 PMR, an open access journal
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