Dose and timing in neurorehabilitation: prescribing motor therapy after stroke

This is so true that our doctors and therapists have NO clue as to what and how much movement to prescribe to recover from a stroke. With no objective diagnosis of the dead and damaged areas they will NEVER be able to determine what works.  Because of failures in this area they should really be working on solving the neuronal cascade of death because with less dead and damaged neurons you are much more likely to be able to recover. But this won't occur until we get appropriate stroke leadership defining what the strategy should be to solve all the problems in stroke.
http://journals.lww.com/co-neurology/Abstract/2015/12000/Dose_and_timing_in_neurorehabilitation__.2.aspx

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Current Opinion in Neurology:

December 2015 - Volume 28 - Issue 6 - p 549–555

doi: 10.1097/WCO.0000000000000256

TRAUMA AND REHABILITATION: Edited by S. Thomas Carmichael

Lang, Catherine E.a,b; Lohse, Keith R.c; Birkenmeier, Rebecca L.a
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Abstract

Purpose of review: Prescribing the most appropriate dose of motor therapy for individual patients is a challenge because minimal data are available and a large number of factors are unknown. This review explores the concept of dose and reviews the most recent findings in the field of neurorehabilitation, with a focus on relearning motor skills after stroke.

Recent findings: Appropriate dosing involves the prescription of a specific amount of an active ingredient, at a specific frequency and duration. Dosing parameters, particularly amount, are not well defined or quantified in most studies. Compiling data across studies indicates a positive, moderate dose–response relationship, indicating that more movement practice results in better outcomes. This relationship is confounded by time after stroke, however, wherein longer durations of scheduled therapy may not be beneficial in the first few hours, days, and/or weeks.

Summary: These findings suggest that substantially more movement practice may be necessary to achieve better outcomes for people living with the disabling consequences of stroke. Preclinical investigations are needed to elucidate many of the unknowns and allow for a more biologically driven rehabilitation prescription process. Likewise, clinical investigations are needed to determine the dose–response relationships and examine the potential dose–timing interaction in humans.