Early Rehabilitation After Stroke: a Narrative Review

My god, no understanding of the neuronal cascade of death in the first days at all. The therapy initiated in the first 24 hours doesn't cause harm. You fuckers need to understand cause and effect.  This lack of knowledge is appalling
https://link.springer.com/article/10.1007/s11883-017-0686-6

• Authors
• Authors and affiliations

• Elisheva R. ColemanEmail author
• Rohitha Moudgal
• Kathryn Lang
• Hyacinth I. Hyacinth
• Oluwole O. Awosika
• Brett M. Kissela
• Wuwei Feng

• Elisheva R. Coleman
  • 1
  Email author
• Rohitha Moudgal
  • 2
• Kathryn Lang
  • 3
• Hyacinth I. Hyacinth
  • 4
• Oluwole O. Awosika
  • 1
• Brett M. Kissela
  • 1
• Wuwei Feng
  • 5

1. 1.Department of Neurology and Rehabilitation MedicineUniversity of Cincinnati Gardner Neuroscience InstituteCincinnatiUSA
2. 2.University of Cincinnati College of MedicineCincinnatiUSA
3. 3.Department of Rehabilitation ServicesUniversity of CincinnatiCincinnatiUSA
4. 4.Aflac Cancer and Blood Disorder Center of Children’s Healthcare of Atlanta and Emory University Department of PediatricsAtlantaUSA
5. 5.Department of NeurologyMedical University of South CarolinaCharlestonUSA

Cardiovascular Disease and Stroke (S. Prabhakaran, Section Editor)

First Online: 07 November 2017

Part of the following topical collections:

1. Topical Collection on Cardiovascular Disease and Stroke

Abstract

Purpose of Review

Despite current rehabilitative strategies, stroke remains a leading cause of disability in the USA. There is a window of enhanced neuroplasticity early after stroke, during which the brain’s dynamic response to injury is heightened and rehabilitation might be particularly effective. This review summarizes the evidence of the existence of this plastic window, and the evidence regarding safety and efficacy of early rehabilitative strategies for several stroke domain-specific deficits.

Recent Findings

Overall, trials of rehabilitation in the first 2 weeks after stroke are scarce. In the realm of very early mobilization, one large and one small trial found potential harm from mobilizing patients within the first 24 h after stroke, and only one small trial found benefit in doing so. For the upper extremity, constraint-induced movement therapy appears to have benefit when started within 2 weeks of stroke. Evidence for non-invasive brain stimulation in the acute period remains scant and inconclusive. For aphasia, the evidence is mixed, but intensive early therapy might be of benefit for patients with severe aphasia. Mirror therapy begun early after stroke shows promise for the alleviation of neglect. Novel approaches to treating dysphagia early after stroke appear promising, but the high rate of spontaneous improvement makes their benefit difficult to gauge.

Summary

The optimal time to begin rehabilitation after a stroke remains unsettled, though the evidence is mounting that for at least some deficits, initiation of rehabilitative strategies within the first 2 weeks of stroke is beneficial. Commencing intensive therapy in the first 24 h may be harmful.