New Technologies and Concepts for Rehabilitation in the Acute Phase of Stroke: A Collaborative Matrix

 You pretty much tell us what needs to be done to create protocols for recovery but don't mention WHOM is going to do the followup research to accomplish that.  This by itself is useless. It has been 14 years, where are we with creating protocols based upon this?

New Technologies and Concepts for Rehabilitation in the Acute Phase of Stroke: A Collaborative Matrix

2007, Neurodegenerative Diseases
 E.M. Siekierka a
K. Eng d
C. Bassetti a
A. Blickenstorfer b
M.S. Cameirao j
V. Dietz g
A. Duff  j
F. Erol d
 T. Ettlin h
D.M. Hermann a
 T. Keller e
B. Keisker b
J. Kesselring i
R. Kleiser b
S. Kollias b
J.P. Kool i
A. Kurre c
S. Mangold e
 T. Nef f
P. Pyk d
R. Riener f
C. Schuster h
F. Tosi d
P.F.M.J. Verschure j
L. Zimmerli j 

a Department of Neurology,
b Institute of Neuroradiology, and
c Rheumaklinik und Institut für Physikalische Medizin, University Hospital Zürich,
d Institute of Neuroinformatics, University/ETH Zürich,
e Automatic Control Laboratory and
f Department of Mechanical and Process Engineering, ETH Zürich,
g Uniklinik Balgrist, Zürich ,
 h Reha Rheinfelden, Rheinfelden , and
i Klinik Valens, Rehabilitationszentrum, Valens , Switzerland;
 j ICREA and  Technology Department, Universitat Pompeu Fabra, Barcelona , Spain

 Abstract

 The process of developing a successful stroke rehabilitation methodology requires four key components: a good under-standing of the pathophysiological mechanisms underlying this brain disease, clear neuroscientific hypotheses to guide therapy, adequate clinical assessments of its efficacy on multiple timescales, and a systematic approach to the application of modern technologies to assist in the everyday work of therapists. Achieving this goal requires collaboration be-tween neuroscientists, technologists and clinicians to develop well-founded systems and clinical protocols that are able to provide quantitatively validated improvements in patient rehabilitation outcomes. In this article we present three new applications of complementary technologies developed in an interdisciplinary matrix for acute-phase upper limb stroke rehabilitation – functional electrical stimulation, arm robot-assisted therapy and virtual reality-based cognitive therapy. We also outline the neuroscientific basis of our approach,  present our detailed clinical assessment protocol and provide preliminary results from patient testing of each of the three systems showing their viability for patient use.
Copyright © 2007 S. Karger AG, Basel

 Introduction

Stroke results in several neurological impairments which often severely reduce patient ability to perform activities of daily living (ADL) in both the short and long term. To individual patients, however, the assessments of impairments performed by attending physicians may be less important than maintaining or restoring premorbid daily-life functions. This is particularly true for upper extremity function and especially for skilled tool use. Constraint induced movement therapy is a well-accepted, evidence based approach for the chronic stage following a stroke [1, 2] . However, the optimal type of therapy for arm and hand function in the acute stage is still unclear, although a variety of treatment concepts has been defined [3]
Evidence from animal trials suggests that early initiation of therapy favorably influences efficacy of rehabilitation. In the early post-stroke stages the brain already shows adaptive plasticity in within-system pathways [4, 5] , and the brain displays elevated sensitivity to rehabilitative experience. Also, there is evidence of a correlation between early initiation of rehabilitation and better functional outcome as assessed by the Barthel index [6] . Other critical factors for sensorimotor therapy to induce long-term brain plasticity and improve functional out-comes are that the therapy is intensive [7] , highly repetitive [8] , task-oriented [9] and rewarded. This has been shown in a longitudinal study where therapy was applied early in a repetitive, task-oriented scenario to significantly improve long-term functional outcomes [10, 11] . Other experiments with healthy animal and human subjects suggest that repetitive task-oriented exercise alone will not increase cortical plasticity; rather, some degree of motor learning is required [12, 13] such as that experienced by stroke patients undergoing rehabilitation. These threads of evidence all point towards the need to develop arm and hand therapies for acute-phase stroke patients that are intensive, repetitive and oriented to-wards ADL. The best methods and technologies to be used are as yet unknown and likely to vary between patients. In this study we are applying new rehabilitation technologies developed in close collaboration with clinical, engineering and computer science groups interconnected in a ‘Rehabilitation Technology Matrix’ within the Swiss National Center for Competence in Research in ‘Neural Plasticity and Repair’.