A scoping review of scientific concepts concerning motor recovery after stroke as employed in clinical trials

So basically no one in stroke has any clue what they are doing to get stroke survivors recovered. And survivors will continue to be screwed until we get survivors in charge providing leadership and a strategy to get to 100% recovery!

A scoping review of scientific concepts concerning motor recovery after stroke as employed in clinical trials

Martina Favetta^1† Alberto Romano^1,2† Nicola Valè^3† Blazej Cieslik⁴ Sara Federico⁴ Alessia Girolami⁵ Deborah Mazzarotto⁶ Giorgia Pregnolato^4* Anna Righetti³ Silvia Salvalaggio^7,8 Enrico Castelli¹ Nicola Smania³ Stefano Bargellesi⁹ Pawel Kiper^4‡ Maurizio Petrarca^1‡

• ¹Movement Analysis and Robotics Laboratory (MARlab), Neurorehabilitation Unit, Neurological Science and Neurorehabilitation Area, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
• ²Department of Health Systems Management, Ariel University, Ariel, Israel
• ³Neuromotor and Cognitive Rehabilitation Research Center (CRRNC), Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
• ⁴Laboratory of Healthcare Innovation Technology, IRCCS San Camillo Hospital, Venice, Italy
• ⁵Spondilos Lab Centro Medico and Riabilitazione, Pordenone, Italy
• ⁶Medicina Fisica e Riabilitazione, ULSS 4 Veneto Orientale, Jesolo, Italy
• ⁷Laboratory of Computational Neuroimaging, IRCCS San Camillo Hospital, Venice, Italy
• ⁸Padova Neuroscience Center, Università Degli Studi di Padova, Padua, Italy
• ⁹Physical Medicine and Rehabilitation Unit, Azienda ULSS 3 Serenissima, Venezia, Italy

The scientific literature on poststroke rehabilitation is remarkably vast. Over the last decades, dozens of rehabilitation approaches have been investigated. However, sometimes it is challenging to trace new experimental interventions back to some of the known models of motor control and sensorimotor learning. This scoping review aimed to investigate motor control models’ diffusion among the literature on motor recovery after stroke. We performed a literature search on Medline, Cochrane, Web of Science, Embase, and Scopus databases. The last search was conducted in September 2023. This scoping review included full-text articles published in English in peer-reviewed journals that provided rehabilitation interventions based on motor control or motor learning frameworks for at least one individual with stroke. For each study, we identified the theoretical framework the authors used to design the experimental treatment. To this aim, we used a previously proposed classification of the known models of motor control, dividing them into the following categories: neuroanatomy, robotics, self-organization, and ecological context. In total, 2,185 studies were originally considered in this scoping review. After the screening process, we included and analyzed 45 studies: 20 studies were randomized controlled trials, 12 were case series, 4 were case reports, 8 were observational longitudinal pilot studies, and 1 was an uncontrolled trial. Only 10 studies explicitly declared the reference theoretical model. Considering their classification, 21 studies referred to the robotics motor control model, 12 to the self-organization model, 8 to the neuroanatomy model, and 4 to the ecological model. Our results showed that most of the rehabilitative interventions purposed in stroke rehabilitation have no clear theoretical bases on motor control and motor learning models. We suggest this is an issue that deserves attention when designing new experimental interventions in stroke rehabilitation.

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