Abstract
Long-term disability caused by stroke is largely due to an impairment of motor function. The functional consequences after stroke are caused by central nervous system adaptations and modifications, but also by the peripheral skeletal muscle changes. The nervous and muscular systems work together and are strictly dependent in their structure and function, through afferent and efferent communication pathways with a reciprocal “modulation.” Knowing how altered interaction between these two important systems can modify the intrinsic properties of muscle tissue is essential in finding the best rehabilitative therapeutic approach. Traditionally, the rehabilitation effort has been oriented toward the treatment of the central nervous system damage with a central approach, overlooking the muscle tissue. However, to ensure greater effectiveness of treatments, it should not be forgotten that muscle can also be a target in the rehabilitation process. The purpose of this review is to summarize the current knowledge about the skeletal muscle changes, directly or indirectly induced by stroke, focusing on the changes induced by the treatments most applied in stroke rehabilitation. The results of this review highlight changes in several muscular features, suggesting specific treatments based on biological knowledge; on the other hand, in standard rehabilitative practice, a realist muscle function evaluation is rarely carried out. We provide some recommendations to improve a comprehensive muscle investigation, a specific rehabilitation approach, and to draw research protocol to solve the remaining conflicting data. Even if a complete multilevel muscular evaluation requires a great effort by a multidisciplinary team to optimize motor recovery after stroke.
Highlights
Stroke is the second leading cause of death worldwide [1], with chronic disability remaining in up to 50% of survivors [2]
We summarized the current knowledge on skeletal muscle changes and primary and secondary changes induced by stroke, looking for the actual literature evidence on specific rehabilitative treatments targeting the muscle
It might be interesting to draw a longitudinal study by monitoring muscle changes with different methods to better understand how and when they occur, allowing to manage a specific and timely rehabilitation intervention aimed at recovery
Summary
Stroke is the second leading cause of death worldwide [1], with chronic disability remaining in up to 50% of survivors [2]. The rehabilitation effort has been oriented toward the treatment of the central nervous system (CNS) damage with a central approach, which exploits the plastic capacity of the neural cells to recover the best motor control. In this paradigm, muscle tissue is often overlooked [6]. Our idea is that only a “multi-target” rehabilitation treatment, which considers both the periphery and the CNS, can improve outcomes for stroke survivors until the best possible recovery Based on this aim, we analyzed the current knowledge on modification of muscle in stroke, considering three fundamental aspects: morphology, metabolism, and electro-mechanical properties. We resumed the principal treatment proposals available in the literature
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