Recent Advances in Stroke Rehabilitation 2006

Abstract

Stroke rehabilitation has benefited from significant advances in the understanding of the natural history of recovery after stroke and the developments of techniques to modulate recovery processes over the last year. The confluence of literature from basic preclinical sciences and human neuroimaging studies has resulted in new insights into the mechanisms of neuronal recovery and cortical reorganization after ischemic injury. There have also been a number of studies that seek to evaluate the efficacy of interventions based on better understanding of recovery processes. The last year has also seen an explosion of meta-analyses on the effectiveness of different therapy techniques in stroke rehabilitation, which have provided valuable information on the validity of various approaches to rehabilitation, previously restricted by sample size considerations. Stroke rehabilitation is based on the concepts of neuroplasticity and reorganization of cerebral activity, the validity of which has been strongly supported in many functional MRI studies over the last decade.1 These studies have also shown the diversity and complexity of reorganization patterns, suggesting that the process of reorganization is dynamic and dependent on the nature of injury, substrates involved and the duration since the initial insult. More recently, hyperacute imaging studies have shown that early rapid recovery of function corresponds with successful reperfusion of the ischemic penumbra, suggesting that successful thrombolysis, optimization of collateral flow and even angiogenesis may be the first step for successful rehabilitation.2 Recent studies in acute recovery have also shown that the integrity of the corticospinal tract system is critical for motor recovery within the first 4 weeks of stroke, irrespective of involvement of the somatosensory system, providing a physiological explanation for the clinical observation of slower recovery in older people and those with underlying white matter disease. These studies also provide added incentive to identify therapies effective in protecting axons …