Stroke Rehabilitation and Motor Recovery

OBJECTIVE Up to 50% of the nearly 800,000 patients who experience a new or recurrent stroke each year in the United States fail to achieve full independence afterward. More effective approaches to enhance motor recovery following stroke are needed. This article reviews the rehabilitative principles and strategies that can be used to maximize post-stroke recovery.

LATEST DEVELOPMENTS Evidence dictates that mobilization should not begin prior to 24 hours following stroke, but detailed guidelines beyond this are lacking. Specific classes of potentially detrimental medications should be avoided in the early days poststroke. Patients with stroke who are unable to return home should be referred for evaluation to an inpatient rehabilitation facility. Research suggests that a substantial increase in both the dose and intensity of upper and lower extremity exercise is beneficial. A clinical trial supports vagus nerve stimulation as an adjunct to occupational therapy for motor recovery in the upper extremity. The data remain somewhat mixed as to whether robotics, transcranial magnetic stimulation, functional electrical stimulation, and transcranial direct current stimulation are better than dose-matched traditional exercise. No current drug therapy has been proven to augment exercise poststroke to enhance motor recovery.

ESSENTIAL POINTS Neurologists will collaborate with rehabilitation professionals for several months following a patient’s stroke. Many questions still remain about the ideal exercise regimen to maximize motor recovery in patients poststroke. The next several years will likely bring a host of new research studies exploring the latest strategies to enhance motor recovery using poststroke exercise.

Address correspondence to Dr Michael W. O’Dell, MD, NeuroRehabilitation Consultants–New York City, c/o Manhattan Medicine, 300 East 56^th St, New York, NY 10021, [email protected].

RELATIONSHIP DISCLOSURE: Dr O’Dell has received personal compensation in the range of $0 to $499 for serving as an officer or member of the board of directors for Franklin College of Indiana, and in the range of $500 to $4999 for serving on a scientific advisory or data safety monitoring board for Merz Pharmaceuticals, LLC.

UNLABELED USE OF PRODUCTS/INVESTIGATIONAL USE DISCLOSURE: Dr O’Dell discusses several clinical trials involving the use of investigational drugs, none of which are US Food and Drug Administration (FDA) approved for use in people with stroke.