Stroke Rehabilitation New lnsight From Neuroscienc - A Focused Review

Abstract

Stroke is the most common cause of disability and the most frequent indication for inpatient rehabilitation. New information from neuroscience indicates that the cerebral cortex can reorganize or remodel after injury. In animal models, exercise of a paretic limb and restraint of the normal limb increase not only motor power, but also the size of the cortical forelimb area. Similar findings have recently been reported in man. Evidence ofcortical reorganization has also been found during recovery of behavioral disorders such as aphasia and neglect. Rehabilitative therapies such as constraint-induced therapy apply these concepts in human stroke rehabilitation. Other promising techniques involve deafferentation procedures, neural transplantation , transcranial magnetic stimulation, and pharmacotherapy for stroke. Considerable evidence exists for the overall benefit of stroke rehabilitation, but the evidence for specific therapies is less compelling, and there is limited evidence favoring inpatient over subacute rehabilitation. Medical complications of stroke are reviewed. In the future, therapy techniques can be tested both for clinical efficacy and for changes in cortical organization by brain imaging.