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Is there a best approach to the rehabilitation of adult hemiplegia?

Abstract Established neuro-rehabilitation approaches to the remediation of hemiplegia have been the mainstay of stroke rehabilitation. Approaches such as proprioceptive neuromuscular rehabilitation, neurodevelopmental treatment for adult hemiplegia, motor relearning program, task specific training and constraint induced movement therapy have all been supported in the literature. While research has supported their efficacy, efforts to establish the most effective approach have been unsuccessful, often inconsistent and sometimes controversial. The evolution of rehabilitation approaches occurring in time with the general acceptance that neuroplastic changes are driven by experience has resulted in the approaches working from a number of common elements that tap into the principles of neuroplasticity. The aim of this perspective article is to challenge the concept that there is a “best” approach to the rehabilitation of adult hemiplegia. It will present a sample of literature relating to the efficacy of neuro-approaches and the literature comparing approaches, identify elements common to the frequently applied approaches, identify the principles of neuroplasticity and demonstrate how each of the approaches taps into a number of these principles. The correlation between the elements common to the neuro-rehabilitation approaches and the principles of neuroplasticity they tap into is proposed as a theory to explain the challenge in establishing the superiority of one approach over another. Employment of an eclectic approach based on patient needs and responses to rehabilitation of adult hemiplegia is presented as a reasonable conclusion.