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What's new in stroke rehabilitation: back to basics.

Stroke rehabilitation has been energized by the increasing confluence of supporting literature from animal studies, neuroimaging investigation of poststroke recovery, and an explosion of clinical rehabilitation trials. As basic scientists and clinical researchers converge, the exciting new technologies and more rigorous clinical methodologies used provide increasing support for some of the basic underpinnings of stroke rehabilitation (ie, the earlier rehabilitation is started the better the recovery), that greater intensity of treatment translates into greater recovery, and that improvement can continue for some time after discharge from hospital or rehabilitation center.

Schallert et al1 noted that the brain appears to be primed to “recover” early after stroke. Biernaskie et al2 used a randomized controlled trial (RCT) in rats to examine the role of delay of therapy on rehabilitation outcomes. A small focal ischemic lesion was induced, and rats were then subjected to social housing (the control) or enriched rehabilitative training for 5 weeks beginning at 5, 14, and 30 days after stroke. Animals with enriched rehabilitative training at day 5 demonstrated a marked improvement in recovery, whereas those animals exposed at day 30 showed insignificant improvements compared with controls. Those in enriched rehabilitation at day 14 achieved an intermediate level of recovery compared with those that received enriched rehabilitation at day 5 and day 30. Rehabilitation at day 5 in rats was associated with an increased complexity of dendritic branching in the undamaged area when compared with those rehabilitated at day 30 or those exposed to social housing only, providing a biological explanation for greater recovery with earlier rehabilitation. The authors noted that their work confirmed previous primate research3 that demonstrated a time-dependent, rehabilitation-induced map reorganization after ischemic injury, with the remaining preserved cortical tissue being most responsive to rehabilitation training in the early compared with later phases …