What’s New in Stroke Rehabilitation
This article requires a subscription to view the full text. If you have a subscription you may use the login form below to view the article. Access to this article can also be purchased.
Stroke rehabilitation has been revolutionized in the last decade through a combination of new imaging techniques looking at brain recovery and clinical trials into what is working in stroke rehabilitation. The fear that rehabilitation was a long way from being rooted in science1 has been overcome by an increasing understanding of neuronal recovery processes and their modulation by various physical and pharmacological interventions. More than 300 randomized controlled trials provide a sound foundation for evidence-based practice in stroke rehabilitation, supplementing and often confirming decades of clinical experience. This growing body of knowledge has been enriched by several studies in 2003. Advances in basic sciences and clinical research are beginning to merge and show that the human brain is capable of significant recovery after stroke, provided that the appropriate treatments and stimuli are applied in adequate amounts and at the right time. What is particularly exciting is the introductions of new technologies such as robotic enhancement of therapies and virtual reality to further enhance that recovery.
Intensity Versus Task-Specificity After Stroke
Stroke rehabilitation is therapy intensive and one of the unresolved debates has been around the issues of quality and quantity. Evidence is building that intensity of therapy is important. This is particularly true for language recovery. Bhogal et al2 identified 8 randomized controlled trials (RCTs), which compared the intensity of speech and language therapy (SLT) delivered by a trained therapist versus a non-therapist or a non-SLT control. Four of the studies were positive and these studies provided a mean of 8.8 hours of therapy per week for 11.2 weeks when compared with the 4 negative trials that provide approximately 2 hours of therapy per week for a total of 22.9 weeks. On average, positive RCTs provided 98.4 hours of therapy over half the time that the negative RCTs provided 43.6 hours. Intensive therapy …