Current issues and considerations about the central role of rehabilitation therapies in the functional recovery of neurological impairments after stroke in adults

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Abstract

Well-organized acute and intermediate rehabilitation after stroke can provide patients with the best functional results. Several studies led to major changes in recommendations concerning remobilization therapies following stroke. Controlled studies including early mobilization in stands and training with partial body weight support on treadmills and "gait training" systems showed superior results compared to traditional treatment strategies. In case of spasticity and equinovarus and stiff knee pattern following stroke, botulinum neurotoxin A injections and/or casting enable the achievement of adequate alignment of the ankle for stance phase and allow the improvement of joint mobility during swing phase when restricted.

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Most cited references 28

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Technique to improve chronic motor deficit after stroke.

Charles Cook, E Taub, Cheryl N Miller … (1993)

The unaffected upper extremity of chronic stroke patients was restrained in a sling during waking hours for 14 days; on ten of those days, these patients were given six hours of practice in using the impaired upper extremity. An attention-comparison group received several procedures designed to focus attention on use of the impaired upper extremity. The restraint subjects improved on each of the laboratory measures of motor function used--in most cases markedly. Extensive improvement, from a multi-year plateau of greatly impaired motor function, was also noted for the restraint group in the life situation and these gains were maintained during a two-year period of follow-up. For the comparison group only one measure showed small to moderate improvement, and this was lost during the follow-up period; there was essentially no overlap between the individuals of the two groups. Thus, prolonged restraint of an unaffected upper extremity and practice of functional movements with the impaired limb proved to be an effective means of restoring substantial motor function in stroke patients with chronic motor impairment identified by the inclusion criteria of this project.

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Functional electrotherapy: stimulation of the peroneal nerve synchronized with the swing phase of the gait of hemiplegic patients.

Jennifer Dow, W T Liberson, D SCOT … (1961)

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Treatment of spasticity with botulinum toxin: a double-blind study.

S Hashimoto, D Calne, Matthew Snow … (1990)

We studied the effect of botulinum-A toxin on spasticity of the leg adductors in 9 patients who were either chair-bound or bed-bound with chronic stable multiple sclerosis. We injected botulinum toxin (400 mouse units) or placebo into the adductor muscles in a randomized, crossover, double-blind design. Two physicians, who were unaware of the treatment order, used an objective rating scale and independently assessed the patients; interobserver correlation was excellent (r = 0.93-0.81). We found that botulinum toxin produced a significant reduction in spasticity (p = 0.009) and a significant improvement in the ease of nursing care (p = 0.009). There were no adverse effects during this short-term trial. This is the first demonstration of the beneficial effect of botulinum toxin on focal spastic muscle contractions.

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Author and article information

Journal

Journal ID (nlm-ta): J Med Life

Journal ID (iso-abbrev): J Med Life

Journal ID (publisher-id): JMedLife

Title: Journal of Medicine and Life

Publisher: Carol Davila University Press (Romania )

ISSN (Print): 1844-122X

ISSN (Electronic): 1844-3117

Publication date (Print): 15 September 2014

Publication date (Electronic): 25 September 2014

Volume: 7

Issue: 3

Pages: 368-372

Affiliations

[* ]Neurological Rehabilitation Clinic HWK I, Bad Zwesten, WWK – Hessen, Germany

[** ]"Carol Davila" University of Medicine and Pharmacy, Bucharest; "Bagdasar-Arseni" Clinical Emergency Hospital; Neuromuscular Recovery Clinic, Bucharest, Romania

Author notes

Correspondence to:Ecaterina Moraru, MD, Neurologist primary doctor Neurological Rehabilitation Clinic HWK I, Bad Zwesten, WWK – Hessen, Germany Phone: 0049.5621.9361544, E-mail: katemoraru@hotmail.com

Article

Publisher ID: JMedLife-07-368

PMC ID: 4233440

PubMed ID: 25408756

SO-VID: 60eed519-24e6-4054-b033-ca8fb49bff59

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This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Current issues and considerations about the central role of rehabilitation therapies in the functional recovery of neurological impairments after stroke in adults

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Abstract

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Stroke MRI

Most cited references 28

Technique to improve chronic motor deficit after stroke.

Functional electrotherapy: stimulation of the peroneal nerve synchronized with the swing phase of the gait of hemiplegic patients.

Treatment of spasticity with botulinum toxin: a double-blind study.

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