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. 2010 May;10(3):158-66.
doi: 10.1007/s11910-010-0091-9.

Rehabilitation after stroke: current state of the science

Alex R Carter  1 , Lisa T Connor, Alexander W Dromerick
Affiliations

Rehabilitation after stroke: current state of the science

Alex R Carter et al. Curr Neurol Neurosci Rep. 2010 May.

Abstract

Stroke rehabilitation is evolving into a clinical field based on the neuroscience of recovery and restoration. There has been substantial growth in the number and quality of clinical trials performed. Much effort now is directed toward motor restoration and is being led by trials of constraint-induced movement therapy. Although the results do not necessarily support that constraint-induced movement therapy is superior to other training methods, this treatment has become an important vehicle for developing clinical trial methods and studying the physiology underlying activity-based rehabilitation strategies. Other promising interventions include robotic therapy delivery, magnetic and electrical cortical stimulation, visualization, and constraint-driven aphasia therapies. Amphetamine has not been demonstrated to be effective, and studies of other pharmacologic agents are still preliminary. Future studies will incorporate refinements in clinical trial methods and improved activity- and technology-based interventions.

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Conflict of interest statement

Disclosure No potential conflicts of interest relevant to this article were reported.

References

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    1. •• Wolf SL, Winstein CJ, Miller JP, et al. Effect of constraint-induced movement therapy on upper extremity function 3 to 9 months after stroke: the EXCITE randomized clinical trial. JAMA. 2006;296(17):2095–2104. This is the largest (n = 222) RCT of CIMT, and because of its size and design, it continues to provide important longitudinal data on the efficacy of CIMT. The fact that its control group is not fully dose matched is an important lesson that will improve the design of future trials.

    1. • Dromerick AW, Lang CE, Birkenmeier RL, et al. Very Early Constraint-Induced Movement during Stroke Rehabilitation (VECTORS): a single-center RCT. Neurology. 2009;73(3):195–201. This trial demonstrated conclusively that just as for drugs, dose– response curves need to be developed for rehabilitation interventions. One cannot always assume more is better.