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Review
. 2017 Nov 7;19(12):59.
doi: 10.1007/s11883-017-0686-6.

Early Rehabilitation After Stroke: a Narrative Review

Elisheva R Coleman  1 , Rohitha Moudgal  2 , Kathryn Lang  3 , Hyacinth I Hyacinth  4 , Oluwole O Awosika  5 , Brett M Kissela  5 , Wuwei Feng  6
Affiliations
Review

Early Rehabilitation After Stroke: a Narrative Review

Elisheva R Coleman et al. Curr Atheroscler Rep. .

Abstract

Purpose of review: Despite current rehabilitative strategies, stroke remains a leading cause of disability in the USA. There is a window of enhanced neuroplasticity early after stroke, during which the brain's dynamic response to injury is heightened and rehabilitation might be particularly effective. This review summarizes the evidence of the existence of this plastic window, and the evidence regarding safety and efficacy of early rehabilitative strategies for several stroke domain-specific deficits.

Recent findings: Overall, trials of rehabilitation in the first 2 weeks after stroke are scarce. In the realm of very early mobilization, one large and one small trial found potential harm from mobilizing patients within the first 24 h after stroke, and only one small trial found benefit in doing so. For the upper extremity, constraint-induced movement therapy appears to have benefit when started within 2 weeks of stroke. Evidence for non-invasive brain stimulation in the acute period remains scant and inconclusive. For aphasia, the evidence is mixed, but intensive early therapy might be of benefit for patients with severe aphasia. Mirror therapy begun early after stroke shows promise for the alleviation of neglect. Novel approaches to treating dysphagia early after stroke appear promising, but the high rate of spontaneous improvement makes their benefit difficult to gauge. The optimal time to begin rehabilitation after a stroke remains unsettled, though the evidence is mounting that for at least some deficits, initiation of rehabilitative strategies within the first 2 weeks of stroke is beneficial. Commencing intensive therapy in the first 24 h may be harmful.

Keywords: Aphasia; Early rehabilitation; Motor recovery; Neuroplasticity; Stroke recovery; Stroke rehabilitation.

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Conflict of interest statement

Conflict of Interest Drs. Coleman, Moudgal, Lang, Hyacinth, Awosika, and Feng have nothing to disclose.

Dr. Kissela was a consultant for Ipsen, received fees for adjudication of clinical trial events for AbbVie and Janssen and grants from the NIH/NINDS.

References

    1. Krakauer JW, Carmichael ST, Corbett D, Wittenberg GF. Getting neurorehabilitation right—what can we learn from animal models? Neurorehabil Neural Repair. 2012;26(8):923–31. https://doi.org/10.1177/1545968312440745. - DOI - PMC - PubMed
    1. Whishaw IQ, Alaverdashvili M, Kolb B. The problem of relating plasticity and skilled reaching after motor cortex stroke in the rat. Behav Brain Res. 2008;192(1):124–36. https://doi.org/10.1016/j.bbr.2007.12.026. - DOI - PubMed
    1. Moon SK, Alaverdashvili M, Cross AR, Whishaw IQ. Both compensation and recovery of skilled reaching following small photothrombotic stroke to motor cortex in the rat. Exp Neurol. 2009;218(1):145–53. https://doi.org/10.1016/j.expneurol.2009.04.021. - DOI - PubMed
    1. Alaverdashvili M, Moon SK, Beckman CD, Virag A, Whishaw IQ. Acute but not chronic differences in skilled reaching for food following motor cortex devascularization vs. photothrombotic stroke in the rat. Neuroscience. 2008;157(2):297–308. https://doi.org/10.1016/j.neuroscience.2008.09.015. - DOI - PubMed
    1. Stinear C, Ackerley S, Byblow W. Rehabilitation is initiated early after stroke, but most motor rehabilitation trials are not: a systematic review. Stroke. 2013;44(7):2039–45. https://doi.org/10.1161/STROKEAHA.113.000968. - DOI - PubMed