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Review
. 2023 Dec;8(4):880-894.
doi: 10.1177/23969873231191304. Epub 2023 Aug 7.

Motor rehabilitation after stroke: European Stroke Organisation (ESO) consensus-based definition and guiding framework

Gert Kwakkel  1   2   3 , Cathy Stinear  4 , Bea Essers  5 , Maria Munoz-Novoa  6 , Meret Branscheidt  7 , Rosa Cabanas-Valdés  8 , Sandra Lakičević  9 , Sofia Lampropoulou  10 , Andreas R Luft  7 , Philippe Marque  11 , Sarah A Moore  12   13 , John M Solomon  14   15 , Eva Swinnen  16 , Andrea Turolla  17   18 , Margit Alt Murphy  6   19 , Geert Verheyden  5
Affiliations
Review

Motor rehabilitation after stroke: European Stroke Organisation (ESO) consensus-based definition and guiding framework

Gert Kwakkel et al. Eur Stroke J. 2023 Dec.

Abstract

Purpose: To propose a consensus-based definition and framework for motor rehabilitation after stroke.

Methods: An expert European working group reviewed the literature, attaining internal consensus after external feedback.

Findings: Motor rehabilitation is defined as a process that engages people with stroke to benefit their motor function, activity capacity and performance in daily life. It is necessary for people with residual motor disability whose goal is to enhance their functioning, independence and participation. Motor rehabilitation operates through learning- and use-dependent mechanisms. The trajectory of motor recovery varies across patients and stages of recovery. Early behavioral restitution of motor function depends on spontaneous biological mechanisms. Further improvements in activities of daily living are achieved by compensations. Motor rehabilitation is guided by regular assessment of motor function and activity using consensus-based measures, including patient-reported outcomes. Results are discussed with the patient and their carers to set personal goals. During motor rehabilitation patients learn to optimize and adapt their motor, sensory and cognitive functioning through appropriately dosed repetitive, goal-oriented, progressive, task- and context-specific training. Motor rehabilitation supports people with stroke to maximize health, well-being and quality of life. The framework describes the International Classification of Functioning, Disability and Health in the context of stroke, describes neurobiological mechanisms of behavioral restitution and compensation, and summarizes recommendations for clinical assessment, prediction tools, and motor interventions with strong recommendations from clinical practice guidelines (2016-2022).

Conclusions: This definition and framework may guide clinical educators, inform clinicians on current recommendations and guidelines, and identify gaps in the evidence base.

Keywords: Review; assessment; intervention; motor recovery; motor rehabilitation; prediction.

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Conflict of interest statement

Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
The international classification of functioning, disability and health.
Figure 2.
Figure 2.
Patterns, processes and treatment opportunities post-stroke (adapted from Dobkin and Carmichael, used with permission).
Figure 3.
Figure 3.
Pictorial abbreviated motor rehabilitation after stroke definition (center) and summarized process of motor rehabilitation after stroke.
See this image and copyright information in PMC

References

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