Early Rehabilitation After Stroke: a Narrative Review

• Type of Material: Article
• Authors: Elisheva R. Coleman, University of Cincinnati; Rohitha Moudgal, University of Cincinnati; Kathryn Lang, University of Cincinnati; Hyacinth Idu Hyacinth, Emory University; Oluwole O. Awosika, University of Cincinnati; Brett M. Kissela, University of Cincinnati; Wuwei Feng, Medical University of South Carolina
• Language: English
• Date: 2017-12-01
• Publisher: Current Medicine Group
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2017, Springer Science+Business Media, LLC.
• Final Published Version (URL): http://dx.doi.org/10.1007/s11883-017-0686-6
• Title of Journal or Parent Work: Current Atherosclerosis Reports
• ISSN: 1523-3804
• Volume: 19
• Issue: 12
• Start Page: 59
• End Page: 59
• Grant/Funding Information: Dr. Kissela received grants from the NIH/NINDS.
• Keywords: Stroke recovery; Stroke rehabilitation; MOTOR CORTEX; NERVE GROWTH-FACTOR; Peripheral Vascular Disease; FOCAL CEREBRAL-ISCHEMIA; Aphasia; Motor recovery; Science & Technology; REDUCES INFARCT SIZE; RANDOMIZED CONTROLLED-TRIAL; DELAYED REHABILITATION; Cardiovascular System & Cardiology; SUBACUTE STROKE; Life Sciences & Biomedicine; TRANSCRANIAL MAGNETIC STIMULATION; Neuroplasticity; DIRECT-CURRENT STIMULATION; Early rehabilitation; BRAIN ISCHEMIA
• Research Categories: Biology, Neuroscience

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. Summary: 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.