Stroke recovery - Methods of rehabilitation

Rehabilitation programs are the most effective way to treat motor disability. It is important for the patients to be started the rehabilitation program as soon as possible after their health has stabilized [Dobkin and Dorsch, 2013].

Physiotherapy rehabilitation is based on two basic principles [Dobkin and Dorsch, 2013]:

a) Neuroplasticity, is the ability to adapt and retrieve the cognitive and motor functions of the adult stroke, and

b) the importance of progressive, specialized motor training immediately after the stroke.

The most common rehabilitation therapies are conventional methods, including occupational therapy, physiotherapy, electrical stimulation, Bobath, Brunnstrom, PNF (specific neuromuscular facilitation), Mirror Therapy, etc.). Several studies have shown the positive effects of these interventions on the recovery of motor functions after a stroke [Chen and Shaw, 2014].

Since the 1990s, new and innovative technological and pharmaceutical approaches to rehabilitation have been developed. These include robotic and electromechanical devices, virtual reality (VR) systems, botulinum neurotoxin injections (BoNT), non-invasive brain stimulation (NIBS), and repetitive transcranial magnetic stimulation (rTMS). At present, there is no high-quality evidence to support any of these interventions, although several of them are used in day-to-day clinical practice [Pollock et al., 2014].

Physiotherapy focuses on improving range of motion and strength by performing exercises and learning functional tasks such as mobility at the bed, upper limb fine motor, walking, and other combined motor functions.

The emphasis is often on functional tasks and patient's goals. An example used by physiotherapists to promote motor learning involves movement therapy caused by limitations. Through continuous practice, the person learns to use and adapt the hemiplegic limb during functional activities to create permanent changes. Physical therapy is effective in restoring function and mobility after a stroke. Occupational therapy is involved in education to help learn the daily activities known as everyday life activities (ADLs), such as eating, drinking, dressing, bathing, cooking, reading and writing. Approaches to help people with urinary incontinence include physical therapy, cognitive therapy, and specialized interventions with experienced physicians. However, it is not clear how effective these approaches are in improving urinary incontinence after a stroke.

Treatment of stroke-related spasticity often involves early mobilization, usually performed by a physiotherapist, combined with spastic muscle lengthening and prolonged stretching through various positions. Obtaining an initial improvement in range of motion is often achieved through rhythmic rotational motifs associated with the affected limb. Once completed, in the therapist's full range of motion, the limb should be placed in extended positions to prevent further contractions, skin damage, and immobilization of the limb with the use of a splint or other tools to stabilize the joint. Ice therapy has been shown to reduce spasticity by temporarily reducing nerve trigger rates briefly. Electrical stimulation in muscle has also been used with some success.

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