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Early Rehabilitation After Stroke: a Narrative Review

  • Cardiovascular Disease and Stroke (S. Prabhakaran, Section Editor)
  • Published:
Current Atherosclerosis Reports Aims and scope Submit manuscript

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.

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Authors and Affiliations

  1. Department of Neurology and Rehabilitation Medicine, University of Cincinnati Gardner Neuroscience Institute, 260 Stetson St., Suite 2300, Cincinnati, OH, 45267-0525, USA

    Elisheva R. Coleman, Oluwole O. Awosika & Brett M. Kissela

  2. University of Cincinnati College of Medicine, Cincinnati, OH, USA

    Rohitha Moudgal

  3. Department of Rehabilitation Services, University of Cincinnati, Cincinnati, OH, USA

    Kathryn Lang

  4. Aflac Cancer and Blood Disorder Center of Children’s Healthcare of Atlanta and Emory University Department of Pediatrics, Atlanta, GA, USA

    Hyacinth I. Hyacinth

  5. Department of Neurology, Medical University of South Carolina, Charleston, SC, USA

    Wuwei Feng

Authors
  1. Elisheva R. Coleman
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  2. Rohitha Moudgal
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  3. Kathryn Lang
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  4. Hyacinth I. Hyacinth
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  5. Oluwole O. Awosika
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  6. Brett M. Kissela
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  7. Wuwei Feng
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Correspondence to Elisheva R. Coleman.

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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.

Human and Animal Rights

All reported studies/experiments with human or animal subjects performed by the authors have been previously published and complied with all applicable ethical standards (including the Helsinki declaration and its amendments, institutional/national research committee standards, and international/national/institutional guidelines).

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This article is part of the Topical Collection on Cardiovascular Disease and Stroke

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Coleman, E.R., Moudgal, R., Lang, K. et al. Early Rehabilitation After Stroke: a Narrative Review. Curr Atheroscler Rep 19, 59 (2017). https://doi.org/10.1007/s11883-017-0686-6

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  • DOI: https://doi.org/10.1007/s11883-017-0686-6

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