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01-06-2013 | Cardiovascular Disease and Stroke (D Leifer and JE Safdieh, Section Editors)

New Evidence for Therapies in Stroke Rehabilitation

Authors: Bruce H. Dobkin, Andrew Dorsch

Published in: Current Atherosclerosis Reports | Issue 6/2013

Abstract

Neurologic rehabilitation aims to reduce impairments and disabilities so that persons with serious stroke can return to participation in usual self-care and daily activities as independently as feasible. New strategies to enhance recovery draw from a growing understanding of how types of training, progressive task-related practice of skills, exercise for strengthening and fitness, neurostimulation, and drug and biological manipulations can induce adaptations at multiple levels of the nervous system. Recent clinical trials provide evidence for a range of new interventions to manage walking, reach and grasp, aphasia, visual field loss, and hemi-inattention.

Go AS, Mozaffarian D, Roger VL, Benjamin EJ, et al. Heart disease and stroke statistics-2013 update: a report from the American Heart Association. Circulation. 2013;127(1):e6–e245.CrossRefPubMed

Stroke Unit Trialists' Collaboration. Organised inpatient (stroke unit) care for stroke. Cochrane Database of Syst Rev. 2009 Jan 21; (1): CD000197.

Centers for Disease Control and Prevention (CDC). Outpatient rehabilitation among stroke survivors–21 states and the District of Columbia, 2005. MMWR Morb Mortal Wkly Rep. 2007;56:504–7.

• Centers for Medicare and Medicaid Services. Therapy cap. http://www.cms.gov/research-statistics-data-and-systems/monitoring-programs/medical-review/therapycap.html. Accessed 4 Mar 2013. It is remarkable how relatively few people of Medicare age are able to obtain stroke rehabilitation services.

Murphy TH, Corbett D. Plasticity during stroke recovery: from synapse to behaviour. Nat Rev Neurosci. 2009;10(12):861–72.CrossRefPubMed

Rehme AK, Grefkes C. Cerebral network disorders after stroke: evidence from imaging-based connectivity analyses of active and resting brain states in humans. J Physiol. 2013;591(Pt 1):17–31.CrossRefPubMed

Iosa M, Morone G, Fusco A, Bragoni M, et al. Seven capital devices for the future of stroke rehabilitation. Stroke Res Treat. 2012;2012:187965.PubMed

Dobkin BH. Progressive staging of pilot studies to improve Phase III trials for motor interventions. Neurorehabil Neural Repair. 2009;23(3):197–206.PubMed

Dobkin BH, Dorsch A. The promise of mHealth: daily activity monitoring and outcome assessments by wearable sensors. Neurorehabil Neural Repair. 2011;25(9):788–98.CrossRefPubMed

10.

Stroke Engine. Stroke Engine-Assess. http://www.strokengine.ca/assess. Accessed 4 Mar 2013.

11.

Hobart JC, Cano SJ, Zajicek JP, Thompson AJ. Rating scales as outcome measures for clinical trials in neurology: problems, solutions, and recommendations. Lancet Neurol. 2007;6(12):1094–105.CrossRefPubMed

12.

Dobkin BH. Clinical practice. Rehabilitation after stroke. N Engl J Med. 2005;352(16):1677–84.CrossRefPubMed

13.

Koyama T, Sako Y, Konta M, Domen K. Poststroke discharge destination: functional independence and sociodemographic factors in urban Japan. J Stroke Cerebrovasc Dis. 2011;20(3):202–7.CrossRefPubMed

14.

• Langhorne P, Bernhardt J, Kwakkel G. Stroke rehabilitation. Lancet. 2011;377(9778):1693–702. This paper reviews the most frequently employed interventions and the scientific basis for them.CrossRefPubMed

15.

Dobkin BH. The clinical science of neurologic rehabilitation. 2nd ed. Oxford University Press; 2004.

16.

• Krakauer JW, Carmichael ST, Corbett D, Wittenberg GF. Getting neurorehabilitation right: what can be learned from animal models? Neurorehabil Neural Repair. 2012;26(8):923–31. This reviews the limitations and potential of animal models to enable development of translational neurorehabilitation strategies. Timing, dose, duration and intensity of a rehabilitation therapy must be determined to optimize the strategy.CrossRefPubMed

17.

Ferrarello F, Baccini M, Rinaldi LA, Cavallini MC, et al. Efficacy of physiotherapy interventions late after stroke: a meta-analysis. J Neurol Neurosurg Psychiatry. 2011;82(2):136–43.CrossRefPubMed

18.

Wolf SL, Winstein CJ, Miller JP, Taub E, et al. Effect of constraint-induced movement therapy on upper extremity function 3 to 9 months after stroke: the EXCITE randomized clinical trial. JAMA. 2006;296(17):2095–104.CrossRefPubMed

19.

•• Lo AC, Guarino PD, Richards LG, Haselkorn JK, et al. Robot-assisted therapy for long-term upper-limb impairment after stroke. N Engl J Med. 2010;362(19):1772–83. This largest randomized clinical trial of upper extremity robotic training versus the same intensity of conventional therapy in highly impaired, hemiparetic participants revealed equivalent primary outcomes, but left open the possibility of some clinical usefulness for future studies. CrossRefPubMed

20.

•• Duncan PW, Sullivan KJ, Behrman AL, Azen SP, et al. Body-weight-supported treadmill rehabilitation after stroke. N Engl J Med. 2011;364(21):2026–36. This largest randomized clinical trial of BWSTT revealed that the experimental, highly task-oriented intervention was equivalent to home-based, progressive exercise and balance training at the same intensity in terms of changes in gait speed, distance, and physical functioning, but significantly better than usual care starting 2 months post stroke. No differences were found between the two active interventions when starting BWSTT at 6 months after onset either. CrossRefPubMed

21.

Baert I, Daly D, Dejaeger E, Vanroy C, et al. Evolution of cardiorespiratory fitness after stroke: a 1-year follow-up study. Influence of prestroke patients' characteristics and stroke-related factors. Arch Phys Med Rehabil. 2012;93(4):669–76.CrossRefPubMed

22.

• Rand D, Eng JJ, Tang PF, Jeng JS, Hung C. How active are people with stroke?: use of accelerometers to assess physical activity. Stroke. 2009;40(1):163–8. Free-living physical activity was very low in 40 subjects and 58 % of the participants did not meet recommended physical activity levels. Use of a single commercial accelerometer to count steps is fairly reliable if walking speeds exceed 0.5m/s. Physicians might encourage longer walks at higher speeds within the limits of confidence about safety. CrossRefPubMed

23.

Manns PJ, Dunstan DW, Owen N, Healy GN. Addressing the nonexercise part of the activity continuum: a more realistic and achievable approach to activity programming for adults with mobility disability? Phys Ther. 2012;92(4):614–25.CrossRefPubMed

24.

Han CE, Kim S, Chen S, Lai YH, et al. Quantifying arm nonuse in individuals poststroke. Neurorehabil Neural Repair. 2013. doi:10.1177/1545968312471904 [Epub ahead of print].

25.

Billinger SA, Coughenour E, Mackay-Lyons MJ, Ivey FM. Reduced cardiorespiratory fitness after stroke: biological consequences and exercise-induced adaptations. Stroke Res Treat. 2012;2012:959120.PubMed

26.

Furie KL, Kasner SE, Adams RJ, Albers GW, et al. Guidelines for the prevention of stroke in patients with stroke or transient ischemic attack: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2011;42(1):227–76.CrossRefPubMed

27.

• Voss MW, Prakash RS HS, et al. The influence of aerobic fitness on cerebral white matter integrity and cognitive function in older adults: Results of a one-year exercise intervention. Hum Brain Mapp. 2012. doi:10.1002/hbm.22119. One of a series of small trials from AF Kramer and colleagues that reveals structural and functional connectivity improvements in the brain, as well as in several cognitive domains, with moderate walking exercise.

28.

Verdelho A, Madureira S, Ferro JM, Baezner H, et al. Physical activity prevents progression for cognitive impairment and vascular dementia: results from the LADIS (Leukoaraiosis and Disability) study. Stroke. 2012;43(12):3331–5.CrossRefPubMed

29.

Brazzelli M, Saunders DH, Greig CA, Mead GE. Physical fitness training for stroke patients. Cochrane Database Syst Rev. 2011;11, CD003316.PubMed

30.

•• Globas C, Becker C, Cerny J, Lam JM, et al. Chronic stroke survivors benefit from high-intensity aerobic treadmill exercise: a randomized control trial. Neurorehabil Neural Repair. 2012;26(1):85–95. Participants randomized to receive 3 months (3×/week) of progressive graded, high-intensity aerobic treadmill exercise improved significantly more than those who received conventional care physiotherapy in Vo2 peak, walking speed, balance and mental self-reported functioning.CrossRefPubMed

31.

Dean CM, Rissel C, Sherrington C, Sharkey M, et al. Exercise to enhance mobility and prevent falls after stroke: the community stroke club randomized trial. Neurorehabil Neural Repair. 2012;26(9):1046–57.CrossRefPubMed

32.

Touillet A, Guesdon H, Bosser G, Beis JM, Paysant J. Assessment of compliance with prescribed activity by hemiplegic stroke patients after an exercise programme and physical activity education. Arch Phys Rehabil Med. 2010;53(4):250-7–257-65.

33.

States RA, Pappas E, Salem Y. Overground physical therapy gait training for chronic stroke patients with mobility deficits. Cochrane Database Syst Rev. 2009;3:CD006075.PubMed

34.

Weerdesteyn V, de Niet M, van Duijnhoven HJ, Geurts AC. Falls in individuals with stroke. J Rehabil Res Dev. 2008;45(8):1195–213.CrossRefPubMed

35.

Saeys W, Vereeck L, Truijen S, Lafosse C, et al. Randomized controlled trial of truncal exercises early after stroke to improve balance and mobility. Neurorehabil Neural Repair. 2012;26(3):231–8.CrossRefPubMed

36.

Chumbler NR, Quigley P, Li X, Morey M, et al. Effects of telerehabilitation on physical function and disability for stroke patients: a randomized, controlled trial. Stroke. 2012 May 24.

37.

• Dobkin BH, Duncan PW. Should body weight-supported treadmill training and robotic-assistive steppers for locomotor training trot back to the starting gate? Neurorehabil Neural Repair. 2012;26(4):308–17. A review of the pitfalls of translating animal studies of stepping interventions into pilot studies and then phase III trials of robotic and treadmill-based strategies for stroke and spinal cord injury. The outcomes have generally been equivalent to the same intensity of over-ground practice despite the theoretical basis for a means to better motor control. CrossRefPubMed

38.

Mehrholz J, Werner C, Kugler J, Pohl M. Electromechanical-assisted training for walking after stroke. Cochrane Database Syst Rev. 2010

39.

Mehrholz J, Pohl M. Electromechanical-assisted gait training after stroke: a systematic review comparing end-effector and exoskeleton devices. J Rehabil Med. 2012;44(3):193–9.CrossRefPubMed

40.

Stein RB, Everaert DG, Thompson AK, et al. Long-term therapeutic and orthotic effects of a foot drop stimulator on walking performance in progressive and nonprogressive neurological disorders. Neurorehabilitation and Neural Repair. 2010;24(2):152–67.CrossRefPubMed

41.

Daly JJ, Zimbelman J, Roenigk KL, McCabe JP, et al. Recovery of coordinated gait: randomized controlled stroke trial of functional electrical stimulation (FES) versus no FES, with weight-supported treadmill and over-ground training. Neurorehabil Neural Repair. 2011;25(7):588–96.CrossRefPubMed

42.

Taylor P, Humphreys L, Swain I. The long-term cost-effectiveness of the use of Functional Electrical Stimulation for the correction of dropped foot due to upper motor neuron lesion. J Rehabil Med. 2013;45(2):154–60.CrossRefPubMed

43.

• Wolf SL, Winstein CJ, Miller JP, Thompson PA, et al. Retention of upper limb function in stroke survivors who have received constraint-induced movement therapy: the EXCITE randomised trial. Lancet Neurol. 2008;7(1):33–40. This clinical trial, first reported in JAMA in 2006, has continued to reveal important information about the recovery of upper extremity functioning, measures of gains, and long-term consequences of the massed practice intervention. CrossRefPubMed

44.

• Smania N, Gandolfi M, Paolucci S, Iosa M, et al. Reduced-intensity modified constraint-induced movement therapy versus conventional therapy for upper extremity rehabilitation after stroke: a multicenter trial. Neurorehabil Neural Repair. 2012;26(9):1035–45. Using the EXCITE trial’s entry criteria, this randomized trial showed that just two hours of CIMT, rather than 6 hours a day for 10 days, may be more effective than conventional rehabilitation in improving motor function and use of the paretic arm in patients with hemiparetic chronic stroke.CrossRefPubMed

45.

Kitago T, Liang J, Huang VS, Hayes S, et al. Improvement after constraint-induced movement therapy: recovery of normal motor control or task-specific compensation? Neurorehabil Neural Repair. 2013;27(2):99–109.CrossRefPubMed

46.

• Wu CY, Chuang LL, Lin KC, Chen HC, Tsay PK. Randomized trial of distributed constraint-induced therapy versus bilateral arm training for the rehabilitation of upper-limb motor control and function after stroke. Neurorehabil Neural Repair. 2011;25(2):130–9. Hemiparetic patients with chronic stroke were randomized to treatment for 2 h/d and 5 d/wk for 3 weeks to either CIMT, bimanual training (BAT) or a neurodevelopmental therapy approach. Outcomes were better for the first two over the latter. BAT led to modestly higher arm forces and CIMT to modestly greater functional ability.CrossRefPubMed

47.

Mann G, Taylor P, Lane R. Accelerometer-triggered electrical stimulation for reach and grasp in chronic stroke patients: a pilot study. Neurorehabil Neural Repair. 2011;25(8):774–80.CrossRefPubMed

48.

Mehrholz J, Hädrich A, Platz T, Kugler J, Pohl M. Electromechanical and robot-assisted arm training for improving generic activities of daily living, arm function, and arm muscle strength after stroke. Cochrane Database Syst Rev. 2012;6:CD006876.PubMed

49.

Hesse S, Waldner A, Mehrholz J, Tomelleri C, et al. Combined transcranial direct current stimulation and robot-assisted arm training in subacute stroke patients: an exploratory, randomized multicenter trial. Neurorehabil Neural Repair. 2011;25(9):838–46.CrossRefPubMed

50.

Shaw LC, Price CI, van Wijck FM, et al. Botulinum toxin for the upper limb after stroke (BoTULS) trial: effect on impairment, activity limitation, and pain. Stroke. 2011;42(5):1371–9.CrossRefPubMed

51.

Rosales RL, Kong KH, Goh KJ, Kumthornthip W, et al. Botulinum toxin injection for hypertonicity of the upper extremity within 12 weeks after stroke: a randomized controlled trial. Neurorehabil Neural Repair. 2012;26(7):812–21.CrossRefPubMed

52.

Blennerhassett JM, Gyngell K, Crean R. Reduced active control and passive range at the shoulder increase risk of shoulder pain during inpatient rehabilitation post-stroke: an observational study. J Physiother. 2010;56(3):195–9.CrossRefPubMed

53.

Brady MC, Kelly H, Godwin J, Enderby P. Speech and language therapy for aphasia following stroke. Cochrane Database Syst Rev. 2012;5:CD000425.PubMed

54.

van der Meulen I, van de Sandt-Koenderman ME, Ribbers GM. Melodic Intonation Therapy: present controversies and future opportunities. Arch Phys Med Rehabil. 2012;93(1 Suppl):S46–52.CrossRefPubMed

55.

Meinzer M, Rodriguez AD, Gonzalez Rothi LJ. First decade of research on constrained-induced treatment approaches for aphasia rehabilitation. Arch Phys Med Rehabil. 2012;93(1 Suppl):S35–45.CrossRefPubMed

56.

Cherney LR, van Vuuren S. Telerehabilitation, virtual therapists, and acquired neurologic speech and language disorders. Semin Speech Lang. 2012;33(3):243–57.CrossRefPubMed

57.

Fridriksson J, Hubbard HI, Hudspeth SG, Holland AL, et al. Speech entrainment enables patients with Broca's aphasia to produce fluent speech. Brain. 2012;135(Pt 12):3815–29.CrossRefPubMed

58.

Ali M, Hazelton C, Lyden P, Pollock A, Brady M. Recovery from poststroke visual impairment: evidence from a clinical trials resource. Neurorehabil Neural Repair. 2013;27(2):133–41.CrossRefPubMed

59.

Mödden C, Behrens M, Damke I, Eilers N, et al. A randomized controlled trial comparing 2 interventions for visual field loss with standard occupational therapy during inpatient stroke rehabilitation. Neurorehabil Neural Repair. 2012;26(5):463–9.CrossRefPubMed

60.

• Gorgoraptis N, Mah YH, Machner B, et al. The effects of the dopamine agonist rotigotine on hemispatial neglect following stroke. Brain. 2012;135(Pt 8):2478–91. Few trials of pharmacologic agents have led to better outcomes after stroke.CrossRefPubMed

61.

Mizuno K, Tsuji T, Takebayashi T, Fujiwara T, et al. Prism adaptation therapy enhances rehabilitation of stroke patients with unilateral spatial neglect: a randomized, controlled trial. Neurorehabil Neural Repair. 2011;25(8):711–20.CrossRefPubMed

62.

Nicolas-Alonso LF, Gomez-Gil J. Brain computer interfaces, a review. Sensors (Basel). 2012;12(2):1211–79.CrossRef

63.

• Hochberg LR, Bacher D, Jarosiewicz B, et al. Reach and grasp by people with tetraplegia using a neurally controlled robotic arm. Nature. 2012;485(7398):372–5. Two subjects with long-standing tetraplegia learned to use a neural interface system-based control of a robotic arm to perform three-dimensional reach and grasp movements. Participants controlled the arm and hand over a broad space without explicit training, using signals decoded from a small, local population of motor cortex (MI) neurons recorded from an implanted 96-channel microelectrode array.CrossRefPubMed

64.

Dimyan MA, Cohen LG. Contribution of transcranial magnetic stimulation to the understanding of functional recovery mechanisms after stroke. Neurorehabil Neural Repair. 2010;24(2):125–35.CrossRefPubMed

65.

Adeyemo BO, Simis M, Macea DD, Fregni F. Systematic review of parameters of stimulation, clinical trial design characteristics, and motor outcomes in non-invasive brain stimulation in stroke. Front Psychiatry. 2012;3:88.CrossRefPubMed

66.

Naeser MA, Martin PI, Ho M, Treglia E, et al. Transcranial magnetic stimulation and aphasia rehabilitation. Arch Phys Med Rehabil. 2012;93(1 Suppl):S26–34.CrossRefPubMed

67.

Michou E, Mistry S, Jefferson S, Singh S, et al. Targeting unlesioned pharyngeal motor cortex improves swallowing in healthy individuals and after dysphagic stroke. Gastroenterology. 2012;142(1):29–38.CrossRefPubMed

68.

Wang RY, Tseng HY, Liao KK, Wang CJ, et al. rTMS combined with task-oriented training to improve symmetry of interhemispheric corticomotor excitability and gait performance after stroke: a randomized trial. Neurorehabil Neural Repair. 2012;26(3):222–30.CrossRefPubMed

69.

• Seniów J, Bilik M, Leśniak M, Waldowski K, et al. Transcranial magnetic stimulation combined with physiotherapy in rehabilitation of poststroke hemiparesis: a randomized, double-blind, placebo-controlled study. Neurorehabil Neural Repair. 2012;26(9):1072–9. Repetitive TMS at 1Hz to contralesional primary motor cortex to suppress its activity and disinhibit the lesioned side did not result in greater upper extremity gains compared to sham stimulation. Other smaller studies suggested modest improvements, but these may depend on the level of spared motor control and lesion location.CrossRefPubMed

70.

Talelli P, Wallace A, Dileone M, Hoad D, et al. Theta burst stimulation in the rehabilitation of the upper limb: a semirandomized, placebo-controlled trial in chronic stroke patients. Neurorehabil Neural Repair. 2012;26(8):976–87.CrossRefPubMed

71.

• Lindenberg R, Renga V, Zhu LL, Nair D, Schlaug G. Bihemispheric brain stimulation facilitates motor recovery in chronic stroke patients. Neurology. 2010;75(24):2176–84. Twenty Participants were randomly assigned to 5 consecutive sessions of either bihemispheric transcranial direct current stimulation to upregulate excitability of ipsilesional motor cortex and downregulate excitability of contralesional motor cortex with simultaneous rehabilitation or to sham stimulation with therapy. Motor function improved significantly more in the real stimulation group (20.7 % in Fugl-Meyer; 19.1 % in Wolf Motor Function Test scores) compared to sham (3.2 % in Fugl-Meyer; 6.0 % in Wolf scores). The effects outlasted stimulation by 1 week.CrossRefPubMed

72.

Hummel FC, Celnik P, Pascual-Leone A, Fregni F, et al. Controversy: Noninvasive and invasive cortical stimulation show efficacy in treating stroke patients. Brain Stimul. 2008;1(4):370–82.CrossRefPubMed

73.

Conforto AB, Ferreiro KN, Tomasi C, dos Santos RL, et al. Effects of somatosensory stimulation on motor function after subacute stroke. Neurorehabil Neural Repair. 2010;24(3):263–72.CrossRefPubMed

74.

Castel-Lacanal E, Marque P, Tardy J, de Boissezon X, et al. Induction of cortical plastic changes in wrist muscles by paired associative stimulation in the recovery phase of stroke patients. Neurorehabil Neural Repair. 2009;23(4):366–72.PubMed

75.

Celnik P, Paik NJ, Vandermeeren Y, et al. Effects of combined peripheral nerve stimulation and brain polarization on performance of a motor sequence task after chronic stroke. Stroke. 2009;40(5):1764–71.CrossRefPubMed

76.

Laufer Y, Elboim-Gabyzon M. Does sensory transcutaneous electrical stimulation enhance motor recovery following a stroke? A systematic review. Neurorehabil Neural Repair. 2011;25(9):799–809.CrossRefPubMed

77.

Garrison KA, Winstein CJ, Aziz-Zadeh L. The mirror neuron system: a neural substrate for methods in stroke rehabilitation. Neurorehabil Neural Repair. 2010;24(5):404–12.CrossRefPubMed

78.

Michielsen ME, Selles RW, van der Geest JN, Eckhardt M, et al. Motor recovery and cortical reorganization after mirror therapy in chronic stroke patients: a phase II randomized controlled trial. Neurorehabil Neural Repair. 2011;25(3):223–33.CrossRefPubMed

79.

Thieme H, Mehrholz J, Pohl M, Behrens J, Dohle C. Mirror therapy for improving motor function after stroke. Cochrane Database Syst Rev. 2012;3:CD008449.PubMed

80.

Winstein CJ, Requejo PS, Zelinski EM, Mulroy SJ, Crimmins EM. A transformative subfield in rehabilitation science at the nexus of new technologies, aging, and disability. Front Psychol. 2012;3:340.CrossRefPubMed

81.

Subramanian SK, Lourenço CB, Chilingaryan G, Sveistrup H, Levin MF. Arm motor recovery using a virtual reality intervention in chronic stroke: randomized control trial. Neurorehabil Neural Repair. 2013;27(1):13–23.CrossRefPubMed

82.

• Saposnik G, Levin M, Outcome research Canada Working Group. Virtual reality in stroke rehabilitation: a meta-analysis and implications for clinicians. Stroke. 2011;42(5):1380–6. A pooled analysis of five randomized trials, motor impairment was decreased by VR interventions, but no differences were found for functional use of the arm and hand.CrossRefPubMed

83.

Schuster C, Maunz G, Lutz K, Kischka U, et al. Dexamphetamine improves upper extremity outcome during rehabilitation after stroke: a pilot randomized controlled trial. Neurorehabil Neural Repair. 2011;25(8):749–55.CrossRefPubMed

84.

Cramer SC, Dobkin BH, Noser EA, et al. Randomized, placebo-controlled, double-blind study of ropinirole in chronic stroke. Stroke. 2009;40(9):3034–8.CrossRefPubMed

85.

Berthier ML, Green C, Lara JP, et al. Memantine and constraint-induced aphasia therapy in chronic poststroke aphasia. Annals of Neurology. 2009;65(5):577–85.CrossRefPubMed

86.

Chollet F, Tardy J, Albucher JF, et al. Fluoxetine for motor recovery after acute ischaemic stroke (FLAME): a randomised placebo-controlled trial. Lancet Neurology. 2011;10(2):123–30. Selective movements (Fugl-Meyer scores) significantly improved in participants with moderate motor impairment who received 20 mg of fluoxetine starting 3-5 days after onset of stroke. Augmentation of gains was hypothesized to be from modulation of mechanisms of cerebral plasticity.CrossRefPubMed

87.

Mead GE, Hsieh CF, Lee R, Kutlubaev M, et al. Selective Serotonin Reuptake Inhibitors for Stroke Recovery: A Systematic Review and Meta-analysis. Stroke. 2013;44:844–50.CrossRefPubMed

88.

Dihné M, Hartung HP, Seitz RJ. Restoring neuronal function after stroke by cell replacement: anatomic and functional considerations. Stroke. 2011;42(8):2342–50.CrossRefPubMed

89.

Lee JS, Hong JM, Moon GJ, et al. A long-term follow-up study of intravenous autologous mesenchymal stem cell transplantation in patients with ischemic stroke. Stem Cells. 2010;28(6):1099–106.CrossRefPubMed

90.

Lindvall O, Kokaia Z. Stem cell research in stroke: how far from the clinic? Stroke. 2011;42(8):2369–75.CrossRefPubMed

91.

Hyun I, Lindvall O, Ahrlund-Richter L, Cattaneo E, et al. New ISSCR guidelines underscore major principles for responsible translational stem cell research. Cell Stem Cell. 2008;3(6):607–9. This working group reviews the ethical uses of cellular interventions; other societies subsequently echoed their recommendations.CrossRefPubMed

92.

Wechsler L, Steindler D, Borlongan C, Chopp M, et al. Stem Cell Therapies as an Emerging Paradigm in Stroke (STEPS): bridging basic and clinical science for cellular and neurogenic factor therapy in treating stroke. Stroke. 2009;40(2):510–5.CrossRef

93.

Kong JC, Lee MS, Shin BC, Song YS, Ernst E. Acupuncture for functional recovery after stroke: a systematic review of sham-controlled randomized clinical trials. CMAJ. 2010;182(16):1723–9.CrossRefPubMed

94.

Zhuangl LX, Xu SF, D'Adamo CR, Jia C, et al. An effectiveness study comparing acupuncture, physiotherapy, and their combination in poststroke rehabilitation: a multicentered, randomized, controlled clinical trial. Altern Ther Health Med. 2012;18(3):8–14.PubMed

95.

Efrati S, Fishlev G, Bechor Y, Volkov O, et al. Hyperbaric oxygen induces late neuroplasticity in post stroke patients - randomized, prospective trial. PLoS One. 2013;8(1):e53716.CrossRefPubMed

96.

Tobinick E, Kim NM, Reyzin G, Rodriguez-Romanacce H, DePuy V. Selective TNF inhibition for chronic stroke and traumatic brain injury: an observational study involving 629 consecutive patients treated with perispinal etanercept. CNS Drugs. 2012;26(12):1051–70.CrossRefPubMed

Title: New Evidence for Therapies in Stroke Rehabilitation
Authors: Bruce H. Dobkin
Andrew Dorsch
Publication date: 01-06-2013
Publisher: Current Science Inc.
Published in: Current Atherosclerosis Reports / Issue 6/2013
Print ISSN: 1523-3804
Electronic ISSN: 1534-6242
DOI: https://doi.org/10.1007/s11883-013-0331-y

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