The term "stroke rehabilitation" is an encompassing term that refers to recovery efforts for any deficits resulting from a stroke. However, there are really two categories of difficulties that can follow stroke, namely:
- Deficits directly caused by the stroke such as motor deficits, mobility, sensory, visual and perceptual, speech/language, and the impact they cause on activities of daily living.
- Deficits that are complications of the stroke, such as cardiovascular complications, neuromuscular deconditioning, pressure sores, bladder and bowel dysfunction, shoulder pain, shoulder subluxation, spasticity, falling, dysphagia, depression, fatigue, sleep apnea, and emotional disturbances.
Rehabilitation of Motor Deficits after Stroke
As a general rule of thumb, the earlier patients show recovery after stroke the better the outcome at 6 months. Spontaneous recovery is strongest within the first 4 weeks and then tapers off over the next five to six months. Traditionally, rehabilitation during this time period is more effective than after six months. A number of methods currently are used to facilitate movement in affected extremities (arms/legs) and teach compensatory techniques to perform activities of daily living (ADL).
Traditional Methods- Conventional - range of motion/strengthening exercises, training in mobility for functional independence
- Neurodevelopmental Training (NDT) - also known as the Bobath technique. This technique was developed in the 1940s and the principle is to reduce muscle spasticity by focusing on normal patterns of movement.
- Proprioceptive neuromuscular facilitation (Knott & Voss) - relies on quick stretching and manual resistance of muscle activation of the limbs in functional directions, which often are spiral and diagonal in direction.
- Brunnstrom technique - facilitates synergistic patterns of movement that develop during recovery from hemiplegia (paralysis of one side of the body). Development of flexor and extensor synergies is encouraged during early recovery with the hope that synergic activation of muscles will transition into voluntary activation of movements
- Rood technique - modifies movement with cutaneous sensory stimulation
When these approaches to stroke recovery are compared to each other, no one method appears to be more effective than another. However, NDT alone may require prolonged periods of time to produce functional results which may be accomplished faster in conjunction with other methods. Some rehabilitation facilities also incorporate biofeedback into their program to complement other types of therapy.
Approaches Based on Motor Learning TheoryMany approaches to motor recovery after stroke are goal oriented, task specific approaches which developed from the application of motor learning theory. This stresses structured practice of goal oriented tasks with specific feedback patterns for successful transfer and retention of a new skill. Stroke survivors practice changing motor behavior rather than normalizing movement patterns. Because of impairments in motor or sensory systems, transfers, activities of daily living (ADL) and ambulation become new skills, and must be taught and performed in different ways.

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