Current trends in stroke rehabilitation. A review with focus on brain plasticity

Authors


Barbro B. Johansson, Department of Clinical Neuroscience, Wallenberg Neuroscience Center, BMC A13, SE 221 84 Lund, Sweden
Tel.: +46 462 220621
Fax: +46 462 220615
e-mail: barbro.johansson@med.lu.se

Abstract

Johansson BB. Current trends in stroke rehabilitation. A review with focus on brain plasticity.
Acta Neurol Scand: 2011: 123: 147–159.
© 2010 John Wiley & Sons A/S.

Current understanding of brain plasticity has lead to new approaches in ischemic stroke rehabilitation. Stroke units that combine good medical and nursing care with task-oriented intense training in an environment that provides confidence, stimulation and motivation significantly improve outcome. Repetitive trans-cranial magnetic stimulation (rTMS), and trans-cranial direct current stimulation (tDCS) are applied in rehabilitation of motor function. The long-term effect, optimal way of stimulation and possibly efficacy in cognitive rehabilitation need evaluation. Methods based on multisensory integration of motor, cognitive, and perceptual processes including action observation, mental training, and virtual reality are being tested. Different approaches of intensive aphasia training are described. Recent data on intensive melodic intonation therapy indicate that even patients with very severe non-fluent aphasia can regain speech through homotopic white matter tract plasticity. Music therapy is applied in motor and cognitive rehabilitation. To avoid the confounding effect of spontaneous improvement, most trials are preformed ≥3 months post stroke. Randomized controlled trials starting earlier after strokes are needed. More attention should be given to stroke heterogeneity, cognitive rehabilitation, and social adjustment and to genetic differences, including the role of BDNF polymorphism in brain plasticity.

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