Pharmacological Therapies to Enhance Motor Recovery and Walking After Stroke

Emerging Strategies

Wieslaw Oczkowski

Disclosures

Expert Rev Neurother. 2013;13(8):903-909. 

In This Article

What is Rehabilitation?

Rehabilitation is a complex reiterative process that involves assessment of the patient needs, goal setting, interventions to achieve these goals and reassessment to assess goal attainment and progress.[12] The interventions are often highly complex treatments that can be provided by one or more healthcare providers.

The treatments may target a loss of function such as motor power, or vision, or speech, among other losses. The treatment may target the resultant limitations in activity or participation such as various aspects of self-care, mobility or return to work, among many other limitations. The heterogeneity of the stroke population with the many and varied, functional losses, limitations in activity and limitations in participation poses a major challenge in standardization of treatment and intervention. This heterogeneity has been one of the major stumbling blocks in designing trials to test therapeutic interventions. This heterogeneity poses challenges in measuring the appropriate outcomes that are not just about recurrent stroke, myocardial infarction or vascular death. The important outcome may be as varied as return of leg strength or return to driving.

Patients may present with various losses of function, including changes in cognition and attention, aphasia, neglect, visual loss and incoordination. Each of these functional losses is a potential target for remediation and intervention. Many varied strategies and techniques are undergoing assessment, including pharmacological therapy for aphasia,[13] transcranial magnetic stimulation (TMS) for motor recovery[14] and cognitive rehabilitation for attention deficits.[12] It is unclear if some of these therapies are useful when used together, for example, is transcranial magnetic stimulation synergistic with pharmacological therapy?

Understandably, much of the research in the area of stroke recovery has focused on recovery of walking. Walking is a basic human function, often affected by a stroke, more easily observed, more easily measured and potentially more easily rehabilitated than other functional losses.

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