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Does Stroke Rehabilitation Really Matter ? An Algorithm for Prescribing an Effective Intensity of Rehabilitation

The proportional recovery rule suggests that current rehabilitation
practices may have limited ability to influence stroke recovery. However, the
appropriate intensity of rehabilitation needed to achieve recovery remains
unknown. Similarities between rodent and human recovery biomarkers may allow
determination of rehabilitation thresholds necessary to activate endogenous
biological recovery processes. OBJECTIVE: We determined the relative influence
that clinically relevant biomarkers of stroke recovery exert on functional
outcome. These biomarkers were then used to generate an algorithm that prescribes
individualized intensities of rehabilitation necessary for recovery of function.
METHODS: A retrospective cohort of 593 male Sprague-Dawley rats was used to
identify biomarkers that best predicted poststroke change in pellet retrieval in
the Montoya staircase-reaching task using multiple linear regression. Prospective
manipulation of these factors using endothelin-1-induced stroke (n = 49) was used
to validate the model. RESULTS: Rehabilitation was necessary to reliably predict
recovery across the continuum of stroke severity. As infarct volume and initial
impairment increased, more intensive rehabilitation was required to engage
recovery. In this model, we prescribed the specific dose of daily rehabilitation
required for rats to achieve significant motor recovery using the biomarkers of
initial poststroke impairment and infarct volume. CONCLUSIONS: Our algorithm
demonstrates an individualized approach to stroke rehabilitation, wherein imaging
and functional performance measures can be used to develop an optimized
rehabilitation paradigm for rats, particularly those with severe impairments.
Exploring this approach in human patients could lead to an increase in the
proportion of individuals experiencing recovery of lost motor function
poststroke.

Langue : ANGLAIS

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